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A Proposal by the American College of Physicians and the American Geriatrics Society

Janet Weiner, MPH

JAMA. 1994;271(19):1525-1529.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

THE United States is poised on an ethical precipice as it deliberates health system reform. As the debate continues about revolutionary changes in the organization and financing of health care, the following dilemma arises: can the long-term care needs of the chronically ill and disabled be included, without dooming the reform itself to political and financial failure?

In 1991, the United States spent $59.9 billion on nursing home care (about 8% of total health care expenditures)¹ and $9.8 billion (1% of national health spending) on formal home health services (services provided by non-facility-based agencies). The reluctance to include long-term care in health system reform stems not from the magnitude of present expenditures, but rather from the anticipation of rapidly rising expenditures in the foreseeable future. Home health care is the fastest growing component of personal health care spending, having risen sevenfold in the last decade and 29% from 1990 . . . [Full Text PDF of this Article]

Author Affiliations
From the American College of Physicians, Philadelphia, Pa.

Footnotes
This proposal was developed by the American College of Physicians Subcommittee on Aging and a joint committee of the American Geriatrics Society.

This article was approved by the American College of Physicians Board of Regents on July 17, 1993, and by the American Geriatrics Society Executive Board on August 30, 1993.

Reprint requests to American College of Physicians, Sixth Street and Race, Philadelphia, PA 19106 (Ms Weiner).

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