Past Research Relating to HCC

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Past Research Relating to HCC

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The Viability of a Universal Health Care System
in an Ageing Society
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if provincial governments continue to pursue
policies that lead to the same rates of growth in
health spending and revenue expenditures will
soon exceed the capacity of governments to pay
for them.
Brett J. Skinner, Mark RoverePaying More,
Getting LessFraser Institute, 2006
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The rates of growth in costs for elderly
careare in fact well within the normal rates of
growth of the Canadian economy.At the end of
the day, the health care costs of the community
must be paid for by the community, regardless of
the channel of payment.

• Robert G. Evans, 1987
• Hang Together or Hang Separately

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Modelling Future Needs
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Opinion-based perspectives

• Increased longevity more chronically ill
  patients in need of prolonged medical care.
• Ehrenfeld 1998
• Shifting demographics - capturing an increasing
  grey vote.
• Metz 2002

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Economic-based perspectives

• Cost effective manners of delivering HCC
  services.
• Using home support and community services as an
  alternative to institutional care.
• Hollander and Chappell 2002
• Weissert, Cready, Pawelak 2005

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Econometric methods

• Standard approach for producing linear models
  using statistical analysis to determine
  parameters.
• Quality and reliability varies. Statistics may
  be thought of as a residue of past events,
  sometimes akin to bones, sometime more akin to
  ashes.
• Difficult to make good long-range forecasts from
  past evidence.

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Modelling Residential Care
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• Berlin, Ramlo, Baxter 2006

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Model developed to test divisions for long-term
care in the UK. Note Residential care here
would correspond to assisted living in B.C.,
nursing home care to residential care.

• Xie, Chaussalet, Millard 2005, 2006

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Age and the Elderly
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Who is a senior citizen?

• The age at which a person may be considered
  old is shifting.
• The utilization of medical services by people
  aged 65 to 74 does not differ much from that by
  the remainder of the adult population. After 74,
  however, it increase rapidly.'
• Rosenberg, Moore 1997

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Which way to model these shifts?

• Yang, Norton, Stearns 2003

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Non-public Home and Community Care
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• 75-85 of home care services are provided by
  unpaid family members or friends.
• About 20 of expenditures for home care services
  in Canada are paid privately.
• MacAdam 2004
• 20,000 privately funded beds in B.C. providing
  meals and 24 hour emergency health care support
  vs 20,820 publicly funded beds with at least this
  level of service.
• Dodd 2007

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Other Issues
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Gender

• From age 65, women have a life expectancy 4.18
  years longer than men.
• Women over the age of 65 spend an average of 1.35
  years longer in an institutional environment that
  their male counterparts.
• Hill, Forbes, Lindsay, McDowell 1997
• (1991 data)

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Marital status

• The health status of single ageing adults,
  particularly men, tends to be lower than that of
  their married counterparts.
• Lund, Holstein, Osler 2004
• Single ageing adults tend to need more formal
  care.

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Ethnicity

• Immigration leads to substantial shifts in the
  ethnic mix of the population of B.C. Many
  immigrants come from societies where care for the
  elderly is substantially provided within families.

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Geographic location

• Population demographics, longevity and health
  status of seniors can vary dramatically from
  region to region.

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Availability of housing

• To what extent is residential care being used to
  provide accommodation for homeless seniors?