In this chapter I consider some of the practical aspects of incorporating preventive care and health promotional strategies for elderly people into existing health and social care delivery systems. An overview will be given of the implications for both the providers and purchasers of health. It is assumed that the majority of purchasers will be governments and also health insurance companies and other third-party payers who commonly meet the costs of provision on behalf of the older population. It is also assumed that the purchasers of health care have (or should have) a close liaison with public health professionals and that the latter will guide purchasers in formulating a strategy and setting quality standards. In the discussion that follows, the boundaries between the provision of certain health care services and health promotional strategies will be deliberately blurred because the distinction between the two is artificial and counterproductive.

Public health

Assist purchasers on appropriate health services

An essential task for public health professionals is to assist health purchasers in buying an appropriate mix of health services that will have maximum impact on the health of an older population. Often the health services available to a local population have arisen because of historical precedent and the interests of the people working within the system. Much money is often spent on high technology aspects of biomedical care that at times have marginal benefit. Some aspects of intensive care and oncology treatments are examples of this.