Don’t blame aging boomers
Why the boomers won’t bankrupt the healthcare system, but over-diagnosis just might
A version of this commentary appeared in the Toronto Star and the Victoria Times Colonist
You’ve heard it before: the boomers are aging and jeopardizingour health care system by the sheer number of them swanninginto their golden years. Sounds right — except it isn’t true.Let’s check the evidence: the older you are, the more likely youare to use health care services. This is a fact, but it does notnecessarily follow that the coming bulge of boomers will bankruptthe health care system. Study after study in Canada over the last30 years shows that aging is an issue, but it exerts only a smalland predictable pressure on health care spending (less than oneper cent annually from 2010 to 2036).More recent research shows that increases in utilization — howmany and how often Canadians use health services — are twice as important as aging in increasing costs year byyear. In other words, while population aging does increase costs, the kinds and amount of services provided to peoplein every age group are a far more important factor. How and why are these changes occurring?
Increased visits to medical specialists, lab tests increasing costs
The “how” is easier to answer. In a recent study published in the journal,
, my colleagues and Ilooked at spending on physician services over a decade and found two major trends. One is that people are seeing alarger number of doctors overall. In particular, they are being referred to specialists more often.Even more significant is the increased use of diagnostic testing: people are being sent for far more lab tests, CATscans and other imaging services. For example, about 6% more of the population in BC had lab tests in 2006compared to 1997; that is an additional 260,000 people being referred for laboratory services — a hefty additionalcost to the health system. There is no reason to think BC is different from other provinces in this or any other trend.The second trend we found is that these increases themselves increase with age. That is, the percentage increase indoctor visits, specialist referrals and laboratory testing are all higher at older and older ages.By 2006 nearly half of people aged 65 and over saw at least one medical specialist during the year, saw at least onesurgical specialist, had at least one imaging service, and three-quarters had at least one lab test. This is why the topic
of aging and its impact on the system is so complex. The fact that populations are aging exerts only a small pressureon the system, but the fact that the system keeps changing so that more services are directed to everyone,particularly older people, compounds the problem.
More care is not always better care
The questions of “why” the system is changing in this way, and even more importantly, whether these changes areactually improving health and quality of life, are far more difficult to answer. Did more diagnostic procedures detectnew conditions, increase the accuracy of diagnosis, alter care management, keep chronic conditions in check andimprove patient outcomes? That is, do more tests keep us healthier and living longer?