Seriously conflicting forces are at hand. There are tremendous areas of need in the care of the elderly, such as humane housing, medications, assistive devices, transportation, day care, respite care and education. Eventually, market forces in health care, like HMO's, will utilize the supply side of economics, i.e. oversupply of providers to cut down cost by competition. Mental health, education, behavior, and socio-economics have an enormous impact on health and its consequences . Look at causes of death in the 15- 24 age group.
Violence is the number one cause of death by suicide, homicide and accidents.
Look at causes of death over age 75. Cardiovascular and cerebrovascular diseases are linked to behavioral factors, like lifestyle, smoking, eating poorly, alcohol as much as intrinsic biological factors, like genetics, hypertension or familial hyperlipidemia. Psychiatrists are uniquely qualified by their training to help with care of the elderly and help re-engineer a sensible approach to planning of a fiscally sound continuum of care for the elderly. Psychiatry, among all specialties, is also the most penetrated by managed care. There is no doubt that Medicare HMO's will be the next instrument for slowing cost.