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The rising cost of health and long term care for the elderly is a major issue in any discussion of the future of the welfare state. This article proposes a long term perspective on the historical relationship between medicine, social policy, and old people. What impact did the changing nature of old age have on the health system from the mid nineteenth century to the present? The thesis is posited that the health needs of the aging were rather neglected or even marginalized in the second half of the nineteenth century, whereas they slowly gained recognition and formed the very core of the modern welfare state since the 1950s. Evidence points up (1) the varying attention paid to geriatric subjects in the medical sciences, (2) the gradual inclusion of pensioners and poor old people in health insurance and social services, and (3) the radical change in the age and gender profile of hospital patients in the course of the twentieth century. From this overview emerges a tentative model of a transition in the allocation of medical services to the different age and sex groups. Like the demographic and the epidemiologic transition, these fundamental changes have created challenges for medicine and social policy which still await responses.