Paying the piper: the crisis in chronic care

The current article reviews the broad outlines of the crisis in chronic care with emphasis on Southern California, a region where the powerful forces buffeting health and long term care have reached gale force intensity. The article argues that a partial solution to the crisis lies in flexible local partnerships among patients, families, providers, and payers focused on helping the chronically ill cope with the tasks of daily life. Such partnerships would emphasize supportive care, prevention, family preservation, assistive devices, and family income supplementation through facilitation of productive work, aspects of chronic care neglected by current financing and service delivery practices. A case example, the Southern California-based Partners in Care Foundation's Family Care Network, illustrates these essential components of a revitalized, responsive chronic care system.