Healthcare Policy, 7(1) 2011: 68-79 Population Aging and the Determinants of Healthcar... - 0 views
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Irene Jansen on 23 Jan 12Rising hospital expenses, use of specialists threaten system; Aging population accounts for one third of increase, says UBC study Vancouver Sun Tue Aug 30 2011 Page: A4 Section: Westcoast News Byline: Matthew Robinson
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research dating back 30 years illustrates that population aging exerts modest pressure on health system costs in Canada (Denton and Spencer 1983; Barer et al. 1987, 1995; Roos et al. 1987; Marzouk 1991; Evans et al. 2001; McGrail et al. 2001; Denton et al. 2009)
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To shed new empirical light on this old debate, we quantified the impacts of demographic and non-demographic determinants of healthcare expenditure using data for British Columbia (BC) over the period 1996 to 2006. Using linked administrative healthcare data, we quantified the trends in and the determinants of expenditures on hospital care, physician services and pharmaceuticals. To our knowledge, this is the first time that all three of these major components of healthcare costs have been analyzed in a single Canadian study.
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We found that population aging contributed less than 1% per year to spending on medical, hospital and pharmaceutical care. Moreover, changes in age-specific mortality rates actually reduced hospital expenditure by –0.3% per year. Based on forecasts through 2036, we found that the future effects of population aging on healthcare spending will continue to be small. We therefore conclude that population aging has exerted, and will continue to exert, only modest pressures on medical, hospital and pharmaceutical costs in Canada. As indicated by the specific non-demographic cost drivers computed in our study, the critical determinants of expenditure on healthcare stem from non-demographic factors over which practitioners, policy makers and patients have discretion.
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We found that population aging in British Columbia contributed less than 1% per year to total growth of expenditures on hospital, medical and pharmaceutical care from 1996 to 2006. We also found that changes in age-specific mortality rates reduced (albeit modestly) per capita healthcare costs over time, confirming what other researchers have suggested (Fries 1980; Breyer and Felder 2006). With rigorous analysis of recent healthcare data, we can therefore confirm what studies spanning earlier decades for British Columbia, elsewhere in Canada and other comparable health systems have found: the net impact of demographic factors on major components of the healthcare system is moderate (Denton and Spencer 1983; Fuchs 1984; Barer et al. 1987, 1995; Gerdtham 1993; Evans et al. 2001; McGrail et al. 2001). Moreover, when we forecasted the effects of expected demographic changes in British Columbia through 2036, we found that the future effects of population aging on healthcare spending will continue to be modest (1% or less per year).
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Our findings also indicated that average payment per unit of hospital care increased over the period. The increase in hospital unit costs may have been an appropriate policy response to increases in age-adjusted clinical complexity per patient remaining in care following reductions in the average length of stay
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After taking into account population aging, the average number of days of prescription drug therapy received by British Columbia residents grew more than 5% per year during the first half of our study period and plateaued in the latter half of the period (data not shown)
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Despite popular claims about population aging and the sustainability of healthcare in Canada, demographic changes exert steady, predictable and modest forces on the cost of major components of our healthcare system. This is likely to remain true for the foreseeable future.
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Despite popular claims about population aging and the sustainability of healthcare in Canada, demographic changes exert steady, predictable and modest forces on the cost of major components of our healthcare system. This is likely to remain true for the foreseeable future. Changes in the age-specific profile of healthcare costs, by contrast, can exert and have exerted significant pressures on health system costs. Clinicians, policy makers and patients have some discretion over the non-demographic sources of healthcare cost increases - unlike population aging. Though these results are largely confirmations of studies from past decades, it is nevertheless important to update the scientific basis for policy debates. Moreover, close attention to recent trends and cost drivers - such as the price of prescription drugs that drove pharmaceutical expenditures in the past decade - also helps to illuminate the non-demographic forces that seem most amenable to policy intervention. Ultimately, then, research of this nature is a reminder that the healthcare system is as sustainable as we want it to be.