AVALANCHE OR GLACIER - HEALTH-CARE AND THE DEMOGRAPHIC RHETORIC

Claims that the health care system is about to be engulfed in a ''wave of grey'' have become commonplace. Recent cost escalation is commonly attributed to the aging of the population, and there is no shortage o f dire warnings about the cost implications of the even more dramatic aging, and costs, still to come. These claims have been largely unsubs tantiated. Yet they persist for a number of reasons. First, over long periods of time, the effects of demographic trends can be (and probabl y will be) quite substantial. But these effects move like glaciers, no t avalanches. Second, the effects of aging populations on sone types o f services which cater differentially to seniors will be much more dra matic; observers of those sub-sectors (such as long-term care) tend to extrapolate that sector-specific experience to health care generally. Third, at the ''coal-face,'' health care providers are seeing their p ractices become ever more dominated by seniors. They mistake this incr eased ''presence'' of patients aged 65 and over in their practices as evidence of the effects of demographic changes. In this paper we discu ss each of these sources of error about the effects of aging populatio n on health care costs. We focus primarily on the confusion between ch anges in patterns of care for particular age groups, and changes in ov erall levels of care. Quite extensive empirical evidence has been coll ected over the past decade from analyses of British Columbia data base s, and these findings are not unique, in Canada, or beyond. The common finding of this body of research is that population aging has account ed for very little of the increase in health care costs over the past three decades, in Canada or elsewhere. Health care utilization has inc reased dramatically among seniors. But this has had less to do with th e fact that there are more of them, than with the fact that the health care system is doing much more to (and for) them than was the case ev en a decade ago. This suggests that the appropriate care of elderly pe ople should be a central issue for health care policy and management, but that demographic issues are, in the short run at least, largely a red herring.