Changing disease patterns, changing values: problems of geriatric care in the U.S.A.: an outsider's view.

Changing disease patterns coupled with recent shift in societal values bring into focus, among other challenges, the problems of geriatric care, with their medical and social aspects. Medicare and Medicaid were meant to respond to the needs of geriatric care. However there is almost a general consensus that in spite of being valuable in many respects, Medicare and Medicaid have failed to generate considerable change in the overall care for the elderly. The basic characteristics of the American Health care system are not conducive to an approach which envisages geriatric care as a comprehensive primary care level, within a system of health care, combining medical with social activities in a team led by a competent physician. Since such an approach seems to be a most appropriate one, an attitude on the part of the medical profession which concentrates on the medical aspects only and neglects the entire complex of problems, substantial and organizational, associated with geriatric care, may lack utility. The problems the U.S. faces in the health field, geriatric care included, are common for today's industrialized societies. However, certain specific difficulties seems to result from the fact that some components of the health care system insist on solving problems generated by changing disease patterns and changing societal values, with no change in their own structure and their own value system.