Skip to main content Accessibility help

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

  • Robert G. Evans (a1), Kimberlyn M. McGrail (a1), Steven G. Morgan (a1), Morris L. Barer (a1) and Clyde Hertzman (a1)...


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.



Hide All
Arnst, C. (1998). Is good marketing bad medicine. Business Week, 4(13), 6263.
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.
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.
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.
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.
Baumol, W., & Bowen, W.G. (1966). Performing arts - the economic dilemma. New York: Twentieth Century Fund.
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.
Canadian Institute for Health Information (CIHI). (2000). National health expenditure trends: 1976-2000. Ottawa: Canadian Institute for Health Information.
Chen, J., & Millar, W.J. (2000). Are recent cohorts healthier than their predecessors? Health Reports, 11(4), 924.
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.
Denton, F.T., & Spencer, B.G. (1975). Health-care costs when the population changes. Canadian Journal of Economics, 7(1), 3448.
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.
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.
Foot, D.K. (2000). [untitled review of Peterson, 1999] Canadian Public Policy-Analyse de Politiques, 42(4), 498500.
Fries, J.F. (1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303(3), 130135.
Gee, E.M., & Gutman, G.M. (2000). The overselling of population aging: Apocalyptic demography, intergenerational challenges and social policy. Don Mills, ON: Oxford.
Health Services Utilisation and Research Commission (HSURC). (1998). Hospital and home care study. Saskatoon: Health Services Utilisation and Research Commission.
Henripin, J. (1994). The financial consequences of population aging. Canadian Public Policy-Analyse de Politiques, 20(1), 7884.
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.
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.
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.
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.
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.
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.
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.
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.
Newhouse, J.P. (1977). Medical-care expenditure: A cross-national survey. Journal of Human Resources, 12(1), 115125.
Northcott, H.C. (1994). Public perceptions of the population aging “crisis”. Canadian Public Policy-Analyse de Politiques, 20(1), 6677.
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.
Peterson, P.G. (1999). Grey dawn: How the comingage wave will transform America and the world. New York: Times Books.
Robson, W.P.B. (2001). Will the baby boomers bust the health budget? CD. Howe Institute Commentary 148. Toronto: Renouf Publishing.
Roos, N.P. (2000). The disconnect between the data and the headlines. Canadian Medical Association Journal, 163(4), 411412.
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.
Savoie, I., Wright, J.M., & Maclure, M. (1998). Lipid lowering therapy. Joint Health Technology Assessment Series. BCOHTA, Vancouver, 1998, 4J.
Statistics Canada. (1999). How healthy are Canadians? Health Reports, special issue, 11(3).
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.
Thomas, L. (1971). The technology of medicine. New England Journal of Medicine, 284, 13661368.
Van Tielen, R., Payes, F., & Genart, J. (1998). The demographic impact on ambulatory pharmaceutical expenditure in Belgium. Health Policy, 45, 114.
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.
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.
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.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed