Americans want quality medical care despite its increasingly high cost. In 1960 the United States spent 5.2% of its gross domestic product (GDP—the total value of all the goods and services produced by the nation) on health care. In 1970 this percentage had risen 2% to 7.2%, and by 1980 it had risen to 9.1%—almost another 2%. But in the next thirteen years, health care expenditures r…
Unlike most developed countries, the United States does not have a universal health care program. Two government entitlement programs that provide health care coverage for older adults (age sixty-five and older), the poor, and the disabled are Medicare and Medicaid. Enacted in 1965 as amendments to the Social Security Act of 1935 (PL 89-97), these programs went into effect in 1966. In 1972 amendme…
The Committee on Care at the End of Life of the Institute of Medicine (IOM) noted in its 1997 report Approaching Death: Improving Care at the End of Life (Washington, DC) that nearly three-fourths (74.7%) of those who die each year are age sixty-five or older. Medicare covers these older adults during the terminal stage of their lives. Medicaid further covers 13% of FIGURE 9.1 The nation'…
Longer life spans and life-sustaining technologies have created an increasing need for long-term care. For some older people, relatives provide the long-term care; but those who require labor-intensive, round-the-clock care often stay in nursing homes. The concept of home health care began as post-acute care after hospitalization, an alternative to longer, costlier hospital stays. Home health care…
Terminal patients often receive high-technology intensive care that simply prolongs the dying process. Studies by the Health Care Financing Administration (HCFA; now the CMS) found that "medical services generally become much more intense as death approaches." In the United States the fear of malpractice suits, physicians trained to fight death to the end, and government reimbursemen…
The Canadian Health Services Research Foundation (CHSRF), in "Myth: The Cost of Dying Is an Increasing Strain on the Healthcare System" (CHSRF, 2003), reported that treating the dying is not growing and overwhelming health care systems. The report describes research conducted in North America and Europe, showing that thirty years of research debunk the myth that health care costs in …
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