reason that economists generally use the term “demand,” which refers to the services an individual would be willing to pay for at a particular price. In economic terms, “need” and “demand” are quite different things.

In the context of health care services for older adults, however, “need” is understood to be “clinical need,” which is what a medical or social services professional believes is appropriate care for an individual, given his or her medical condition. And since the public and private third-party payment system uses “clinical need” to determine which services will be paid for, in practice the distinction between demand and clinical need is much smaller. In this report most of the estimates concerning the “demand” for aging services and for a workforce to provide such services are in reality estimates based on clinical need.

Similar considerations apply to the term “supply.” The committee recognizes, for example, that the supply of health care workers available to take care of older adults will depend on the expected wages or compensation paid to workers providing aging services. Thus baseline estimates of the workforce that will be available to provide aging services in the future are based on straightforward projections of the current compensation package for such workers. Several of the committee’s recommendations to increase the “supply” of personnel focus on increasing the compensation package in order to attract more workers into the aging-services field. Therefore when the committee speaks of supply and demand or supply and clinical need, it does so with the recognition that all of these terms require an appreciation for the prices paid for the services and the wages paid to workers. The level of economic analysis needed to fully address these projections is beyond the scope of this report.

While the committee concluded that a full consideration of likely health expenditures was beyond the scope of its charge, committee members were mindful of financial realities during the course of their deliberations. The committee also focused their attention on those aspects of the health care system that are unique or especially important to the care of older adults. For example, while the committee explicitly recognized the importance and influence of health information technology, care coordination, and financing, it curtailed its discussion of these types of challenges that may apply to the health care workforce and system of care delivery as a whole. The committee concluded that fuller discussion of these general issues was beyond the scope of its charge.

Previous Work

This year marks the 30th anniversary of the IOM’s first report on the geriatric workforce, Aging and Medical Education (IOM, 1978), which raised national awareness of the challenges posed by the aging of the U.S. popula-



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