Cardiovascular care of the elderly: Economic considerations

Abstract

Escalating costs of medical care have stimulated dramatic changes in the organization and financing of health care in the United States. Prospective payment for hospitalizations, the growth of Health Maintenance Organizations, increased emphasis on fee schedules and salaried arrangements to reimburse physicians and trends toward increased use of ambulatory services, day surgery and home care services are some of the manifestations of change. Priorities for health care are being reconsidered, and the prospects for future rationing of medical services are real. This environment creates important opportunities, as well as challenges, for the practicing physician and for organized medicine, including the American College of Cardiology. On the one hand, it provides a stimulus to the medical profession to reassess the traditional norms of medical practice'and to consider seriouslyhow cost control can be achieved without adverse effects on the quality of care. On the other hand, it creates incentives for constructive dialogue among physicians, policymakers and the general public to shape the direction of change toward an optimal balance between individual and societal priorities. The overriding obligation of the physician is to protect the interests of the patient. Fundamental to fulfilling this obligation are preservation of to quality health care and assurance that neither nor quality will be compromised by considerations of age or of the ability to pay for health care. To put this guiding principle into operation, we need definitions of the best interests of the patient, reasonable access and high quality. Moreover, arguments that more is better have to be supported by convincing evidence that the costs of health care are warranted in terms of the health benefits achieved. Considerable common ground exists among policymakers, physicians and the general public. This ground has to be carefully explored and creatively tilled.