Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-17T20:11:12.365Z Has data issue: false hasContentIssue false

APOCALYPSE NO: Population Aging and The Future of Health Care Systems

Published online by Cambridge University Press:  29 November 2010

Robert G. Evans
Affiliation:
The University of British Columbia
Kimberlyn M. McGrail
Affiliation:
The University of British Columbia
Steven G. Morgan
Affiliation:
The University of British Columbia
Morris L. Barer
Affiliation:
The University of British Columbia
Clyde Hertzman
Affiliation:
The University of British Columbia

Abstract

Illness increases with age. All else being equal, an older population has greater needs for health care. This logic has led to dire predictions of skyrocketing costs “apocalyptic demography”. Yet numerous studies have shown that aging effects are relatively small, and all else is not equal. Cost projections rest on specific assumptions about trends in age-specific morbidity and health care use that are far from self-evident. Sharply contrasting assumptions, for example, are made by Fries, who foresees a “of morbidity” and falling needs. Long-term trends in health care use in British Columbia show minimal effects of population aging, but major effects, up and down, from changes in age-specific use patterns. Why then is the demographic apocalypse story so persistent, despite numerous contrary studies? It serves identifiable economic interests.

Résumé

La maladie croît avec l'âge. Toutes choses étant égales par ailleurs, vine population plus vieille présentent des besoins de services de santé plus importants. Cette logique a donné lieu à des prédictions apocalyptiques basées sur les tendances démographiques. Pourtant, de nombreuses études ont démontré que les effets du vieillissement sont relativement peu importants et que tout le reste n'est pas egal. Les projections de couts reposent sur des hypothèses spécifiques qui n'ont rien d'évident, sur l'évolution de la morbidité en fonction de l'âge et sur l'utilisation des services de santé. Fries, par exemple, pose des hypotheses exactement contraires à celles nécessaires à la validité de l'hypothèse de tendances démographiques apocalyptiques. Il prévoit une compression de la morbidité et une diminution des besoins de soins. Les tendances à long terme de l'utilisation des soins de santé en Colombie-Britannique illustrent les faibles répercussions du vieillissement de la population et la forte influence des modifications des taux d'utilisation à l'intérieur de chacune des states d'âge. Pourquoi done sommes-nous aux prises avec des histoires apocalyptiques alors que de nombreuses études démontrent une réalité contraire? Cette légende sert des intérêts économiques identifiables.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnst, C. (1998). Is good marketing bad medicine. Business Week, 4(13), 6263.Google Scholar
Barer, M.L., McGrail, K.M., Cardiff, K, Wood, L., & Green, C.J. (2000). Tales from the other drug wars. Vancouver: Centre for Health Services and Policy Research.Google Scholar
Barer, ML., Evans, R.G., Hertzman, C., & Lomas, J. (1987). Aging and health care utilization: new evidence on old fallacies. Social Science & Medicine, 24(10), 851862.CrossRefGoogle ScholarPubMed
Barer, M.L., Evans, R.G., & Hertzman, C. (1995). Avalanche or glacier?: Health care and the demographic rhetoric. Canadian Journal on Aging, 14(2), 193224.CrossRefGoogle Scholar
Barer, M.L., Evans, R.G., Hertzman, C., & Johri, M. (1998). Lies, damned lies, and health care zombies: Discredited ideas that will not die. HPI Discussion Paper 10, Health Policy Institute, The University of Texas-Houston, Health Science Center, 03.Google Scholar
Baumol, W., & Bowen, W.G. (1966). Performing arts - the economic dilemma. New York: Twentieth Century Fund.Google Scholar
Boulet, J.A., & Grenier, G. (1978). Health expenditures in Canada and the impact of demographic changes on future government health insurance program expenditures. Discussion Paper #123, Ottawa, Economic Council of Canada.Google Scholar
Canadian Institute for Health Information (CIHI). (2000). National health expenditure trends: 1976-2000. Ottawa: Canadian Institute for Health Information.Google Scholar
Chen, J., & Millar, W.J. (2000). Are recent cohorts healthier than their predecessors? Health Reports, 11(4), 924.Google ScholarPubMed
Clark, D.O., Von Korff, M., Saunders, K., Baluch, W.M., & Simon, G.E. (1995). A chronic disease score with empirically derived weights. Medical Care, 33(8), 783795.CrossRefGoogle ScholarPubMed
Denton, F.T., & Spencer, B.G. (1975). Health-care costs when the population changes. Canadian Journal of Economics, 7(1), 3448.Google Scholar
Evans, R.G. (2001). Financing health care: Taxation and the alternatives. In Mossialos, E., Dixon, A., & Figueras, J. (Eds.), Funding health care: Options for Europe. Buckingham: Open University Press, forthcoming.Google Scholar
Evans, R.G., Barer, M.L., Stoddart, G.L., & Bhatia, V. (1994). Who are the zombie masters, and what do they want? Toronto: The Premier's Council on Health, Well-being and Social Justice.Google Scholar
Foot, D.K. (2000). [untitled review of Peterson, 1999] Canadian Public Policy-Analyse de Politiques, 42(4), 498500.Google Scholar
Fries, J.F. (1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303(3), 130135.Google Scholar
Gee, E.M., & Gutman, G.M. (2000). The overselling of population aging: Apocalyptic demography, intergenerational challenges and social policy. Don Mills, ON: Oxford.Google Scholar
Health Services Utilisation and Research Commission (HSURC). (1998). Hospital and home care study. Saskatoon: Health Services Utilisation and Research Commission.Google Scholar
Henripin, J. (1994). The financial consequences of population aging. Canadian Public Policy-Analyse de Politiques, 20(1), 7884.CrossRefGoogle Scholar
Hill, M.N., Levine, D.M., & Whelton, P.K. (1988). Awareness, use, and impact of the 1984 Joint National Committee Consensus Report on High Blood Pressure. American Journal of Public Health, 78(9), 11901193.CrossRefGoogle ScholarPubMed
Maclure, M., Dormuth, C., Naumann, T., McCormack, J., Rangno, R., Whiteside, C., & Wright, J.M. (1998). Influences of educational interventions and ad-verse news about calcium-channel blockers on first-line prescribing of antihypertensive drugs to elderly people in British Columbia, The Lancet, 352, 943978.Google Scholar
Martel, L., & Bélanger, A. (1999). An analysis of the change in dependence-free life expectancy in Canada between 1986 and 1996. In Report on the demographic situation in Canada. Current demographic analysis (pp. 164183). Ottawa: Statistics Canada.Google Scholar
McAlister, F.A., Teo, K.K., Lewanczuk, R.Z., Wells, G., & Montague, T.G. (1997), Contemporary practice patterns in the management of newly diagnosed hypertension. Canadian Medical Association Journal, 157(1), 2330.Google ScholarPubMed
McGrail, KM., Evans, R.G., Barer, M.L., Sheps, S.B., Hertzman, C., & Kazanjian, A. (2001). The quick and the dead: Managing’ inpatient care in British Columbia hospitals, 1969-1995/96. Health Services Research, forthcoming.Google Scholar
Michael, P., Phillips, C., & Mulrow, C. (2000). Use of lipid lowering drugs for primary prevention of coronary heart disease: meta-analysis of randomised trials. British Medical Journal, 321, 983986.Google Scholar
Mintzes, B. (2000). The truth, the half-truth and nothing like the truth. In Barer, M.L., McGrail, KM., Cardiff, K., Wood, L., & Green, C. J. (Eds), Tales from the other drug wars. Vancouver: Centre for Health Services and Policy Research.Google Scholar
Morgan, S.G. (2001). An index approach to drug expenditure decompositions, Discussion Paper, Health Policy Research Unit, Centre for Health Services and Policy Research, Vancouver, BC.Google Scholar
Newhouse, J.P. (1977). Medical-care expenditure: A cross-national survey. Journal of Human Resources, 12(1), 115125.CrossRefGoogle ScholarPubMed
Northcott, H.C. (1994). Public perceptions of the population aging “crisis”. Canadian Public Policy-Analyse de Politiques, 20(1), 6677.CrossRefGoogle Scholar
Pascali, M.V. (1995). Controlling expenditures for physicians’ services: An evaluation of British Columbia's cost containment policies, 1979-1991. Doctoral dissertation (Health Services and Policy Analysis), University of California at Berkeley.Google Scholar
Peterson, P.G. (1999). Grey dawn: How the comingage wave will transform America and the world. New York: Times Books.Google Scholar
Robson, W.P.B. (2001). Will the baby boomers bust the health budget? CD. Howe Institute Commentary 148. Toronto: Renouf Publishing.Google Scholar
Roos, N.P. (2000). The disconnect between the data and the headlines. Canadian Medical Association Journal, 163(4), 411412.Google ScholarPubMed
Savoie, I. (2000). lipid lowering drugs. In Barer, M.L., McGrail, KM.Cardiff, K., Wood, L., Green, C.J. (Eds), Tales from the other drug wars. Vancouver: Centre for Health Services and Policy Research.Google Scholar
Savoie, I., Wright, J.M., & Maclure, M. (1998). Lipid lowering therapy. Joint Health Technology Assessment Series. BCOHTA, Vancouver, 1998, 4J.Google Scholar
Statistics Canada. (1999). How healthy are Canadians? Health Reports, special issue, 11(3).Google Scholar
Steinberg, E.P., Gutierrez, B., Momoni, A., Boscarino, J.A., Neuman, P., & Deverka, P. (2000). Beyond survey data: A claims-based analysis of drug use and spending by the elderly. Health Affairs, 19(2), £198-211.Google Scholar
Thomas, L. (1971). The technology of medicine. New England Journal of Medicine, 284, 13661368.CrossRefGoogle Scholar
Van Tielen, R., Payes, F., & Genart, J. (1998). The demographic impact on ambulatory pharmaceutical expenditure in Belgium. Health Policy, 45, 114.CrossRefGoogle ScholarPubMed
Woods Gordon Management Consultants. (1984). Investigation of the impact of demographic change on the health care system in Canada - Final Report. (Prepared for the Task Force on the Allocation of Health Care Resources (Joan Watson, chairman). Toronto: Woods Gordon.Google Scholar
Wright, C.J., Cardiff, K., & Kilshaw, M. (1997). Acute medical beds: How are they used in British Columbia? Vancouver: Health Policy Research Unit 07:D, Centre for Health Services and Policy Research.Google Scholar
Wright, J.M., Lee, C.H., & Chambers, G.K. (1999). Systematic review of antihypertensive therapies: Does the evidence assist in choosing a first-line drug? Canadian Medical Association Journal, 161(1), 2532.Google Scholar