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  • Canadian Journal on Aging / La Revue canadienne du vieillissement, Volume 14, Issue 2
  • January 1995, pp. 193-224

Avalanche or Glacier?: Health Care and the Demographic Rhetoric

  • Morris L. Barer (a1), Robert G. Evans (a1) and Clyde Hertzman (a1)
  • DOI:
  • Published online: 29 November 2010

Claims that the health care system is about to be engulfed in a “wave of grey” have become commonplace. Recent cost escalation is commonly attributed to the aging of the population, and there is no shortage of dire warnings about the cost implications of the even more dramatic aging, and costs, still to come. These claims have been largely unsubstantiated. Yet they persist for a number of reasons. First, over long periods of time, the effects of demographic trends can be (and probably will be) quite substantial. But these effects move like glaciers, not avalanches. Second, the effects of aging populations on some types of services which cater differentially to seniors will be much more dramatic; observers of those sub-sectors (such as long-term care) tend to extrapolate that sector-specific experience to health care generally. Third, at the “coal-face,” health care providers are seeing their practices become ever more dominated by seniors. They mistake this increased “presence” of patients aged 65 and over in their practices as evidence of the effects of demographic changes. In this paper we discuss each of these sources of error about the effects of aging population on health care costs. We focus primarily on the confusion between changes in patterns of care for particular age groups, and changes in overall levels of care. Quite extensive empirical evidence has been collected over the past decade from analyses of British Columbia data bases, and these findings are not unique, in Canada, or beyond. The common finding of this body of research is that population aging has accounted for very little of the increase in health care costs over the past three decades, in Canada or elsewhere. Health care utilization has increased dramatically among seniors. But this has had less to do with the fact that there are more of them, than with the fact that the health care system is doing much more to (and for) them than was the case even a decade ago. This suggests that the appropriate care of elderly people should be a central issue for health care policy and management, but that demographic issues are, in the short run at least, largely a red herring.


Les déclarations à l'effet que le système de soins de santé canadien est sur le point de s'enliser sont devenues chose courante. La montée en flèche des coûts est communément attribuée au vieillissement de la population, et les mises en garde sinistres quant aux conséquences sur le plan financier de la hausse importante du taux de vieillissement et des coûts à venir viennent de toute part. La majorité de ces déclarations sont sans fondement, mais celles-ci persistent pour un certain nombre de raisons. Premièrement, les répercussions des changements démographiques peuvent être, à la longue (et le seront probablement), très importantes. Toutefois, ces effets se font sentir très lentement (comme un glacier) plutôt que subitement (comme une avalanche). Deuxièmement, l'impact du vieillissement de la population sera encore plus évident sur certains types de services offerts uniquement aux personnes âgées. Les observateurs de ces sous-secteurs (comme celui des soins de longue durée) ont tendance à extrapoler ce phénomène touchant un secteur particulier à l'ensemble des soins de santé. Troisièmement, en étant «au front,» les prestateurs de soins de santé constatent qu'ils desservent un nombre croissant d'aînés. Ils croient, à tort, que cette «présence» accrue de patients de 65 ans et plus dans leur bureau reflète les effets des changements démographiques. Dans le cadre de cet article, nous discutons de chacune de ces erreurs quant aux effets du vieillissement de la population sur le coût des soins de santé. Nous nous concentrons principalement sur la confusion entre les changements au niveau des modèles de soins destinés à un groupe d'âge particulier et les changements survenant dans l'ensemble du système de soins de santé. Au cours des 10 dernières années, de nombreuses conclusions empiriques ont été tirées d'analyses de bases de données de la Colombie-Britannique, et ces résultats ne sont pas uniques, ni au Canada, ni à l'étranger. Cet ensemble de recherches a permis de conclure que le vieillissement de la population n'a causé qu'une faible augmentation du coût des soins de santé au cours des 30 dernières années, au Canada comme ailleurs. L'utilisation des services de soins de santé a connu une hausse importante chez les personnes âgées. Pourtant, ce phénomène est moins attribuable à la croissance du nombre de personnes âgées qu'au fait que le système de soins de santé offre à cette clientèle davantage de services que par le passé. Cette constatation suggère donc que les services de soins appropriés destinés aux personnes âgées devraient être au centre de toutes discussions en matière de politiques et de gestion de soins de santé, et que les questions démographiques, à court terme à tout le moins, ne font que brouiller les pistes.

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Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
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