Elsevier

Health Policy

Volume 120, Issue 1, January 2016, Pages 81-88
Health Policy

Cohort effects on the need for health care and implications for health care planning in Canada

https://doi.org/10.1016/j.healthpol.2015.10.007Get rights and content

Highlights

  • Self-assessed health has improved across cohorts in Canada since 1920.

  • Accounting for cohort effects reduces estimated need for healthcare in ageing populations.

  • The effect of ageing is reduced due to successive cohort health improvements.

Abstract

The sustainability of publicly funded health care systems is an issue for governments around the world. The economic climate limits governments’ fiscal capacity to continue to devote an increasing share of public funds to health care. Meanwhile the demands for health care within populations continue to increase. Planning the future requirements for health care is typically based on applying current levels of health service use by age to demographic projections of the population. But changes in age-specific levels of health over time would undermine this ‘constant use by age’ assumption. We use representative Canadian survey data (Canadian Community Health Survey) covering the period 2001–2012, to identify the separate trends in demography (population ageing) and epidemiology (population health) on self-reported health. We propose an approach to estimating future health care requirements that incorporates cohort trends in health. Overall health care requirements for the population increase as the size and mean age of the population increase, but these effects are mitigated by cohort trends in health—we find the estimated need for health care is lower when models account for cohort effects in addition to age effects.

Section snippets

Background

Historically, planning for future health care expenditures and health human resources has rested on applying current levels of workforce supply and/or service use to expected changes in the size and demographic profile of the population, with little attention given to the needs for health care within populations and the changes in those needs over time (see for example, Nova Scotia Health Research Foundation [1] and MacKenzie et al. [2]) even though the objectives of publicly funded health care

Data

We use data from the Canadian Community Health Survey (CCHS) for 2001, 2003, 2005, 2007, 2010 and 2012. The CCHS is a cross-sectional survey, whose survey samples were constructed to provide reliable cross-sectional data on the health of the Canadian population, and include data on family physician and hospital utilisation as well as self-reported measures of health problems such as chronic and acute conditions. We weigh all analyses using the CCHS sampling weights which aim to ensure the

Results

The full sample contains 652,850 person–year observations. Excluding those aged less than 12 and those aged 80+ (since no upper cohort limit can be inferred from this open ended age group), and those with no information for the health measures results in a study sample of 612,115 person–years with 16 cohorts (1920–1924 to 1995–1999). Sample sizes for each age group over each survey year are presented in Supplementary Table S1.

Table 1 contains average rates of low SAH by age group and cohort.

Discussion

We set out to analyse the differences in health among different cohorts in the Canadian population and identify the implications for health care planning. We found that the effects of demographic change on the need for health care over time (as proxied by various specifications of low self-assessed health), are lower once we allow for cohort effects. In other words, applying current age-specific levels of health care use to future demographic changes in the population overestimates health care

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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