Meeting the challenge of the ageing of the population: issues in access to specialist care for arthritis.

This chapter presents an overview of access to specialist care for arthritis and related conditions in Western countries with an emphasis on emerging directions in care delivery to respond to increasing demands and limitations in resources, focussing mainly on rheumatologists and orthopaedic surgeons. The need for care will be driven by the ageing of the population, and in many countries there is a concern about a current and/or future shortage of the rheumatology and orthopaedic surgeon workforce to meet these needs. A number of different models of care have been developed to expedite timely access to specialists for early inflammatory arthritis therapy and total joint replacement. A major gap in care is access to specialist input to support the primary care management of osteoarthritis. For all conditions, the feasibility of interventions to enhance access will depend on the constraints of arthritis-care delivery systems, including funding mechanisms of the health-care system.