be introduced in the coming decades (e.g., intraventricular cardioverter defibrillators, continuous blood sugar monitors, pacemakers to control atrial fibrillation, treatment of acute stroke, and cancer vaccines) that could extend or improve life for older patients and, depending on the technology, increase or decrease the total demand for health services (AHA, 2007; Goldman et al., 2004). More care may be provided remotely, and older adults may be better able to monitor their conditions and to communicate with health care providers from home. Additionally, more or different options for care may offer better matches to patient preferences. For example, an increase in the availability of assisted-living options may result in fewer older adults living in nursing homes (Stone, 2000).

Furthermore, in the future older adults may have different preferences for care than older adults have had up to this point. Some data indicate that the physician visit rates for the baby boom generation are higher than for previous generations (AAMC, 2007). Baby boomers may have greater expectations about care or may treat their illnesses more aggressively than did their parents. Market research suggests that most baby boomers expect to be healthier in their retirement than their parents were, and one-quarter of them believe that a cure for cancer will be found before they retire (Del Webb Corporation, 2003).

Finally, future changes in coverage, cost sharing, and reimbursement policies could have a significant effect on access to care for older adults, but it is not possible to predict exactly what these changes might be. For example, the projected rise in Medicare and Medicaid spending may lead policymakers to consider new ways to improve efficiency in the programs, such as the use of health care rationing (Aaron et al., 2005). Researchers from Dartmouth estimated that nearly 20 percent of total Medicare expenditures provide no benefit in terms of patient survival or quality of life (Skinner et al., 2001); these expenditures might be cut to improve efficiency. Or, if all regions of the country could lower their spending levels to be commensurate with the lowest-spending regions, Medicare could potentially save 30 percent per year (Fisher et al., 2003). Policy makers are currently exploring the expanded use of comparative effectiveness research (Jacobson, 2007). Many of the new services provided to older adults today have little or no evidence showing that they are more effective than established treatments, and it is difficult for patients and providers to make informed decisions (MedPAC, 2007b). Policy makers may also explore the potential of alternative payment mechanisms, such as bundled payments, to provide incentives for providers to deliver care more efficiently.

Health Services Utilization

A number of projections have been developed to estimate the future demand for care from certain types of health care providers using age-, sex-,



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