Demographic Paper
Angela McDowell
HCS/490
08/25/2013
Tina Folk-Cromartie

Demographic Paper
Like the rest of the world, the US is an ageing society. This will place substantial additional pressure on publicly-funded health, long-term and income support programs for older people. This paper analyses the demographic changes that the US faces and how they will affect those programs, concentrating on the factors that may affect the economic burden that these programs impose. The aging of the baby boom generation, the extension of life, and progressive increases in disability-free life expectancy have generated a dramatic demographic transition in the United States. Official government forecasts may, however, have inadvertently underestimated life expectancy, which would have major policy implications, since small differences in forecasts of life expectancy produce very large differences in the number of people surviving to an older age. Forecasts were made with a cohort-components methodology, based on the premise that the risk of death will be influenced in the coming decades by accelerated advances in biomedical technology that either delay the onset and age progression of major fatal diseases or that slow the aging process itself (Wiener & Tilly, 2013).
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Population Demographic Data
Like the rest of the world, the US is an ageing society. Between 2000 and 2050, the number of older people is projected to increase by 135%. Moreover, the population aged 85 and over, which is the group most likely to need health and long-term care services, is projected to increase by 350%. Over this time period, the proportion of the population that is over the age of 65 will increase from 12.7% in 2000 to 20.3% in 2050; the proportion of the population that is age 85 and older will increase from 1.6% in 2000 to 4.8% in 2050. From now until 2032, the SSA assumes that total mortality will decline annually by 0.86 percent at all ages (from 0 through 100+). From 2032 to 2082, the SSA assumes that for those under age sixty-five, total mortality will fall each year by 0.73 percent and that at ages sixty-five and older, it will fall each year by 0.65 percent. The SSA therefore assumes that rates of mortality improvement will slow throughout this century owing to the constant percentage reductions in death rates, yielding smaller annual absolute declines, and owing to an explicit shift toward smaller percentage reductions in death rates after 2032 (Olshansky, Goldman, & Zheng, 2009). Impact on Health Care Market
The ageing of the population will have a major impact on the organization and delivery of health care. Of particular importance will be the shift from acute to chronic illnesses and the likely growing shortage of health care workers, especially nurses and paraprofessionals. The ageing population will require focusing on chronic diseases, such as Alzheimer’s Disease, heart disease, and osteoporosis, rather than acute illnesses. First, the style of medicine will need to change from one-time interventions that correct a single problem to the ongoing management of multiple diseases and disabilities; doctors and patients will have to have an ongoing relationship designed to help patients cope with illnesses rather than curing them. Second, with chronic illness often comes disability, meaning that long-term care services, such as nursing homes, home health, personal care, adult day care, and congregate housing, will become much more important sources of care. Third, new ways will need to be found to integrate medical and long-term care services, a feat that will be difficult in the US because of the fragmentation of the financing and delivery systems (Wiener & Tilly, 2013). Health Care Related Challenges
Like other developed countries, the US has large public programs for the older population that provide health care, long-term care, and income support. While these account for the vast bulk of government spending for the older population, there are also numerous other smaller public programs that provide housing, social services, transportation, and additional cash assistance. Medicare covers a fairly broad range of services, but does not cover prescription drugs outside of institutions, dental services, or eyeglasses, and has extensive cost-sharing requirements. The program covers a limited amount of skilled nursing home and home health care. Proposals that provide coverage for outpatient prescription drugs for older people were seriously considered in 2000 and 2001. The declining economic situation and the shift of priorities for spending to anti-terrorism activities in the wake of the tragedies of September 11th 2001, make enactment of additional benefits unlikely. In the absence of action at the national level, some states are developing pharmaceutical assistance programs for the low-income elderly and disabled populations who are not eligible for Medicaid, the federal-State health program for low-income people or people with high medical expenses. Financing for long-term care services, such as nursing home care and home and community-based services, is through a combination of Medicaid, Medicare, state-funded program, out-of-pocket payments and private insurance. By far the dominant source of long-term care funding is Medicaid. Approximately two-thirds of nursing home residents have their care paid by Medicaid. Financial eligibility standards are strict, with Medicaid nursing home residents having to contribute all of their income towards the cost of care, except for a small personal needs allowance of about $30 a month. Individuals may keep only $2000 in financial assets, although the home is generally an exempt asset. With some exceptions, the Medicaid program operates as an open-ended entitlement to individuals. Federal and state Medicaid long-term care expenditures for older people with disabilities were about $43 billion in 2000, about 0.4% of GDP. Many states also operate their own program for home care, although most are fairly small (Wiener & Tilly, 2013). Chronic Disease Wellness Program
Poor health is not an inevitable consequence of growing older. In fact, many effective strategies exist for individuals and communities to take charge of their health and prevent, reduce, or delay disease and disability. Health aging is the development and maintenance of optimal physical, mental, and social well-being and function in older adults. This definition of healthy aging, created by the CDC Prevention Research Centers Healthy Aging Research Network and adopted by the CDC Healthy Aging Program, forms the basis for the key strategies that CDC has developed to address the health needs of older adults. Wellness initiatives include many approaches to both preventing disease in people who are well, and managing diseases and preventing complications in those who are ill. Traditionally, states that have explored disease management have done so as a cost-containment strategy. Chronic disease prevention is a longer-term strategy where it has been harder to evaluate cost-effectiveness. However, some data are now being generated, mostly by the private sector, on the cost benefits and effectiveness of wellness initiatives. Disease management is used by states to curtail health care costs and keep people well. It is an integrated approach to health care delivery that seeks to improve health outcomes and reduce health care costs. Disease management has a variety of components, but programs involve one or more of the following: Establishing a coordinated system of intervention and information sharing for patients with a particular chronic condition or set of conditions and their providers, encouraging health care providers to use established practice guidelines when treating chronic illnesses, educating patients to manage their conditions well and avoid disease complications, and monitoring quality of care provided and patient outcomes over time to ensure the program achieves its desired goals. Disease management is not only a tool to prevent chronically ill patients from further disease and costly treatments, it also involves patients in managing their own care and thereby freeing up scarce health care resources. Nationally, the Centers for Medicare and Medicaid Services (CMS) have been conducting pilot studies on disease management. In 2004, CMS established rules that encourage states to adopt such programs to help chronically ill patients better manage their diseases, improve health outcomes and lower medical costs (Lang, Moore, & Harris, 2005). Marketing Needs and Services for the Aging
There is a service crisis in the United States, and many companies don't know it. The price of their ignorance will be significant. Companies will be shaken by their inability to render customer services to the 40+ populations, and the spoils will go to those companies who perceive the crises, and out-service their competitors. With the market at more than 100 million, and growing at a rapid rate, clearly, the aging boomer and senior customer is the ”New Customer Majority” today's target population, and, even more so, tomorrow's. The penalty is growing for those companies that render insensitive service. Aging customers are smarter than companies think they are, and they are willing to take their dollars elsewhere. Business people seem to know that good customer service is essential for the health of their organization and for survival in a highly competitive industry, but paradoxically, service may be getting worse for the largest segment of their market (Gilmartin, n.d.). Addressing These Challenges
Many governments have support systems in place for elderly persons such as social security and free or discounted medical care, for example. However, most of these systems were built on the premise that there will always be significantly fewer older persons than younger or middle-aged individuals living at one time. Because of declining death rates, therefore, these systems are beginning to feel a strain that will only increase over time. Additionally, the older-person support ratio is falling in both more and less developed regions, which could further lessen the ability of societies and governments to care for their aging populations. These demographic trends create unique challenges for all people, particularly for the governments of nation-states around the globe. Elderly individuals are often subject to discrimination and abuse because they are perceived as easily taken advantage of. There is also a prevalent belief among many that elderly persons are worthless in today’s fast-paced, globalized and increasingly industrialized world. Obviously, with the number of elderly people on earth at any one time rising rapidly, there is an increased urgency to address the rights and roles of elderly persons in our world.

References
Wiener, J. M., & Tilly, J. (2013). Population ageing in the United States of America: implications for public programmes. Oxford Journals, 31(4), 776-781.
Lang, J. E., Moore, M. J., & Harris, A. C. (2005, Summer). Healthy Aging. ProQuest, 29(2), 24-29.
Olshansky, S. J., Goldman, D. P., & Zheng, Y. (2009). Aging in America in the Twenty-first Century: Demographic Forecasts from the MacArthur Foundation Research Network on an Aging Society. The Milbank Quarterly, 87(4), 842-862.
Gilmartin, J. (n.d.). Aging Markets Myopia Why Companies Must Change Their Frame of Reference About Baby Boomer & Senior Markets. Retrieved from http://www.comingofage.com/wp-content/themes/coa/articles/Aging-Market-Myopia.pdf