The medicalization of chronic disease and costs.

U.S. health care spending has increased dramatically in the past several decades, consuming 17.6% percent ($2.6 trillion) of GDP in 2010. Although historical spending drivers do not account for this recent increase, two major changes in population health--the rise in obesity and obesity-related chronic disease--provide a likely explanation. This article reviews the contribution that rising treated obesity-related chronic disease prevalence and its associated treatment (spending per treated case) has made to the growth in health care spending. We discuss trends in the clinical incidence of obesity and chronic disease as well as timely advancements in disease detection, treatment, and management. Evidence shows that rising obesity rates are influencing spending largely by increasing the treated prevalence of obesity-related chronic disease. Therefore, preventing individuals from becoming treated cases in the first place is one key way that our country can cut health care spending moving forward.

Impact of health care reform on medicare and dual medicare-medicaid beneficiaries.

The Affordable Care Act (ACA) HR 4972 (Public Law 111-148 and 111-152) contains a broad sweeping set of health care reforms that will move our country toward universal insurance coverage, change how Medicare and Medicaid pay for services, and infuse a new focus on wellness and care coordination into our previously reactive health care system. Each of these reforms will have important implications for patients with cancer, both those who have been diagnosed as well as those who have yet to be diagnosed. This article provides a brief overview of how some of the key changes included in the ACA will affect Medicare patients and those dually eligible for the Medicaid program. We focus on Medicare in particular because individuals 65 years or older make up only 12% of the U.S. population, but account for more than half of all cancer patients. The ACA will also have important impacts for cancer patients without health insurance-nearly 10% of all cancer patients-as we move toward universal coverage that does not discriminate against individuals with pre-existing conditions. Changes in the ACA that will affect access to and payment for cancer care among Medicare and dually eligible patients are outlined in this article.

The Archstone Foundation Elder Abuse and Neglect Initiative: outcomes and lessons learned in three years from 2006 to 2008.

An independent evaluation of the Archstone Foundation Elder Abuse and Neglect Initiative was conducted to identify major outcomes and lessons learned collectively by 20 funded projects, as well as to document innovative program models for dissemination. Data from the first three years of this initiative show these projects have been productive and have had a measurable impact on services for elder abuse and neglect. Major lessons learned address issues in recruiting, engaging, and maintaining active involvement of diverse stakeholders, as well as innovative and effective models of education, training, and direct services for elder abuse and neglect.

Changing systems to address elder abuse: examples from aging services, the courts, the long-term care ombudsman, and the faith community.

The authors describe their use of systems change as a means of ameliorating elder abuse. After assessing the needs of their target audiences, projects developed a variety of strategies. These include disseminating promising practices in courts, creating Elder Law Clinics to assist with conservatorships, educating older adults about predatory mortgage lending, building a new response system for complaints of abuse and neglect in unlicensed care facilities, and convening clergy and lay leader groups to learn how faith communities can make a difference in elder abuse and neglect. The authors share tips on replicating their work, describing barriers to implementation and possible solutions.