Three aspects of demographic change will shape future demand for health services and the provision of health care. They are (1) shifts in age distribution, which will give greater prominence to the health needs of the elderly; (2) changing settlement patterns, which will alter the geography of demand and shift some of it away from large population centers to places where specialty medicine is less readily accessible; and (3) the increasing concentration in large central cities of the disadvantaged and the undocumented, whose needs tend to strain the health care delivery system in areas where they are a sizable presence.
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