Emerging Issues

Primary care and preventive health care services remain the central health promotion and disease prevention components of the American health care system.²⁴ The continuing work of the U.S. Preventive Services Task Force and its Guide to Clinical Preventive Services, the Healthy People 2000 chapter on clinical preventive services, the Healthy People 2010 objectives on clinical preventive care, and national prevention initiatives strive to achieve a heightened public and health professional awareness of the importance of clinical preventive services. The Medicare Prescription Drug, Improvement, and Modernization Act (Medicare Modernization Act), enacted in 2003, has expanded Medicare's menu of preventive benefits by covering an initial preventive physical examination. The Medicare Modernization Act also provides coverage for cardiovascular screening blood tests and for diabetes screening tests.²⁵ Input from insured populations and corporate cost-management initiatives may also be contributing to a heightened focus on reimbursement for preventive services.

No national data regarding which preventive services are covered by health insurance exist. Initiating and sustaining collection of such information would be useful in assessing and increasing access to preventive care.

Timely access to the ED should be studied and tracked using measures that address health care disparities. Outcome measures could include EMS diversion times, patients leaving without being seen, patients in the ED longer than 6 hours, admitted patients who must wait for an inpatient bed more than 2 hours, antibiotics initiated for community-acquired pneumonia within 6 hours of ED arrival, and per-shift nurse-to-patient ratios (means and ranges) adjusted for triage acuity.

Emerging issues in LTC include topics of workforce, insurance, and consumer-directed services.²⁶ In addition, quality of care remains an enduring issue, but new approaches may have a positive impact.  Because the older population has a higher rate for disability,²⁷ the aging of the baby boomers could result in increased demand for LTC services. This increase in demand will lead to a need for a LTC workforce. A major issue is how to attract, train, and retain a LTC workforce of health and social service providers.²⁸

Increasing effectiveness and use of chronic disease management may reduce disability and slow the increase in demand for LTC services.  Education of older and middle-aged persons may increase the purchase of LTC insurance, especially if incentives are used. Recent illustrations of consumer direction of supportive services have shown promise in giving older persons and their families greater control over delivery of LTC services.²⁸ One consequence of consumer-directed services may be an even greater demand for LTC services, such as home health care and adult day care, that emphasize living independently in the community.²⁹

Recommendations of the Institute of Medicine Committee on Improving Quality in Long Term Care include, among others, efforts to help LTC providers redesign care processes consistent with best practices and improvements in quality of life.³⁰ Others have recommended more consumer-centered emphasis in quality of life domains.³⁰ How each of these issues evolves will have an impact on future demand for and access to specific types of LTC services.

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