Restructuring Our Healthcare System
Population aging will not overwhelm the healthcare system. That said, this does not mean the system is properly structured to care for the elderly. The publicly-funded healthcare system in Canada is acute care oriented, and is not optimally designed to provide care for those with ongoing care needs, such as chronically ill elderly (Denton & Spencer, 2010; Hollander et al., 2007).
Increases in longevity is also expected to increase the cost of some health services. For instance, using US data, Spillman and Lubitz (2000) predict that increases in longevity after the age of 65 years may result in greater spending for long-term care because the cost of long term care increases with age. The average expenditure for nursing home care for persons who die at the age of 75 years is $12, 168, for those who die at 85 it is $39,009 and for those who die at age 95 it is $104,069. Similarly, the costs of homecare are also expected to increase with advancing age of death. Further, if the number and combination of chronic illnesses remains the same in the future as it was in 2005, researchers have projected that demand for healthcare services such as hospital stays and consultations with physicians and specialists will increase more than the rate of population growth by 2030 (45%, 25%, and 22% increase vs. 20% population growth; Denton & Spencer, 2010)2.
Evidence suggests, however, that implementing a system of integrated, continuing care can produce cost savings and care delivery efficiencies (Hollander et al., 2007). Using Canadian data, Hollander et al (2007) have shown that it is possible to make cost-effective substitutions between homecare and residential care services through implementation of an integrated healthcare delivery system that has the following characteristics:
- a single or highly coordinated administration;
- a single funding envelope (budget based, capitation or a coordinated model in which parties jointly agree to resource allocations);
- coordinated case management across all service components in the system;
- a standardized assessment;
- a one care level classification system that is the same irrespective of the site of care.
In addition, even modest reductions in the prevalence of chronic illness (as a product of healthier lifestyles or policy initiatives toward prevention and health promotion), could lead to significant cost savings associated with chronic disease management (Denton & Spencer, 2010). Denton and Spencer (2010) project that if 50% of the population with one or more chronic illnesses had one less chronic illness, in hospital stays and physician consultations would drop by 16 and 10%, respectively, which would represent a cost savings of more than a third of the projected increased cost of healthcare associated with chronic disease management. Although it cannot be conclusively stated that the overall rates of chronic illness are decreasing3, reductions in at least some chronic illnesses have occurred. For example, rates of arthritis/rheumatism, hypertension, and bronchitis/emphysema have declined from the 1970’s to the late 1990’s (Wister, 2005). Rates of smoking―a major risk factor for many chronic diseases―is also declining in Canada: The Canadian Tobacco Use Monitoring Survey reported less than 18% of the Canadian population smoked in 2008 compared to 35% of the population in 1985. If people over the age of 65 are healthier than their predecessors―something the health system can help facilitate through policy initiatives for prevention and health promotion ―cost savings can be realized.
2 While evidence does not conclusively state the overall rate of chronic illness is decreasing, the prevalence rates of some chronic illnesses are decreasing. For instance, at least one study has found a reduced prevalence of dementia (Manton, Gu, & Ukranintseva, 2005).
3 And in fact, rates of some chronic illness, such as obesity, are on the rise (http://ezinearticles.com/?Smoking-Statistics-in-Canada&id=1932999.), and even expected to increase by 5% over the next 10 years (http://www.cbc.ca/canada/story/2010/09/23/obesity-canada-adults-oecd.html.
Denton FT, Spencer BG. Chronic health conditions: Changing prevalence in an aging population and some implications for the delivery of health care services. Can J Aging 2010;29:11-21.
Hollander MJ, Chappell NL, Prince MJ, Shapiro E. Providing care and support for an aging population: Briefing notes on key policy issues. Healthc Q 2007;10(3):34-45.p
Spillman B, Lubitz J. The effect of longevity on spending for acute and long-term care. N Engl JMed 2000;342(19):1409-15.
Wister AV. Baby Boomer Health Dynamics, How are we Aging? Toronto, ON: University of Toronto Press; 2005.