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
Weiner J. Financing Long-term CareA Proposal by the American College of Physicians and the American Geriatrics Society. JAMA. 1994;271(19):1525-1529. doi:10.1001/jama.1994.03510430079039