Threat to health care from a ‘grey tsunami’ is a myth

You’ve heard it before: the boomers are jeopardizing our health care system by the sheer number of them swanning into their golden years. Sounds right – except it isn’t true.

Let’s check the evidence: the older you are, the more likely you are to use health care services. This is a fact, but it does not necessarily follow that the coming bulge of boomers will bankrupt the health care system. Study after study in Canada over the last 30 years shows that aging is an issue, but it exerts only a small pressure on health care spending.

More recent research shows increases in utilization – how many and how often Canadians use health services – are twice as important as aging in increasing costs year by year. While population aging does increase costs, the kinds and amount of services provided to people in every age group are a far more important factor. How and why are these changes occurring?

The ‘how’ is easier to answer. In a recent study published in the journal Healthcare Policy, my colleagues and I looked at spending on physician services over a decade and found two trends. One is that people are seeing a larger number of doctors overall. 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, CAT scans and other imaging services. The second trend we found is that these increases themselves increase with age.

By 2006 nearly half of people aged 65 and over saw at least one medical specialist during the year, saw at least one surgical specialist, had at least one imaging service and three-quarters had at least one lab test.

The fact that populations are aging exerts only a small pressure on the system, but the fact that the system keeps changing so that more services are directed to everyone, particularly older people, compounds the problem.

The questions of ‘why’ the system is changing in this way, and whether these changes are improving health are far more difficult to answer. Further, were increased referrals to medical specialists necessary or the predictable outcome of a poorly organized and overly-burdened system of primary care?

Unfortunately, we don’t routinely collect information on diagnostic outcomes and quality of life in health care so these questions are sometimes difficult to answer. But there are some important general cultural facts at play.

We like new things and we seem to have an assumption that if something is good, then more of it is better. New tests, screening devices and procedures are invented and we expect they will be adopted into the system. But we too often forget that care itself comes with certain risks.

There is plenty of research to show that more use of specialist services, tests and imaging do not necessarily create better outcomes. More care is not always better care.

People who need care should absolutely receive what they need. The trick is in defining and understanding that need.

There is a lively ongoing debate about whether earlier and earlier screening, detection and labeling actually improves quality of life and outcomes for patients. We need better ways of measuring the outcomes of increased diagnostic testing beyond our now somewhat crude measurements of morbidity (the number of people with a specific disease) and mortality.

In other words, we need to put our efforts toward tracking more subtle changes in health and quality of life over time.

It is time to shift the conversation from finger pointing at boomers to a much broader discussion about technology, the value and potential dangers of increased diagnostic testing and whether we are getting value for money from our ever increasing utilization of health services.

Kimberlyn McGrail is expert advisor with EvidenceNetwork.ca and an assistant professor at the University of B.C.

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