ISSN: 1923-1253
MYTH BUSTED JANUARY 2002
BUSTED AGAIN! FEBRUARY 2011
mythbusters
USING EVIDENCE TO DEBUNK COMMON
MISCONCEPTIONS IN CANADIAN HEALTHCARE
MYTH: THE AGING POPULATION IS TO BLAME
FOR UNCONTROLLABLE HEALTHCARE COSTS
FACT: The proportion of Canadians 65 years of age and
older is increasing as the baby-boom generation reaches
retirement age.
FACT: Older adults need more medical services than younger
people.
Taken together, these snippets of reality can conjure a
frightening image, in which the healthcare costs of the aging
population balloon until the system becomes unsustainable,
necessitating cuts to services and/or tax increases. But,
healthcare costs don’t inflate uncontrollably just because
there are more seniors. “Boomerangst”, as it has been cleverly
dubbed, isn’t based in reality, so say the experts.
THE COST OF AGING
Healthcare costs generally increase with age. When CHSRF
first busted this myth in 2002, Canada was spending $8,208
per year per senior versus $1,428 (in 2008 dollars) per person
under the age of 65. By 2008, these figures had grown to
$10,742 and $2,097, respectively. Among older seniors, the
data are even more telling. Seniors 80 years of age and older
cost the system $18,160 per capita, more than three times the
cost of seniors aged 65 to 69.i
Estimates of how the aging population will affect healthcare
costs vary considerably, with some predicting doom and
gloom and others a minor blip on the radar.ii Only time will
tell the true story, but developing credible predictions is a
core component of responsible health systems planning.
Some of the best research shows that, although healthcare
costs will begin to rise as baby-boomers age, the impact will
be modest in comparison to that of other cost drivers, such as
inflation and technological innovation.iii;iv Economic models
suggest that growth in healthcare costs due to population
aging will be about 1% per year between 2010 and 2036v
(although it has been argued that the assumptions used in
these models make for rosy predictions). These low figures
can be reassuring, but with the public share of healthcare
spending topping $120 billion as it did in 2008i, even growth
of 1% translates into a lot of money.
AGING AND SUSTAINABILITY
There are two issues at play when it comes to age and
healthcare delivery. First, the older we are the more
healthcare we use. While the overall population is using
more care than ever, seniors are using proportionally
more care than younger age groups, which is why seniors
cost the system more. They are more likely than younger
people to have chronic conditions (and more of them)
such as heart disease, dementia and diabetes, which
require longer hospital stays and more physician visits.vi
Having multiple chronic conditions may also involve the
use of many different drugs to treat each condition
separately. Research has shown that such treatment
regimens are often not managed properly, leading to
adverse drug reactions and further hospitalization.vii
With respect to sustainability, it’s the more rapid growth
in age-specific healthcare utilization for seniors that may
be cause for concern. Studies have shown that per capita
use of medical, surgical and diagnostic specialists is
increasing more for seniors than for younger people, and
CANADIAN HEALTH SERVICES RESEARCH FOUNDATION | MYTHBUSTERS | FEBRUARY 2011
mythbusters
USING EVIDENCE TO DEBUNK COMMON MISCONCEPTIONS IN CANADIAN HEALTHCARE
services provided to seniors are altogether more costly.viii An 80-year-old
today is twice as likely to have cataract surgery, a knee replacement,
and/or a coronary bypass as in 1990.ix
Some of these increases in utilization relate to medical and technological
advances (e.g. equipment for new surgical techniques or increased use
of medical imaging technology).x Others relate to age-specific healthcare
needs, which will increase in tandem with the aging population (e.g. the
number of seniors with dementia is expected to double by 2038).xi
Without changes in policy, care delivery, prevention or treatment for
those with dementia, the economic implications of this greater
utilization could be considerable.
Second, dying is expensive. Research shows that we cost the
healthcare system the most in our final years of life—and, obviously,
our likelihood of dying increases as we age.xii In fact, the high (and
rising) service use by older people is in many ways a reflection of their
greater probability of dying.
RESTRUCTURING CARE FOR SENIORS
Ensuring that age-specific increases in utilization do not spiral out of
control will require tough decisions, which may include disinvesting
from some services and investing more in others. It will also mean
designing systems that make sense for the care of seniors. Arguably,
there are too many seniors in acute care settings because community
supports (whether residential care, assisted living or home care) are
not available. Our reliance on alternate level of care (ALC) beds
(i.e. non-acute patients residing in acute care beds waiting for
admission elsewhere)xiii demonstrates the need for stronger
continuing care supports.
A move toward integrated continuing care delivery can produce
sizeable cost savings, create efficiencies, and improve the quality
of care and caregiver satisfaction.xiv;xv;vi Supporting the education,
recruitment and retention of caregivers to help with home support
is an essential element of a broader labour strategy to meet seniors’
care needs while controlling costs.
REFERENCES
i.
Canadian Institute for Health Information. (2010). National health expenditure
trends, 1975-2010. Ottawa, Canada: CIHI.
ii.
Infrastructure Canada. (2010). Population aging and public infrastructure:
A literature review of impacts in developed countries. Ottawa, Canada:
Government of Canada.
iii.
Evans, R. G. (2010). Sustainability of health care: Myths and facts. Retrieved
September 15, 2010 from: http://medicare.ca/.
iv.
Constant, A., Petersen, S., Mallory, C. D., & Major, J. (2011). Research synthesis
on cost drivers in the health sector and proposed policy options. CHSRF series
of reports on cost drivers and health system efficiency: Paper 1. Ottawa,
Canada: CHSRF.
v.
Mackenzie, H., & Rachlis, M. M. (2010). The sustainability of Medicare.
Canadian Federation of Nurses Unions. Retrieved August 27, 2010 from:
http://www.nursesunions.ca/.
vi.
Denton, F. T., & Spencer, B. G. (2010). Chronic health conditions: Changing
prevalence in an aging population and some implications for the delivery of
health care services. Canadian Journal on Aging, 29, 11-21.
vii.
Canadian Institute for Health Information. (2011). Seniors and the health care
system: What is the impact of multiple chronic conditions? Ottawa, Canada:
CIHI.
viii.
Barer, M. L., Evans, R. G., McGrail, K. M., Green, B., Hertzman, C., & Sheps, S.
B. (2004). Beneath the calm surface: the changing face of physician-service
use in British Columbia, 1985/86 versus 1996/97. Canadian Medical
Association Journal, 170, 803-807.
ix.
Lee, M. (2007). How sustainable is Medicare? A closer look at aging,
technology and other cost drivers in Canada’s health care system.
Vancouver, Canada: Canadian Centre for Policy Alternatives.
x.
Canadian Institute for Health Information. (2008). Medical imaging in Canada,
2007. Ottawa, Canada: CIHI.
xi.
Alzheimer Society of Canada. (2010). Rising tide: The impact of dementia on
Canadian society. Retrieved December 20, 2010 from: http://www.alzheimer.ca/.
xii.
Payne, G., Laporte, A., Foot, D. K., & Coyte, P. C. (2009). Temporal trends in the
relative cost of dying: Evidence from Canada. Health Policy, 90, 270-276.
xiii.
Velhi, K. (2010). Presentation at CIHR Café Scientific: How Canada’s aging
population will impact the health care system, November 24, 2010.
xiv.
Hollander, M. J., & Chappell, N. (2002). Final report of the national evaluation
of the cost-effectiveness of home care. Victoria, BC: National Evaluation of
the Cost-Effectiveness of Home Care.
xv.
Hollander, M. J., Chappell, N. L., Prince, M. J., & Shapiro, E. (2007). Providing
care and support for an aging population: Briefing notes on key policy issues.
Healthcare Quarterly, 10(3), 34-45.
CONCLUSION
While the impact of the aging population alone won’t bankrupt the
healthcare system, there is still a need to get age-specific cost increases
under control, especially those related to death and dying. The good
news is that problems expected to arise from population aging can be
managed with smart changes to care delivery for the elderly. It’s the
other issues—such as the growing cost of healthcare services and the
increased costs arising from technological innovation—that are
causing expenditures to escalate. These are the cost drivers that
require our foremost attention.
Mythbusters articles are published by the Canadian Health Services Research
Foundation (CHSRF) only after review by experts on the topic. CHSRF is an
independent, not-for-profit corporation funded through an agreement with the
Government of Canada. Interests and views expressed by those who distribute this
document may not reflect those of CHSRF. © 2011.
CANADIAN HEALTH SERVICES RESEARCH FOUNDATION | MYTHBUSTERS | FEBRUARY 2011