So when politicians warn of health spending surpassing 50% of budget expenditure, it could mean that spending on other programs has been reduced. Health care costs are rising but not nearly as steeply as most people are led to believe.
Dr. Rachlis also debunks the myth that an older population will devastate healthcare. It’s true that Canada is aging and health costs increase with age. But, he argues, aging is responsible for only moderate cost increases. Dr. Rachlis and Toronto economist Hugh Mackenzie analyzed the impact of population aging on health costs in the summer (see: here.
). They concluded that aging per se has only increased health costs by 0.8% per year since 2001 and will only increase costs by 1% per year for the next twenty-five years.
Dr. Rachlis notes that increased utilization of the health system by all Canadians is the major reason for increases in health costs. In fact, Canadians over 65 are increasing their utilization at slower rate than younger Canadians. While some service utilization has been appropriate and helpful to older Canadians much of it has been ineffective and wasteful.
Dr. Rachlis points to the Vioxx debacle as an example of waste. In 2003, the Ontario Drug Benefit plan spent $65 million for Vioxx, an anti-arthritic drug. The next year, it was withdrawn from the market because it was linked to heart attacks. Not only was Vioxx more dangerous than alternatives like ibuprofen, it was 50 times more expensive. Dr. Rachlis observes that while the province claimed that there was no money for home care, it poured $65 million down the drain and hundreds of Ontarians died premature deaths.
Health care is replete with waste. Fifteen per cent to 20 per cent of patients with heart failure are readmitted to hospital within one month of discharge. Simply ensuring home-care nursing follow-up would eliminate half the readmissions, save hundreds of lives and avert costs of $2,500 per patient.
Dr. Rachlis cautions that these problems are not due to incompetent or uncaring doctors or nurses. Rather, as we’ve been told for decades, it is the structure of our health system that puts patients in persistent peril.
Finally, aging isn’t expensive. Sickness and disability are the cost drivers. Dr. Rachlis notes that today’s elderly are much healthier than previous generations and we have many reasons to believe that the next generation of elderly will be healthier still.
According to Dr. Rachlis, inter-sectoral action, guided by a Healthy Public perspective, is the foundation of an effective, efficient health system. For example, supportive housing integrated with health and social services would increase the quality of life of seniors and reduce unnecessary use of hospitals and long term care facilities.
Fear mongering can’t improve the state of our healthcare system. Misreading or distorting the effects of an aging population, likewise, gets us nowhere but into intergenerational discord. Instead, we ought to demystify the threats, with the intent of better understanding the challenges that lie ahead. Only by honestly approaching the problem, can we hope to arrive at real and meaningful changes to healthcare.
