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

Published online by Cambridge University Press:  29 November 2010

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


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.


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.

Copyright © Canadian Association on Gerontology 2001

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