Coordinating Health Care for the Elderly: Problems and Prospects

The 4 programs administered by the federal government which have a major impact on the delivery and financing of health services to the elderly are: 1. Medicare, 2. Medicaid, 3. the Older Americans Act, and 4. Title XX of the Social Security Act. The 4 programs have overlapping and conflicting goals, but some coordination could be achieved by exchanging information. Lack of coordination causes confusion and results in gaps in the health care delivery or financing system for the elderly. Difficulty in coordinating the 4 programs has been the result of differences in the budgets of the programs, the different intergovernmental environments of each of the programs, and the overall fragmentation of the health sector in the US. Although still politically weak, the Administration on Aging and its Area Agencies have a legislative mandate to pursue coordination in the elderly health arena and are pursuing the mandate through the National Long Term Care Channeling Demonstration Project. Programs like Triage, the Community Care Organization, and ACCESS have utilized one or more of the federal programs and achieved a degree of service coordination for their clients.