The effects of health changes on projections of health service needs for the elderly population of the United States

The 1982-1994 National Long-Term Care Surveys indicate an accelerating decl ine in disability among the U.S. elderly population, suggesting that a 1.5% annual decline in chronic disability for elderly persons is achievable. Fu rthermore, many risk factors for chronic diseases show improvements, many l inked to education, from 1910 to the present. Projections indicate the prop ortion of persons aged 85-89 with less than 8 years of education will decli ne from 65% in 1980 to 15% in 2015. Health and socioeconomic status trends are not directly represented in Medicare Trust Fund and Social Security Adm inistration beneficiary projections. Thus, they may have different economic implications from projections directly accounting for health trends. A 1.5 % annual disability decline keeps the support ratio (ratio of economically active persons aged 20-64 to the number of chronically disabled persons age d 65+) above its 1994value, 22:1, when the Hospital Insurance Trust Fund wa s in fiscal balance, to 2070. With no changes in disability, projections in dicate a support ratio in 2070 of 8:1-63% below a cash flow balance.