Policy and epidemiology: financing health services for the chronically ill and disabled, 1930-1990

The six-decade rise in chronic disease and disability, along with interested parties and their beliefs about duly organized health care, shaped financing policy for American health services. If by the late 1930s some scientists and health experts convinced other colleagues to recognize the prominence of chronic illness, physicians and hospital leaders took ten more years to view the management of those illnesses as a major priority, largely owing to prevailing payment schemes. Chronic disease, since the introduction of Medicare and Medicaid, has become the key focus of insurer and public health care financing. Added incentives for disease prevention and treatment in less costly settings, and recalculation of doctors' fees, may lead to meeting the growing chronic care demands without sharp cost increases.