Widespread concerns about demographic change, particularly population aging, prompted The Health Professional to delve into the subject of demographics in this issue. Like a tide’s ebb and flow, population change on its own need not worry us, but when a natural phenomenon we can’t control catches us by surprise, bad things can and do happen. As demographer David Foot reminds us, “Change can’t be avoided, but it can be prepared for and managed.”
When planning future capacity, service types and their delivery, it is logical that demographic variables be taken into account. In a health system that relies primarily on public sources of funding that is effectively frozen, demographic change has profound implications for service planning, capacity planning and standards of care.
We need better alignment of the increasing demand for health services with the capacity required to fulfill it. We know it’s a tall order, especially so when consensus on the impact of population change is elusive.
Alan Cassels, one of this issue’s authors, feels that concerns about population aging are overblown. Cassels argues that only 1% of the annual increase in health care spending is due to our aging population. Tom Closson of the OHA has another perspective. He tells us that, because they have nowhere else to go, older people account for much of the dramatic increase in alternative level of care patients occupying acute care, rehab, complex continuing care and mental health beds. According to Closson, between 2005 and 2009 the number of such occupancies increased by 300% – to 4,500 beds or 17% of the Ontario total.
Such bottlenecking surely impedes rates of progression to inpatient or community rehab. With hospitals, LHINs and CCACs monitoring so much data, are we effectively tracking the supply/demand challenge? And let’s not forget about subjective quality ratings. Thankfully, more of this kind of information is coming onstream, such as the Canadian Institute of Health Information’s tracking not only of inpatient rehabilitation activity and patient safety indicators but of patient satisfaction as well.
Sustaining a health care system of which even more of us can be proud will take heroics at all levels, from the many individual Ontarians who will have to abandon their unhealthy lifestyles, to health care providers and administrative and regulatory bodies. Heroics start at the top and Health Minister Deb Matthews, a social demographer in her own right whose comments appear in this issue, has stepped up to the plate by taking on Ontario’s most challenging portfolio.
In Ontario we have experimented with a number of approaches to quality, safety and capacity over the years – at great cost. There have been some impressive victories, such as those for wait times for certain procedures, and streamlined clinical protocols that employ process improvement methods invented in other sectors. Yet there have been lukewarm results as well. My hope is that the challenge will encourage more of us in leadership roles to play our full part. We can certainly do better than lukewarm.
