Abstract:

Because an estimated 97% of the elderly are covered by Medicare, the effect of this program on health care delivery systems is profound; social services to the elderly are also affected by Medicare. Utilizing information from social security & Medicare experts, government reports, & key informants in institutions & agencies serving the aging, various propositions concerning the relationship of Medicare & human services are developed & examined. (1) Medicare has driven up the price of covered services through the operation of increased demand on scarce resources, making it more difficult for social agency clients to obtain medical services. (2) Medicare regulation has shortened hospital stays, releasing less healthy older people into the care of social workers. (3) Medicare has diminished the role of hospital social services. (4) Although Medicare has generally improved health & longevity, many people now live years with disabilities requiring complex medical supervision, taxing the overburdened human service system. (5) Medicare reimburses few costs of nursing home care, & some patients who cannot pay, but still require care, are released to the general human service network. (6) The reimbursement scheme rewards efficiency, so institutional treatment may be more impersonal, leaving it to social workers & community agency personnel to add the personal touch so essential to well-being. (7) Although Medicare recipients are desired as consumers by some service providers, other providers want nothing to do with them, a situation that could lead to development of a two-tiered system of medical care, with poorer clients needing social agency personnel for advocacy & brokerage functions. (8) Community social services will continue to be responsible for helping the elderly obtain hearing aids, dental care, & services for chronic conditions, since Medicare funding for these is minimal. (9) Coverage of home health care will encourage treatment in the home, increasing the burdens on social & community resource systems to meet associated family needs. Medicare is remarkably effective & beneficial, & it has increased the functioning & security of many elderly. However, it has placed additional burdens on human service systems in an era when funding for these systems is being cut rather than increased.