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It's Time To Rethink Health-Care Policy For The Elderly

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As the Canadian population continues to age, there is a need to revisit conventional thinking regarding the provision of health-care services for seniors to ensure that the system is sustainable for all Canadians. There are a number of misperceptions in current thinking.

First, there is a belief that a growing seniors' population will result in runaway health-care costs that will bankrupt the health-care system. But a body of research shows that growth in the senior population will add less than one per cent per year to health-care costs -- a manageable increase. In fact, the main factors driving increased health-care costs are increases in the use of technology (including drugs), increased use of health services across all ages and increases in wages for health-care providers.

A second related belief is that the percentage of provincial budgets consumed by health care is increasing as a direct result of the proportion of seniors in our population. However, Canadians may be surprised to learn there is no runaway cost increase in the health-care system based on the percentage of GDP spent on health care in Canada. There was only a minor percentage increase from 10 per cent to 10.5 per cent between 1992 and 2007. There was a major increase during the financial crisis such that the percentage for 2009 was 11.9 per cent. But that percentage has been declining ever since because the economy has been recovering.

The percentage of GDP spent on health care in Canada was 10.7 per cent in 2013 -- a modest increase since 1992.

A third belief has been that the health-care system for seniors needs to focus on public health and physician services. This belief resulted in a shift in policy priorities in the 1990s from continuing development of an integrated national care delivery system for seniors to a focus on enhancements to public health and physician services. This, in turn, resulted in the breakup of integrated systems of care for older adults into their component parts, each competing separately for additional funds.

One consequence has been an increased focus on home care. While this is helpful, and home care is necessary, it is essentially an add-on cost unless it is part of an integrated system of care where pro-active trade-offs can be made to substitute less costly home care for more expensive residential and hospital care.

A fourth belief has been that the focus should be on individuals with high care needs and that relatively little attention need be given to preventive care for people who already have a given health condition. However, the evidence seems to indicate that, overall, individuals with low level care needs who are cut from care actually cost the health-care system more as they deteriorate faster and are more likely to need more costly residential and hospital care than people who continue to receive minimal preventive care.

The cutting of people from care who have lower level care needs can result in significant hardships and -- perversely -- an incentive to get sicker quicker to qualify for publicly funded care services.

A focus on home care for seniors with high care needs has resulted in models that integrate home care and family physician services. While such models can be part of an integrated system of care for older adults, they are not a substitute for a continuum of support that enhances quality of life and delays more expensive care.

How damaging have these popular misconceptions been to our health system? Health policy makers have made choices based on them. The result has been an apparent acceptance of the fiscal status quo without the adoption of possible efficiencies to avoid costs. We can do better.

Clearly a rethink is required. We need an integrated system of care delivery for older adults, which increases the quality and continuity of care and has the potential to reduce costs and enhance the sustainability of the health-care system for all Canadians.

A first step to correct the negative consequences of current policy is for decision makers to recognize that a continuing care system for older adults is a key component of our health-care system -- equivalent to hospital care, physician care and public health. This would allow the currently splintered components of home care, home support, residential care facilities and geriatric units in hospitals to be brought together into one system of care for seniors.

Such a system would be the third largest component of our health-care system, in terms of public expenditures, after hospitals and physician care. Given that most of the component parts are already in place in most jurisdictions, it would cost relatively little to set up integrated systems of care for the elderly. It would be money well spent.

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