Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T10:31:50.537Z Has data issue: false hasContentIssue false
  • English
  • Français

Rising Use of Physician Services by the Elderly: The Contribution of Morbidity*

Published online by Cambridge University Press:  29 November 2010

Charlyn Black ,
Noralou P. Roos ,
Betty Havens  and
Leonard MacWilliam
Charlyn Black
Affiliation:
University of Manitoba
Noralou P. Roos
Affiliation:
University of Manitoba
Betty Havens
Affiliation:
University of Manitoba
Leonard MacWilliam
Affiliation:
University of Manitoba
Get access Rights & Permissions [Opens in a new window]

Abstract

Use of medical services by the elderly population is increasing. While rising numbers of elderly persons account for much of the overall increase, per capita increases in use of medical services within this group have been substantial. This phenomenon is commonly attributed to greater need due to the “aging” of the elderly population (i.e. an increased proportion of those 85 years of age and over) and to changing patterns of morbidity or to changing patterns of servicing the old and sick. Research to date suggests that the impact of the aging of the elderly population has been small. However, because the relationship between morbidity and rising utilization has not yet been studied, there is considerable debate about the extent to which increased “need” for care contributes to patterns of rising utilization. This research studied the impact of changes in numbers, demographics, and morbidity patterns of the elderly on per capita and aggregate consumption of ambulatory physician services at two points in time. Linked survey and physician claims data for representative samples of the elderly in 1971 and 1983 were used to study patterns of utilization of total ambulatory, consultative and non-consultative care by age and health status. The research found that per capita utilization of both consult and non-consult visits rose across all categories, with older individuals and those in poor health experiencing greater increases in utilization than younger and healthier individuals. At the aggregate level, a large percentage of the increase in utilization of medical services was related to increased numbers of elderly. Changes in ‘need’ attributable to aging of the elderly population and increased morbidity had only minor effects. At least 35 per cent of the increase in non-consult visits and 50 per cent of the increase in consult visits were not specifically related to changes in need of the elderly population and remain as unexplained changes in patterns of servicing individuals. While some of this increase was directed to individuals in poor health, the majority of increased servicing (32% of the increase in non-consultative visits and 58% of the increase in consultation visits) was directed to individuals in good health. Policy implications are discussed.

Résumé

La population des aînés utilise de plus en plus de services médicaux. Bien que le nombre croissant de personnes âgées contribue en grande partie à l'ensemble de cette augmentation, l'utilisation des services médicaux par personne a également affiché une hausse importante au sein de ce groupe. Ce phénomène est souvent attribué à un besoin accru découlant du «vieillissement» de la population des aînés (c'est-à-dire une plus grande proportion de personnes de 85 ans et plus) ainsi qu'aux tendances changeantes de la morbidité ou aux tendances changeantes en matière de prestation de services à l'intention des personnes âgées et malades. À ce jour, les études suggèrent que les effets du vieillissement de la population des aînés ne sont que minimes. Toutefois, comme la relation entre la morbidité et l'accroissement de l'utilisation des services n'a pas encore été étudiée, la mesure dans laquelle la hausse des besoins en soins a une incidence sur l'augmentation de l'utilisation des services fait l'objet d'une grande controverse. Cette étude porte sur les répercussions des changements survenus au niveau du nombre, de la démographie et des tendances de morbidité chez les personnes âgées sur la consommation, par personne et globale, des services médicaux ambulatoires, à deux périodes distinctes. Des données tirées de sondages et de declarations de médecins de même nature provenant d'un échantillon représentatif de la population des aînés en 1971 et en 1983 ont servi à étudier les tendances d'utilisation de l'ensemble des soins ambulatoires, consultatifs et non consultatifs et ce, en fonction de l'âge et de l'état de santé. L'étude révèle que l'utilisation par personne des visites consultatives et non consultatives augmente dans toutes les catégories; les personnes d'un âge plus avancé et celles ayant un mauvais état de santé utilisent davantage les services que les personnes moins âgées et en meilleure santé. Pour ce qui est de la consommation globale des services, un pourcentage important de la hausse de l'utilisation des services médicaux est attribuable à l'augmentation du nombre de personnes âgées. Les changements en «besoins» dus au vieillissement de la population des aînés et à l'augmentation de la morbidité n'ont que des effets minimes. Au moins 35 pour cent de l'augmentation des visites non consultatives et 50 pour cent de la hausse des visites consultatives ne sont pas spécifiquement liés aux changements des besoins de la population des aînés, et demeurent des changements inexpliqués dans les tendances en matière de prestation de services auprès de particuliers. Même si une partie de ces services accrus est destinée aux personnes ayant un mauvais état de santé, la majorité des services additionnels (32% de la hausse en visites non consultatives et 58% en visites consultatives) sont offerts aux personnes en bonne santé. L'article discute des consequences de ces résultats sur le plan des politiques.

Keywords

AgingHealth Care UtilizationMorbidityAmbulatory Care.Vieillissementutilisation des soins de santémorbiditésoins ambulatoires.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 14 , Issue 2 , Été/Summer 1995 , pp. 225 - 244
Copyright
Copyright © Canadian Association on Gerontology 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barer, M.L., Evans, R.G., Hertzman, C., & Lomas, J. (1987). Aging and health care utilization: New evidence on old fallacies. Social Science and Medicine, 24, 851–862.CrossRefGoogle ScholarPubMed
Barer, M.L., Pulcins, I.R., Evans, R.G., Hertzman, C., Lomas, J., & Anderson, G.M. (1989). Trends in use of medical services by the elderly in British Columbia. Canadian Medical Association Journal, 141, 39–45.Google ScholarPubMed
Boulet, J.A., & Grenier, G. (1978). Health expenditures in Canada and the impact of demographic changes on future government health insurance program expenditures. Discussion paper no. 123. Economic Council of Canada.Google Scholar
Conn, H.F., & Conn, R.B. (1980). Current Diagnosis 6. Philadelphia: W.B. Saunders Co.Google Scholar
Denton, F.T., Feaver, C.H., & Spencer, B.G. (1986). Prospective aging of the population and its implications for the labour force and government expenditures. Canadian Journal on Aging, 5, 75–98.CrossRefGoogle Scholar
Denton, F.T., & Spencer, B.G. (1975). Health care costs when the population changes. Canadian Journal of Economics, 8, 34–48.CrossRefGoogle Scholar
Denton, F.T., & Spencer, B.G. (1979). Some economic and demographic implications of future population change. Journal of Canadian Studies, 14, 81–93.CrossRefGoogle Scholar
Denton, F.T., & Spencer, B.G. (1993). Population aging and future health costs in Canada. Canadian Public Policy — Analyse de Politiques, IX, 155–163.Google Scholar
Dunt, D.R., Kaufert, J.M., Corkhill, R., Creese, A.L., Green, S., & Locker, D. (1980). A technique for precisely measuring activities of daily living. Community Medicine, 2, 120–125.Google ScholarPubMed
Evans, R.G. (1985). Illusions of necessity: Evading responsibility for choice in health care. Journal of Health Politics & Policy Law, 10, 439–467.CrossRefGoogle ScholarPubMed
Evans, R.G., Barer, M.L., Hertzman, C., Anderson, G., Pulcins, I.R., & Lomas, J. (1989). The long good-bye: The great transformation of the British Columbia hospital system. Health Services Research, 24, 436–459.Google Scholar
Green, S., Kaufert, J., Corkhill, R., Creese, A., & Dunt, D. (1979). The collection of service utilization data: A research note on validity. Social Science and Medicine, 13, 231–234.Google Scholar
Horvitz, D.G., & Thompson, D.J. (1952). A generalization of sampling without replacement from a finite universe. American Statistical Association Journal, 47, 663–685.CrossRefGoogle Scholar
Kahn, R.L., Goldfarb, A.I., Pollack, M.E., & Peck, A. (1960). Brief objective measures for the determination of mental status in the aged. American Journal of Psychology, 117, 326–328.CrossRefGoogle ScholarPubMed
Morbidity and Mortality Weekly Report. (1989). Comorbidity of chronic conditions and disability among older persons — United States 1984. Morbidity and Mortality Weekly Report, 38(46), 788–792.Google Scholar
Mossey, J.M., Havens, B., Roos, N.P., & Shapiro, E. (1981). The Manitoba longitudinal study on aging: Description and methods. The Gerontologist, 21, 551–558.CrossRefGoogle Scholar
Roos, L.L., Nicol, J.P., Johnson, C., & Roos, N.P. (1979). Using administrative data banks for research and evaluation: A case study. Evaluation Quarterly, 3, 236–255.CrossRefGoogle Scholar
Roos, L.L., Roos, N.P., Cageorge, S.M., & Nicol, J.P. (1982). How good are the data? Reliability of one health care data bank. Medical Care, 20, 266–276.CrossRefGoogle ScholarPubMed
Roos, L.L., Sharp, S.M., & Wajda, A. (1989). Assessing data quality: A computerized approach. Social Science and Medicine, 28, 175–182.CrossRefGoogle ScholarPubMed
Roos, N.P., Havens, B., & Black, C. (1993). Living longer but doing worse: Assessing health status in elderly persons at two points in time in Manitoba, Canada, 1971 and 1983. Social Science and Medicine, 36(3), 273–282.CrossRefGoogle ScholarPubMed
Roos, N.P., & Shapiro, E. (1981). The Manitoba longitudinal study on aging: preliminary findings on health care utilization by the elderly. Medical Care, 19, 644–657.CrossRefGoogle ScholarPubMed
Waldo, D.R., Sonnefeld, S.T., McKusick, D.R., & Arnett, R.H. (1989). Health expenditures by age group, 1977 and 1987. Health Care Financial Review, 10, 111–120.Google ScholarPubMed
Wolinsky, F.D., Mosely, R.R. II, & Coe, R.M. (1986). A cohort analysis of the use of health services by elderly Americans. Journal of Health and Social Behaviour, 27, 209–219.CrossRefGoogle ScholarPubMed
Woods Gordon Management Consultants. (1984). Investigation of the impact of demographic change on the health care system in Canada — Final report. Prepared for the Task Force on the Allocation of Health Care Resources.Google Scholar