The aging of the population and health services.

The demographic revolution--engendered in large part by modern medicine--which has led to the extraordinary and continuing increase in the number and proportion of elderly persons in the population has profound implications for health services. The elderly are disproportionately heavy utilizers of health care, primarily because of the prevalence of chronic disease. In the United States most health care for the elderly is financed through public funds, and costs have been increasing at an alarming rate. There is wide consensus that, for all the excellence of performance of the medical care system in treating acute episodes, care of chronic disease is frequently unsatisfactory in both quality and cost. Given the demographic imperatives, reform of mechanisms for chronic care is thus essential.