Social Services for the Elderly Based on the New Rurality: The Japanese Experience

Since the 1920s, Japan has changed from being a relatively youthful society, with an average age of about 26, to an elderly society with an average age of over 40 (Fordyce, 1999). The number of elderly is rising and the number of births is falling. Concurrently, the health and infrastructure needs of many of the retired elderly are increasing while, for the same retirees, their contribution to productivity and revenue is diminishing (Fordyce, 1999). As the population ages, inevitably the burdens of taxes, pensions, public medical insurance and social services have been rapidly increasing. To meet the challenges of these changes in population structure, Japan has established policies such as the Gold Plan and the Public Long-term Care Insurance Program and it has expanded social services into rural agricultural areas. This article examines those policies and the care services and productive aging programs that have developed due to population aging and new rural patterns in Japan.     

Inpatient Hospital Utilization among the Uninsured Near Elderly: Data and Policy Implications for West Virginia

Objective. To inform state policy discussions about the insurance coverage of the near elderly in West Virginia (WV) and the impact of the uninsured near elderly on hospitals in the state.
Data Sources. 2003 West Virginia Uniform Bill (UB) hospital discharge data. The data represent all adult inpatient discharges in the state during the year.
Study Design. We compare the near elderly with other adults and examine differences by insurance status. Key variables include volume of discharges, health insurance coverage, patient characteristics, and charges incurred.
Findings. The near elderly constitute the largest group of nonelderly adult inpatient hospital discharges. They are more likely than younger adults to be admitted for emergency conditions; have comorbidities and complications; have longer hospital stays; and incur higher charges on average. Although the near elderly are least likely to be uninsured, they represent the second largest group of uninsured discharges and incur the most in uninsured charges.
Conclusions. The specific needs of the near elderly warrant consideration in WV's (and other states') ongoing development and evaluation of policies aimed at reducing uncompensated care costs, including programs to expand access to health insurance and primary and mental health care among the uninsured.     

Rurality,stress, and illness among women: A pilot study

The purpose of this pilot study was to explore the relationships among rurality, stressful life events, and illness in women. A purposive sample of 13 Texas urban and rural women was surveyed. Instruments included an adapted version of the Norbeck Life Experiences Survey for Women and an adapted version of the Wyler Seriousness of Illness Scale. Rurality was measured according to the percentage of lifetime spent in a rural area.

A significant correlation of r = .76 (p < .01) was found between stressful life events scores and illness. No significant relationship, however, was found between rurality and stressful life events scores, nor rurality and illness. Demographic variables including age, number of children, socioeconomic status, and work outside of the home also failed to significantly relate to rurality, stress, or illness. The most common areas of stressful events cited by rural women were health, work, personal/social, finances, and environment. These preliminary results suggest that stereotypical rural‐urban differences among women related to stress and illness may not exist.     

Patterns and Factors Associated with Health Care Utilization among Korean American Elderly

OBJECTIVE: To examine patterns and factors associated with the utilization of health care services among Korean American elderly (KAE). DATA SOURCES/STUDY SETTING: Data collected from a survey of face­to­face interviews with 205 KAE, aged 60 years and older, residing in the Greater Baltimore Metropolitan area in 1999. STUDY DESIGN: We employed a cross-sectional design, based on the behavioral model of health service utilization for vulnerable populations. Poisson regression was used to estimate parameters associated with physician visits, the utilization of Oriental medicine, and hospitalization. DATA COLLECTION: Data were collected using face-to-face interviews with 205 KAE. PRINCIPAL FINDINGS: About 60% of respondents reported that they could not get care when needed, and the majority (86%) had experienced difficulty getting care. About 71% of respondents visited a physician, and 25% used Oriental medicine at least once during the previous 6 months. Only 8% visited an emergency room. Enabling factors such as public insurance and having a regular physician were important to the utilization of physician care and hospitalization, whereas perceived or evaluated needs were crucial to the utilization of Oriental medicine. The level of acculturation was not significant. CONCLUSIONS: Korean American elderly grossly underutilized ambulatory health facilities, a finding which suggests that this vulnerable population needs culturally effective interventions and policies. KEY WORDS: Korean American, Elderly, Health Service Utilization, Behavioral Model for Vulnerable Population     

深圳市老年人群生活质量的流行病学研究

目的：为了解深圳市老年人群生活质量现状及其影响因素。方法：采用随机抽样的方法,对深圳市１１０９例老年人进行了生活质量调查分析。结果：８７．５％的老年人月收入在５００元以上;患病率为６７．２％,有躯体残疾者占３．９％;ＡＤＬ量表评分完全自理者占９２．０％,ＩＡＤＬ量表评分全部能完成者占５６．４％;近２年有负性生活事件者占５３．０％;ＬＳＩＡ（满分４０分）平均得分１９分,男性高于女性,干部高于工人和农民;社会支持量表（满分５２分）平均得分１８．３分;影响健康自评和生活满意度的因素有经济收入、慢性疾病、生活功能、社会支持、严重负性生活事件和深圳市户口等。结论：应从影响生活质量的因素出发制订老年卫生保健政策,有针对性、有重点地开展社区卫生保健项目,以促进老年人生活质量的提高。     

Insurance Coverage of Prescription Drugs and the Rural Elderly

CONTEXT: Rural impacts of a Medicare drug benefit will ultimately depend on the number of elderly who are currently without drug coverage, new demand by those currently without coverage, the nature of the new benefit relative to current benefits, and benefit design. PURPOSE: To enhance understanding of drug coverage among rural elderly Medicare beneficiaries and their expenditures for pharmaceuticals. METHODS: Estimates of the extent of coverage, expenditures, and sources of drugs were obtained using data are from the 1997 Medicare Current Beneficiary Survey and the Pharmacy Verification and Household Components of the 1996 Medical Expenditure Panel Survey. FINDINGS: Three-quarters of the urban elderly had some type of drug coverage in 1997 versus 59% of the elderly in rural areas. Urban residents were more likely to have obtained their drug coverage from an employer-sponsored supplemental plan, and rural residents were more likely to have self-purchased Medigap drug coverage. Expenditures and use of drugs by Medicare beneficiaries are greater for those with than without coverage, and differences are invariant with respect to geographic location. Coverage under self-purchased supplemental plans appears less generous than under employer-sponsored plans in both rural and urban areas. Rural and urban elderly are more than twice as likely to receive at least 1 prescribed medication through the mail than the general population. CONCLUSION: A well-designed Medicare drug benefit would be especially beneficial to the rural elderly because relatively more rural elderly currently lack coverage or have less generous coverage than urban beneficiaries. Mail-order distribution may help contain future program expenditures.     

How the US Food and Drug Administration Can Solve the Prescription Drug Shortage Problem

Drug shortages are threatening care quality and cost-containment efforts. I describe the pharmaceutical marketplace changes that have caused the problem, and propose new policies to solve it, through changing incentives for producers and purchasers. I propose a grading scheme for the Food and Drug Administration when it inspects manufacturing facilities in the United States and abroad. The inspections’ focus would change from closing unsafe plants to improving production process quality, reducing the likelihood that plants will be closed—the most frequent cause of drug shortages.Shortages of pharmaceuticals are suddenly occurring frequently in medical practice, and represent a bewildering situation for clinicians—one that most have never encountered. The shortages appear primarily among generic drugs, reliance on which is the main mechanism that health systems in the United States use to constrain pharmaceutical costs. According to the US Food and Drug Administration’s (FDA’s) report on drug shortages of October 31, 2011, the number of annual drug shortages had tripled from 61 in 2005 to 178 in 2010.1 As of July 2012 there were more than 200.2 What is it that has changed in the pharmaceutical market that has caused these shortages? What will it take to solve the problem? Once we better understand the underlying reasons for the shortages, remedies can be sought.The shortages are occurring in all therapeutic categories. Although early reports noted the high incidence of shortages of sterile injectible drugs3—often those used for cancer treatment—subsequent observations have pointed out that the problem is far more widespread than that.4,5 In fact, one report in 2008 studied the sudden shortage of heparin, the drug widely used for surgery patients.6The shortages are the result of a sort of “perfect storm” involving 3 phenomena:

1. A consolidation of the market for generic drugs, with reduced numbers of both buyers and manufacturers;
2. An increased penetration of generic drugs in the overall pharmaceutical marketplace; and
3. An increased dependence on outsourced drug products, either chemical ingredients or manufactured drugs, coming from countries where inspections are more difficult to conduct.

Solving the problem will present difficult choices within our health system. The choices will be difficult because required changes will entail reordering priorities. For example, decreasing our reliance on generic drugs would reduce the enormous cost savings that generics have provided us. Increasing the number of competing generic firms and pharmaceutical purchasers would require far more aggressive enforcement of antitrust policies. Allowing the FDA more authority in overseeing shortages and regulating or redistributing production to alternative companies would expand the FDA’s authority into uncharted areas. And more aggressive inspection of foreign suppliers to prevent contamination and other irregularities would raise the FDA’s budget at a time of severe government attempts at cost constraint or (if the costs are passed on to manufacturers) raise the cost of many of our drug products.