Canada’s Aging Population and the Cost of Healthcare

Abstract

This paper is a study of the cost of healthcare in Canada in regards to the increasing aging population. The paper begins with an introduction, which addresses the fact that the medical field is advancing constantly. It states that due to these advancements people are living much longer. The aging population is growing, and there is bound to be some effect. This paper does not claim to know exactly what the effect is (nor how significant the effect could be). Instead, it serves as more of a literature review, discussing various articles, studies, and scholarly contributions that are related to this subject. It describes and evaluates the already existing arguments—and attempts to find new insight into the debate by juxtaposing the articles. It addresses the importance of preventive care and a better integrated health system and presents some of the more drastic approaches to cutting costs (e.g., health care rationing). The paper ends its discussion by posing what seems to be an as yet unasked question—does it really matter if these costs are increasing? Isn’t quality and length of life more important than a larger dent in our wallets? Canada has one of the best, most comprehensive government funded health care systems. This paper attempts to convince its readers that it is worth the extra cost to support it.

Canada’s Aging Population and the Cost of Healthcare

The medical health profession is growing every day. Advancements in health care regarding preventative care and treatment occur all of the time. It should be no surprise that the gaining population is growing as well. In fact, in Canada, the fastest growing population is that of our elderly. There is no doubt that this is a positive thing. People are not only living longer, but they are living better. However, the cost of these longer lives must be considered. We are, of course, less expensive dead than alive. Just how much greater the costs related to our ever-increasing aging population are, is still up for debate. In addition to this, just how we should go about addressing these costs also requires consideration. Most individuals believe that a better integrated health care system which encourages preventive care and healthy living will help mitigate health care costs from the aging population. Others, who feel rising health care is a bigger issue than many other believe, argue for more drastic measures, such as health care rationing. In any case, the rapidly growing aging population, and their relationship with health care, must be reevaluated in light of recent changes in Canada’s modern society.

In an editorial for the Canadian Pharmacists Journal, Rosemary Killeen stated that in 2010 there were nearly five million Canadians aged 65 or older. She wrote that that number is expected to reach higher than ten million in the next twenty-five years (Killeen, 2010, p. 248). Killeen explained that most seniors are on at least one—though likely more than one—prescribed medication, and that as age increases so does the number of specific drug classes used by individual seniors. Obviously, more individuals using more drugs would result in a higher cost in pharmaceuticals. Not only that, but there are other “physical, mental and social barriers associated with aging” that must have attention paid to them (Killeen, 2010, p. 248). Older individuals are at a greater risk of physical and cognitive impairments due to age and this increased levels of medications. This has always been the case, but now, there are more seniors than ever that must be more closely monitored than younger individuals who are at less risk for these issues (Killeen, 2010).

Killeen’s strategy for dealing with these issues is not to complain about rising healthcare costs, but instead to encourage pharmacists to be more aware and vigilante in filling their prescriptions. As she points out, they may be the only medical professionals in frequent contact with these seniors, so they may have a better idea of what their actual prescription needs are than a doctor who is only involved for routine visits. She urges that medication education be increased for seniors, so that the chance of over-prescribing and/or prescription errors can be mitigated. It is likely that there are extra costs tied up in poorly prescribed medications, so in this way, she hopes to improve both the medical field, and the lives of the growing senior population (Killeen, 2010, p. 248).

Shortly after Rosemary Killeen’s editorial, Yves Joanette released his profile for the Canadian Institutes of Health Research–Institute of Aging, titled “Living Longer, Living Better: Preview of CIHR Institute of Aging 2013–2018 Strategic Plan.” It also set out to show that appropriate planning and prescribing can help to cut down on the otherwise rising healthcare costs related to the ever-growing aging population. In 2011, the number of aged individuals over 65 broke the five million mark. At that point, they comprised nearly fifteen percent of the total population: a high at that point (Joanette, 2011, p. 209). Joanette gives his readers a few reasons as to why life expectancy is so much longer than it was in the past. He cites “increased survival rates at birth, higher life expectancy, healthier lifestyles, better control of infections, and better management and treatment of certain chronic diseases” (Joanette, 2001, p. 211). While all of this is true, it does not explain what to do with the lives of people who are living far past the age we ever believed they could. Joanette attempts to explore this in the profile.

What the profile aims to do is highlight how to best improve the life of the aging population. It may not seem directly evident, but improving health conditions and quality of life for these people will cut down on what can be very expensive health care costs related to what Joanette refers to as the “biological, psychological, social, and environmental determinants of health and wellness” (2011, p. 210). All of these determinants can be improved through certain strategies, which Joanette dedicates the rest of the profile to exploring.

Joanette believes that the best strategy is to optimize the aging population’s levels of health and wellness. He writes that this is achieved through “preventative strategies and lifestyle interventions” (2010, p. 210). He refers to the need to address and treat some of the more serious, and often frightening, issues of aging. These issues include many of the neurodegenerative diseases that affect older adults (e.g., dementia). Joanette recommends that interventions encompass a holistic approach and “establish a continuum of integrated services” (2010, p. 211). Joanette lists preventive support, medical care, and a diversity of caregivers as important ways of addressing positive health care for aging individuals.

The profile stresses the importance of using products and services that “combine and integrate continuity, innovation, and efficiency” (Joanette, 2001, p. 212). That is, products and services that find new ways to establish and encourage wellbeing. He addresses allowing for health care services that are more appropriate and efficient for the elderly. In fact, he believes that the health care system needs to be adapted to better fit the needs of the elderly. He argues that it should be more effective at helping the elderly manage their chronic illnesses, and that research efforts should be refocused to deciding the health care services and systems that are more effective and efficient than what is currently in place (Joanette, 2010, p. 212). Integrating all of these ideas will, hopefully, lead to a healthier, more fulfilled life for our aging population. In doing so, quality of life will be improved, and the high costs of more extreme healthcare measures will be cut down.

In a background paper prepared for the Federal, Provincial and Territorial Committee of Officials of Manitoba, it is also argued that healthy living will help to mitigate the health care costs associated with the aging population in Canada. The paper states that sixty-seven percent of direct health care costs come from chronic diseases, and another sixty percent of indirect health care costs (e.g., early death, productivity decline, loss of income) come from these same diseases (2006, p. vi). The paper suggests addressing these issues at a population level, encouraging even the smallest changes in approaches to handling risk factors for these diseases.

“For example,” the paper states, “even modest rates of physical activity have been shown to stave off functional declines in people with osteoarthritis” (2006, p. 8). Increasing awareness about how to deal with these diseases and focusing on preventive care will cut down on bigger costs associated with these chronic diseases, so the fact of the aging population will not weigh as heavily on Canada’s health care budget—at least, this is what this paper and authors such as Yves Joanette believe.

While preventive care seems a good way to cut down on health care costs associated with Canada’s aging population, there are some people who believe that rising health care costs are not a result of longer living individuals. In their book, Aging in Canada, Neena L. Chappell and Marcus J. Hollander make it clear, with their facetious use of the phrase “grey tsunami” to describe the growing aging population, that they do not believe the Canadian economy is doomed. Instead, they present the idea that growing costs have more to do with expanding technologies and labour costs, as opposed to an increase in population growth. They argue that controlling these issues lies in reorganizing the system, not in cutting down on health care for the elderly. A system that runs more streamlined, is more cost effective, this is true no matter the industry, and Chappel and Hollander simply apply this logic to the health care system. It is important to remember, however, that while Aging in Canada does focus primarily on rethinking how we view health care costs and the aging population, it does not dismiss the importance of preventive care and healthy living. These two ideas seem to show up in every study and book on this topic. Everyone who has weighed on the issue seems to be in agreement that taking better care of we in the first place is a good way to cut down on health care costs.

Another aspect of health care in which most people seem to be in agreement is in the need for a more integrated health care system. Most of the associated literature offers this as one of the necessary outcomes of the current restructuring and rethinking of health care that has arisen in conjunction with the growing aging population. A 2012 study conducted by Debra Sheets and Elaine Gallagher explains that the health care system in place in Canada is aimed more at acute, emergency care as opposed to long-term, ongoing treatments. It does not allow for streamlined communication across providers and types of care (p. 1). The study asserts that “an integrated health care system designed to address chronic illness and continuing care is needed to ensure better health outcomes” (Sheets & Gallagher, 2012, p. 2). A better functioning system will cut down on errors, miscommunications, and misdiagnoses, all of which contribute to unnecessary health care costs. And, of course, Sheets and Gallagher stress the importance of prevention and healthy living to avoid chronic conditions, cut down on hospitalizations (which are hugely expensive), and encourage independent living (2012, p. 2). It is important to think about the fact that when many people discuss the rising costs of health care (especially those costs associated with the aging population), they do not often consider restricting the whole system, which, when explained by experts such as Sheets and Gallagher, seems an obvious strategy.

Debra Sheets and Elaine Gallagher are not the only experts who believe that there are flaws in our health care system that are likely adding to our health care costs. The 2009 study, “Aging at Home: Integrating Community-Based Care for Older Persons” discusses the fact that hospitalizations and “medically necessary” doctor services are fully insured—provided they are delivered by doctors. These services—when delivered outside of a hospital, or by a medical practitioner other than a doctor—may not be covered (Williams, Lum, Deber, Montgomery, Kuluski, et al., p. 12). As the study points out, “this has particular relevance to home and community care, which encompasses a range of professional services (e.g., nursing, rehabilitation therapy) as well as personal and social supports (e.g., transportation and homemaking)” (Williams, et al., 2009, p. 12). What this means is that, despite the fact that so many agree about the importance of preventive care and encouraging independent living among seniors, Canada’s health care system does not allow for this. Seniors may be forced to wait until an issue is dire, requiring hospitalization, surgery, or has reached a chronic status, to seek treatment. It is easy to see how this may add to unnecessary, easily prevented costs.

Barbara A. Mitchell’s, Family Matters: An Introduction to Family Sociology in Canada suggests a more novel way to approach cutting down on costs associated with the growing aging population. Mitchell suggests that there are often unseen, indirect costs related to elderly care that should be addressed. She provides a statistic that approximately 2.7 million people reported provided unpaid medical care to someone sixty-five or older in the year 2007. Mitchell explains that using the General Social Surveys of 2002 and 2007 it is shown that adult, unpaid caregivers have grown in number from 19.5 to 28.9 percent, and that seventy-five percent of these individuals also work a paid job (2008. p. 269). One would think that unpaid caregivers would cut down on the costs associated with elderly care, but considering the fact that fifteen percent of these individuals have had to reduce their time working a paid career in order to provide more care to the aged individual (Mitchell, 2008, p. 269). These are wages lost due to care provided. This number does not include money lost due to a decrease in productivity or unforeseen time lost due to emergencies that arise. Refocusing funding to encourage healthy, independent living among seniors would allow for seniors to need less care from friends and relatives, cutting down on unpaid elderly care.

In his book, Pricing Life: Why It’s Time for Health Care Rationing, Peter Ubel argues for a concept to which most people feel opposed. In Canada, government funded does not mean free. It is still important that we try to cut-down on health care costs (as long, of course, as it is reasonable to do so). We are obviously in not nearly so dire a situation as the US, (avoiding for-profit insurance helps this) but medical costs are high no matter where one goes. Ubel believes that health care rationing is the way to do this. Health care rationing is a very controversial topic, but it is one that must be explored when considering rising health care costs, especially those related to the aging community. Ubel believes that rationing health care is inevitable. He argues that doctors should be trained on when it is best to withhold medical services. This seems cruel, and it is interesting to consider what this would mean for our elderly population who suffer from chronic, but non-life threatening illnesses, or those who are struggling with something that is life-threatening, but stands the chance of responding to treatment. Would these people be stopped from receiving health care because they do not likely have many years of life left? What does this mean for the fact that the elderly are living longer?

Ubel argues that the best way to implement health care rationing is with a system of cost effective analysis. He proposes this in place of what many people believe health care rationing would entail—cost benefit analysis. The latter suggests that we only do what is most effective—cost wise—when it comes to healthcare. The former, instead, weighs cost and effectiveness. In the case of cost benefit analysis, as Ubel writes, “prolonging the life of elderly people who are draining social security budgets is not very cost beneficial.” He continues, “In contrast, [cost effective analysis] measures health outcomes and says that health improvements in old fogies are worth just as much as similar improvements in young fogies” (Ubel, 2010, p. 68). Many people fear that health care rationing would allow for the justification of withholding care from the elderly. Instead, it sets out to withhold care that is not deemed necessary, no matter the age. How to deem necessity in medical care is an entirely different debate with its own set of challenges. Needles to say, health care rationing is a sensitive subject that needs to be handled carefully, but it should not be ignored all together. With the medical field growing so rapidly, and our ideas of living and life being changed as well, it is important that we explore all options available to us as people who, in some way, shape, or form pay into the health care from which the elderly community will benefit. It is important to remember that life expectancy and the aging population will continue to increase as the current generation ages, and that these issues, though they may not seem relevant right now, will be sooner rather than later.

It is encouraging to consider the fact that many nations look to Canada as inspiration regarding how we treat our aged. In “Aged in India and Canada: the Missing Social Capital,” Chittaranjan Das Adhikary uses Canada as a model upon which India should be building their plan for treatment of the aged. Adhikary brings up the point that Canada is not the only country with a growing aging population; the fact deserves consideration and planning, especially when, as Adhikary writes, “Canadian seniors are no less wealthy and healthier than the young which at times even fuel debates on issues like mandatory retirement, tax credits, age based pension system, etc.” (2013, p. 484). What this means is that the idea of aging, and how we look at the spending necessary to keep the elderly population healthy, must be rethought. At this point, Canada has one of the best funded programs to account for this in the world, but this does not mean that—if left unattended—this will not change. As the author of this article writes, “Canada seems a good place to grow older” (Adhikary, 2013, p. 484). For this to continue, we must decide how big an issue the rising costs of health care will be, and how this should be handled.

At the end of the day, the aging population is growing. There are going to be costs associated with this. Individuals such as Yves Joanette are trying to cut down on these costs, or at least aim these costs toward more useful options. Once it understood that health care must be reinterpreted to take into account our growing aging population, the question becomes, to what do we devote our extra time? In his Aging: Conflicts and Controversies, author Harry Moody discusses the “moral economy of the life course” (2010, p. 139). The moral life course hinges on specific exchanges we agree upon as we age. We finish out school so that we may get good jobs. We work into old age so that we may retire. But with life expectancy growing, there must be a new model. Individuals living well into their later years and having our health care system to thank for it, should—and likely want to—continue contributing to society in whatever way is appropriate to their place and point in their life course. Moody recommends that these individuals assume mentor roles, acting as leaders, teachers, and coaches for those entering adult phases of life—professionally and socially. In this way, our elderly population can still be paying into the system from which they benefit—if not in a monetary capacity, at least in a way that enriches our world. With this in mind, the high costs of health care may not seem so difficult a burden a to bear.

References

Adhikary, C. (2013). Aged in India and Canada: the missing social capital. Indian Journal of Gerontology, 27(3), 476.

Aging in Canada: a new vision, a vital investment: from evidence to action. (n.d.). Province of Manitoba. Retrieved March 17, 2014, from http://www.gov.mb.ca/shas/fpt/docs/ healthy_aging_in_canada_long.pdf

Chappell, N. L., & Hollander, M. J. (2013). Aging in Canada. Don Mills, Ont.: OUP Canada.

Joanette, Y. (2013). Living longer, living better: preview of CIHR Institute of Aging 2013-2018 strategic plan. Canadian Journal on Aging / La Revue canadienne du vieillissement, 32(02), 209-213.

Killeen, R. (2011). Eldercare — meeting the needs of our aging population. Canadian Pharmacists Journal, 144(6), 248-249.

Mitchell, B. A. (20082009). Family matters: an introduction to family sociology in Canada. Toronto: Canadian Scholars' Press.

Moody, H. (2010). Aging: Conflict and Controversies (6th ed.). Thousand Oaks: Pine Forge Press.

Sheets, D. J., & Gallagher, E. M. (2013). Aging in Canada: State of the Art and Science. The Gerontologist, 53(1), 1-8.

Ubel, P. A. (1999). Pricing life why it's time for health care rationing. Cambridge, MA: MIT Press.

Williams, A., Ying, A., Williams, A., Watkins, J., Peckham, A., Kuluski, K., et al. (2009). Aging at home: integrating community-based care for older persons. HealthcarePapers, 10(1), 8-21.