An ever-aging population and its challenges for Canada’s health care system

ABOVE:  Wendy Nicklin, RN, BN, MSc(A), CHE, FACHE is the President and Chief Executive Officer of Accreditation Canada

No society is static and Canada is no exception to this rule. As is the case in other countries, the makeup of Canada’s population is changing with time. Canadian are getting older and with that comes increasing strains and high demand for health care services. Our system in the coming years will be pushed to the max. How will we respond?

Contrasting a snapshot of Canadian society at the time when Canada’s health care system was introduced with the present day situation is an important starting point to help contextualize both the challenges and stresses that a growing population of aging Canadians will place on our nation’s health care system in the not-so-distant future.

Jeffrey Simpson, the Globe & Mail’s national affairs columnist and long-time health care analyst, provides this historical snapshot by describing the average Canadian when Canada’s health care system came into existence, a Canadian who was almost a full generation younger than the average Canadian today. For instance, Simpson explains that, “When Medicare came into play 50 years ago, the average Canadian was 27 years old but now the average Canadian is 47 years old and aging.” Despite the difference in age between average Canadians past and present, many health care scholars, analysts and practitioners have argued that the health care system has not been retrofitted to allow it to provide the most appropriate delivery of services and treatment to Canada’s changing population. Dr. Philippe Couillard, a neurosurgeon and former Quebec Minister of Health and Social Services, is one of those individuals. In a recent conference paper, Dr. Couillard, like Jeffrey Simpson, pointed out that Canada’s aging population has grown noticeably since the introduction of our public health care system but that this pattern has induced little change in the organization of the health care system itself. “At its inception, Canada’s Medicare was narrowly defined as covering services provided by physicians, especially in hospitals. This made sense at the time. In the second half of the 20th century, Canada’s population was young and acute health care issues were the major concern. This is no longer the case.”

Wendy Nicklin is the President and CEO of Accreditation Canada, an organization which functions at arm’s length from the federal, provincial and territorial governments and which develops and implements the standards that enable a health care organization or provider to assess and improve their performance. She, however, believes that the challenges confronting Canada’s health care system are nothing new. Nicklin reasons that, “Any change in population creates challenges for delivery of efficient and effective health care. Probably for each generation or each era of time in society there will be shifts in demographics or some other variable that will impact health care delivery. There are always stresses on the system; it’s not a surprise.”

Simpson points out that 44 per cent of health care spending in Canada goes to 14 per cent of the population, most of whom are over the age of 65. In 2020, that will be about 20 per cent and, by 2030, about 25 per cent. Put differently, industry analysis has shown that by 2036 approximately 25 per cent of all Canadians will be over 65 years of age compared to the 14 per cent of today. And this has important financial repercussions.

Simpson says, “As a large portion of the Canadian work force (most notably Canada’s Baby Boomers) gets older, many of those people tend to drop out of the work force by retiring. And, therefore, health care costs go up since we have fewer people in the work force to tax to pay for these challenges and increases in health care spending.”

Therefore, as Canada’s demographics evolve with a growing percentage of seniors, changes will be required to retool our health care system if it is to deliver effective and efficient healthcare not only to Canada’s Baby Boomers, but to the rest of the Canadian population as well. These changes will primarily reflect a greater emphasis on the delivery of chronic care treatment, the provision of long-term care to patients in the most convenient and affordable setting possible and also an increase in the already expanding use of out- patient care.

To do so, a significant portion of Canada’s health care system must be restructured in a way that would allow for a greater emphasis to be placed on the delivery of chronic health care while preserving the integrity of the acute care delivery system. Also, since the incidence of Alzheimer’s, glaucoma and diabetes as well as heart and stroke (conditions which require extensive and expensive treatment) is more likely to be higher in an aging population, more prominence must be attached to research, teaching and treatment of these chronic diseases. Changing Canada’s health care system to a model that invests more in researching, preventing and treating chronic disease is a necessary step for ensuring that our health care system functions optimally since, as Jeffrey Simpson notes, “about 30 per cent of health care costs in Canada are driven by about 1 per cent of the population that has numerous health problems. These people tend to be older people and those with multiple chronic conditions, the two often being the same group.”

In this context, rising to meet the challenges faced by Canada’s health care system requires pragmatic analysis of how to provide the most appropriate and affordable long-term care possible. That will become increasingly important since, as indicated, the occurrence of chronic diseases requiring such treatment is likely to rise in the years ahead. If the situation is left unaddressed, there may be a disproportionate increase in the demand for long-term health care services, a demand which will quickly outstrip the current supply of physicians, nurses and other health care practitioners across the country who specialize in geriatrics. Yet, it is important to remember that the long-term care for chronic diseases need not necessarily be administered in Canada’s hospitals where patients have to be admitted for extended periods of time. Accreditation Canada’s Wendy Nicklin insists that the following two questions must be asked when considering how to reframe the discussion about, and the delivery of, long-term care for Canadians: “What are the patient’s or client’s needs? Where is the most effective place to deliver preventative care or continuing care?” In addressing these questions, Nicklin states that, “I think we’re recognizing that individuals are best cared for in their home environment or as close to home as possible.”

Nicklin is not alone in her thinking. health care practitioners and researchers also maintain that many individuals requiring long-term care could just as easily be treated in their own homes (or in a less expensive long-term care facility). According to Nicklin, “the shift from in-patient to out-patient (or day surgery) began about 15 or 20 years ago.” Expanding the use of out-patient care for the treatment of chronic diseases and out-patient surgery for more acute health care conditions could play an important role in safeguarding the long-term viability of Canada’s health care system, preserving its efficacy even as it confronts the challenge of an aging population.