We need an integrated system for older adults that increases the quality and continuity of care
We need to revisit conventional thinking on health-care services for seniors so the system is sustainable for all Canadians.
To do that, we need to overcome a number of misperceptions.
First, there is a belief that a growing seniors population will result in runaway costs that bankrupt the health-care system. But research shows that growth in the seniors population will add less than one per cent a year to health costs. In fact, the main factors driving increased health-care costs are increased use of technology (including drugs), the rising use of health services across all ages and hikes 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 fact, there is no runaway rise in health-care costs based on the percentage of gross domestic product spent on health care in Canada. There was only a minor increase, from 10 to 10.5 per cent, between 1992 and 2007. After a major increase during the last financial crisis (11.9 per cent in 2009), the percentage has declined as the economy recovers. The percentage of GDP spent on health care in Canada was 10.7 per cent in 2013 – a modest increase since 1992.
A third misperception is that the health-care system for seniors needs to focus on public health and physician services. This resulted in a shift in policy priorities in the 1990s from 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 integrated systems of care for older adults being broken into component parts, each competing 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 proactive tradeoffs 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 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 system more – 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 result is – perversely – an incentive to get sicker quicker to qualify for publicly-funded care services.
A focus on home care for high-needs seniors has resulted in models that integrate home care and family physician services. While such models can be part of an integrated system, they don’t replace 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? Policy makers have made choices based on them, creating an apparent acceptance of the fiscal status quo without looking for cost-saving efficiencies.
Clearly we need an integrated system for older adults that increases the quality and continuity of care, and can reduce costs and enhance the sustainability of the health-care system for all Canadians.
A first step is for decision makers to recognize that a continuing care system for older adults is a key component of our health system – equivalent to hospital care, physician care and public health. This would allow the splintered components of home care, home support, residential care facilities and geriatric units in hospitals to be brought together.
Such a system would be the third largest component of our health expenditures, after hospitals and physician care. Given that most of the 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.
By Neena Chappell and Marcus Hollander
Neena Chappell is a professor in the Institute on Aging and Lifelong Health and the Department of Sociology at the University of Victoria; she holds a Canada Research Chair in Social Gerontology. Marcus J. Hollander is a national health services and policy researcher and president, Hollander Analytical Services Ltd. Both are expert advisors for the EvidenceNetwork.ca and recipients of the Canadian Association on Gerontology’s highest honour, the Distinguished Member Award and the Queen Elizabeth II Diamond Jubilee Medal for contributions to gerontology. They recently published Aging in Canada (Oxford University Press).