Health Care of Old People in Scotland: Lessons for the United States?

Gawa)r COTLAND andtheother technologicallyadvancednations of Western Europe and North America have experienced similar trends of growth in their populandons t simiof elderly people, along with the increased demands for health and social services that are an accompaniment of populations that are aging. Compared with the United States, the magnitude of the problem is probably greater in Scotland, since nearly thirteen percent of its population is sixty-five years of age or older, compared with ten to eleven percent for the United States, and the pressures for increased service provision have had to be dealt with in a historically more stringent resource allocation environment. Against this background, the Scots have evolved a distinctive pattern of geriatric services and policies that are deserving of careful scrutiny and study for the lessons they may yield to nations, such as the United States, that are more "underdeveloped" in this area of health care provision. While one must exercise caution in applying the experiences of a small, sparsely populated and ethnically homogeneous country like Scotland to a large, culturally and racially diverse and more highly populated country, its smallness of scale and relatively less complex organizational pattern renders its health and social care system more easily visible than is the case in our country. The distribution of its population is not unlike the U.S. pattern. Fifty percent of its s'!2 million people live in the industrialized South, with Glasgow the pnrncipal urban metropolitan center. A visitor from the United States would recognize in Glasgow, as in most large U.S. urban centers, evidence of urban blight and decay, familiar high-rise apartment dwellings, and vast public housing projects in a central city, ringed by cleaner and more affluent suburban communities. The rural countryside is less densely populated, with agriculture, fishing, and, of more recent origin, North Sea oil as the principal industries.