Many elders are concerned about the existing and potential disparities in the American health care system.  One’s quality of life depends on having a supportive and conscientious environment within which to age.  Recognizing the danger that healthcare disparities represent in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and the disparities that occur at the patient level.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill – something that is of disproportionate importance to elders. 
Franks and Fiscella argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to relieve their own biases and actions that result in healthcare disparities.  They explain what is part of a larger effort to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
While elders experiencing a chronic illness find themselves in difficult situations because health care knowledge and information are often limited, physicians are not always able to individualize care to patient needs because their information about patient preferences and lifestyle are also limited.  Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  With Health Care Advocacy, the Rosenkranz law firm is dedicated to helping elders and families in this process.