Additional Ethical Issues

Unfortunately, many of the issues that affect younger individuals with regard to access to healthcare and research do not disappear when people get older. While this is not a great concern in countries with a national health service or national health insurance, it remains a major issue in the United States. Many people, including a surprising number of older people, assume that Medicare, the federal health insurance program for older people, covers most healthcare needs. While Medicare pays a substantial portion of hospital and physician fees for acute care, it does not cover the cost of medications, many preventive services, and important items for older people such as eyeglasses and hearing aids; most important, Medicare pays for very few long-term care services. Older people who are poor, female, or minority, especially African Americans, are disproportionately affected by problems with access to care. In the United States, as noted by David Barton Smith, the difference between African Americans and whites in terms of access to hospitals and nursing homes narrowed from the 1960s to the 1980s. However, studies in the late 1980s and 1990s, such as that by Kenneth Goldberg and others, continued to uncover less utilization of aggressive and expensive treatments for cardiac disease, for example, in African Americans and women compared with white men, even when insurance status was taken into account.

GREG A. SACHS (1 995) REVISED BY AUTHOR

SEE ALSO: Access to Healthcare; Dementia; GriefandBereave-ment; Life Sustaining Treatment and Euthanasia; Long-Term Care; Medicaid; Medicare; Research, Human; Research Policy; and other Aging and the Aged subentries

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