Health Care System for Older Adults

During 2006, most health policy experts would categorically deny that there is a health care system for older adults in the United States. Health services researchers have frequently used the term “the health care nonsystem” to describe what is available to the older population.

A health care system is commonly defined as the practice of health and medical professionals preventing and treating illness as well as maintenance of mental and physical well-being. The system aspect refers to the structures that facilitate the organization, delivery, and financing of the health care services as well as the structures that monitor the access, quality, and cost of these health care services. Putting all of this together, a health care system is defined as the structures that facilitate the organization, delivery, and financing, as well as monitor the access, quality, and cost, of health care services designed to prevent, treat, and manage illnesses and to preserve the mental and physical well-being of patients through an array of inpatient, outpatient, institutional or community long-term care, rehabilitation, pharmaceutical, and community services provided by trained medical and allied health professionals.

From the perspective of this definition of a health care system, one can understand the skepticism of the many researchers who refer to the U.S. health care system for older adults as a nonsystem. In all but one or two of the other countries of the developed world, and increasingly in many developing countries, the cornerstone of the health care system is national health insurance (NHI). NHI is typically a formal public policy recognizing that health care is a right of citizenship and that the central government has a responsibility to its citizens to provide access to quality health care services and finance them. Under NHI, the central government then has the designated responsibility to establish the health care delivery system for its citizens. The central government has the responsibility to facilitate the organization, delivery, and financing, as well as to monitor the access, quality, and cost, of health care services designed to prevent, treat, and manage illnesses and to preserve the mental and physical well-being of patients through an array of inpatient, outpatient, institutional or community long-term care, rehabilitation, pharmaceutical, and community services provided by trained medical and allied health professionals.

But the United States does not have NHI. Can Medicare be considered as NHI for those age 65 years and older? Many would like to think so, and many others would like to hope so, but unfortunately that is not the case. At the time of this writing in 2006, Medicare does not facilitate the organization, delivery, and financing, as well as the monitor the access, quality, and cost, of health care services designed to prevent, treat, and manage illnesses and to preserve the mental and physical well-being of patients through an array of inpatient, outpatient, institutional, or community long-term care, rehabilitation, pharmaceutical, and community services provided by trained medical and allied health professionals.

The charter of Medicare, as enacted into legislation in 1965, was to provide comprehensive and complete hospital (not for all health care organizations or facilities) insurance (under Medicare Part A, with no additional premiums to enrollees) to those age 65 years and older who enroll. Therefore, the federal government has responsibilities for financing inpatient care, [Page 262]monitoring its quality, and controlling its costs. Some copayments and deductibles are incurred by patients even for inpatient episodes. Thus, it is accurate to infer that the federal government has responsibility for a hospital care system for the elderly, but hospital care should never be confused with health care.

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