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Does It Matter How You Slice It? The Relationship Between Population Ageing and Use of Hospital and Posthospital Care in the United States

Published online by Cambridge University Press:  14 November 2008

Andrea Steiner
Andrea Steiner
Affiliation:
Institute for Health Policy Studies, University of Southampton, Southampton SO171BJ, UK.
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Abstract

In the context of demographic transition, one would expect public health planners to allocate resources according to changing needs. This paper explores the effects that definitions of population ageing have on the images of, and subsequent responses to, demographic transition in the United States. Data are drawn from the 1988 U.S. Census and from a 20-percent national random sample of Medicare patients during the same period (n = 1.9 million). Main findings are that supply and use of acute services do differ according to definitions and the way in which population ageing has occurred; that, regardless of definition, older people in high-ageing states make far greater use of posthospital home health care than in low-ageing states; and that, although individual-level clinical factors appear central to rehabilitative decisions, all states seem to use very old age (85-plus) as a proxy to determine who goes where, with low-ageing states also affected by structural constraints at the hospital and market levels.

Keywords

Demographyhealth services planningMedicarestrokesocial burden of ageing.
Type
Research Article
Information
Ageing & Society , Volume 16 , Issue 2 , March 1996 , pp. 205 - 232
Copyright
Copyright Cambridge University Press 1996

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References

Aday, L. A., Andersen, R. M. and Fleming, G. V. 1980. Health Care in the U.S.: Equitable for Whom? Sage Publications, Beverley Hills and London.Google Scholar
Andersen, R. M. 1968. A Behavioral Model of Families' Use of Health Services. Center for Health Administration Studies, Chicago.Google Scholar
Andersen, R. M. and Newman, J. F. 1973. Societal and individual determinants of medical care utilization in the United States, Milbank Memorial Fund Quarterly, 51, 95–124.CrossRefGoogle ScholarPubMed
Baszanger, I. and Bungener, M. 1995. 120 years old: why and at what price? Social Sciences and Medicine, 41 (1), 1.CrossRefGoogle ScholarPubMed
Brook, R. H., Kamberg, C. J., Mayer-Oakes, A., Beers, M. H., Raube, K., Steiner, A. 1990. Appropriateness of acute medical care for the elderly: an analysis of the literature. Health Policy, 14, 225–242.CrossRefGoogle ScholarPubMed
Callahan, D. 1987. Setting limits: Medical Goals in an Ageing Society. Simon and Schuster, New York.Google Scholar
Cassell, C. K. 1992. Issues of age and chronic care: another argument for health care reform. Journal of the American Geriatrics Society, 40 (4), 411–428.Google Scholar
Coale, A. 1974. The history of the human population. Scientific American, 231, 15–25.Google Scholar
Cuba, L. 1991. Models of migration decision making reexamined: the destination search of older migrants to Cape Cod, The Gerontologist, 31 (2), 204–209.CrossRefGoogle ScholarPubMed
Cumming, E. and Henry, W. 1961. Growing Old. Basic Books, New York.Google Scholar
Douglass, C. 1994. Diagnostic Assessment and Treatment Service Utilization Among Alzheimer's Disease Clients in California. RAND, RGSD-116, Santa Monica, CA.Google Scholar
Easterlin, R. A. 1991. The economic impact of prospective population changes in advanced industrial countries: An historical perspective. Journal of Gerontology: Social Sciences, 46 (6), S299–S309.CrossRefGoogle ScholarPubMed
Getzen, T. E. 1992. Population aging and the growth of health expenditures. Journal of Gerontology: Social Sciences, 47 (3), S98–S104.Google Scholar
Graff, T. O. and Weisman, R. F. 1978. Changing concentrations of older Americans. The Geographical Review, 66, 379–393.Google Scholar
Grigsby, J. S. 1991. Paths for future population ageing. The Gerontologist, 31 (2), 195–203.CrossRefGoogle Scholar
Inter-University Consortium for Political and Social Research at Ann Arbor, Michigan. 1983. Elderly composition of the population of all U.S. states and counties, 1980. In U.S. Senate Special Committee on Aging, Developments on Aging: 1982, 2, Appendix, Special Report 98–13, 2.Google Scholar
Kahn, K. L., Rubenstein, L. V., Draper, D., Kosecoff, J., Rogers, W., Keeler, E., Brook, R. 1990. The effects of the DRG-based prospective payment system on quality of care for hospitalized Medicare patients. Journal of the American Medical Association, 264 (15), 1953–1956.CrossRefGoogle ScholarPubMed
Kaufman, S. and Becker, G. 1986. Stroke: health care on the periphery. Social Science and Medicine, 22 (9), 983–989.CrossRefGoogle ScholarPubMed
Keyfitz, N. 1986. Social Security and solidarity. Population Change and Social Policy, Abt Books, Cambridge, Massachusetts.Google Scholar
Lee, A. S. 1980. Aged migration: Impact on service delivery. Research on Ageing, 2, 243–254.Google Scholar
Lewin, J. C. and Sybinsky, P. A. 1993. Hawaii's employer mandate and its contribution to universal access. Journal of the American Medical Association, 269 (19), 2538–2543.CrossRefGoogle ScholarPubMed
Longino, C. F. Jr and Bigger, J. C. 1981. The impact of retirement migration on the south. The Gerontologist, 21, 283–291.Google Scholar
Longman, P. 1982. Taking America to the cleaners. The Washington Monthly, 11, 24–30.Google Scholar
McCarthy, K. F. 1983. The Elderly Population's Changing Spatial Distribution: Patterns of Change since 1960. RAND, R-2916-NIA, Santa Monica, California.Google Scholar
Moody, H. R. 1991. Allocation, yes; age-based rationing, no! Binstock, R. H. and Post, S. G. (eds) Too Old for Health Care? Controversies in Law, Economics and Ethics. Johns Hopkins University Press, Baltimore.Google Scholar
Morgan, K. O. and Morgan, S. (eds) 1990. 1990 State Rankings: A Statistical View of the 50 United States. Morgan Quitno Corporation, Lawrence, Kansas.Google Scholar
Moy, E. and Hogan, C. 1993. Access to needed follow-up services: Variations among different Medicare populations. Archives of Internal Medicine, 153, 1815–1823.CrossRefGoogle ScholarPubMed
Myers, G. C. 1990. Demography of ageing. In Binstock, R. and George, L. (eds), Handbook of Ageing and the Social Sciences (3rd edition). Van Nostrand Reinhold, New York.Google Scholar
Neu, C. R., Harrison, S. C. and Heilbron, J. Z. 1989. Medicare Patients and Postacute Care: Who Goes Where? RAND, R-3780-MN, Santa Monica, California.Google Scholar
Pol, L. G. and Thomas, R. K. 1992. The Demography of Health and Health Care. Plenum Press, New York and London.Google Scholar
Preston, S. H. 1984. Children and the elderly in the U.S. Scientific American, 251, 44–49.CrossRefGoogle ScholarPubMed
Reid, J. 1982. Black America in the 1980s. Population Bulletin, 37.Google ScholarPubMed
Ricketts, R. C., Savitz, L. A., Gesler, W. M. and Osborne, D. N. (eds) 1994. Changes and measures in the crucial dimension of population. Chapter 3 in Geographic Methods for Health Services Research. University Press of America, Lanham, New York, London.Google Scholar
Siegel, J. S. and Taeuber, C. M. 1986. Demographic perspectives on the long-lived society, Daedalus, 115 (1), 77–117.Google ScholarPubMed
Smith, T. L. and Zopf, P. E. 1976. Demography: Principles and Methods (2nd edition). Alfred, Port Washington, New York.Google Scholar
Starfield, B. 1995. Access: Perceived or real, and to what? Journal of the American Medical Association, 274 (4), 346–347.CrossRefGoogle ScholarPubMed
Steiner, A. and Neu, C. R. 1993. Monitoring the Changes in Use of Medicare Posthospital Services. RAND, MR-153-HCFA, Santa Monica, California.Google Scholar
U.S. Bureau of the Census. 1988a, 1989, 1991. Statistical Abstract of the United States: 1988; 1989; 1991 (108th, 109th, 111th editions, respectively), Washington D.C.Google Scholar
U.S. Bureau of the Census. 1988 b. County and City Data Book, 1988. Washington D.C., Table A.Google Scholar
U.S. Senate Special Committee on Aging. 1986. Aging America: Trends and Projections (1985–96 Edition). Washington D.C.Google Scholar
Waidmann, T., Bound, J. and Schoenbaum, M. 1995. The illusion of failure; trends in the self-reported health of the U.S. elderly. The Milbank Quarterly, 73 (2), 253–287.CrossRefGoogle ScholarPubMed
Warnes, A. M. 1993. Being old, old people and the burdens of burden. Ageing and Society, 13, 298–338.Google Scholar