An argument for more health care funding that’s getting old

B. C. will have far more seniors by 2036, and so will the other provinces

HSo, given these facts, where does that leave B. C. when it comes to the new per capita health care funding imposed on it by the federal government? It leaves it in the same predicament as most other provinces — struggling to control costs.

ere’s a few notions British Columbians like to believe about the elderly and health care here: • More than any other province, B. C. is top- heavy with the elderly.

• B. C. attracts a huge number of retirees from other provinces and overseas.

• Those out- of- province retirees are a massive burden on B. C.’ s health care budget.

• Seniors constitute the greatest burden to the health care budget, and represent the greatest threat to its financial solvency.

As I wrote, these are popular notions. And none of them are true. But they do form the basis of the provincial government’s argument against the federal government’s new per capita funding formula for health care.

The province argued this week that the new formula should allow for certain demographic imbalances. In B. C.’ s case, the province argued, it meant taking into account our growing number of seniors — a number, it maintains, that is problematic because of seniors coming here to retire.

“It means that provinces with more seniors, provinces where people come to retire like B. C.,” Premier Christy Clark said, “are going to be really struggling, while provinces full of young people, where people use health care a lot less, are going to have an abundance of money.”

B. C. does have a high percentage of seniors, and that percentage is growing. But that percentage is nothing out of the ordinary. In terms of an aging population, B. C. is right in the middle of the pack.

In descending order, Saskatchewan, Nova Scotia, Prince Edward Island and New Brunswick all have a greater percentage of seniors, while Quebec’s and Manitoba’s percentages are virtually identical to B. C.’ s.

Nor will B. C.’ s ranking change much.

According to figures supplied by BC Stats, projections for the percentage of people over 65 in 2036 show, again in descending order, Newfoundland, New Brunswick, Nova Scotia, Prince Edward Island, Quebec and Saskatchewan all having a greater percentage of seniors than B. C. In that year, according to the projections, 23.7 per cent of our population will be 65- plus. It is, at present, 14 per cent. From now to 2036 that is significant demographic growth but, again, it is nothing out of the ordinary in comparison to the rest of the country.

But what about that flood of inter- provincial migrants retiring in B. C. for our balmy weather?

It’s no flood. From 2000 to 2010, 37,000 inter- provincial migrants over the age of 65 moved to B. C.

But during that same decade, 28,500 of us over the age of 65 moved out of B. C. to other provinces.

That leaves B. C., for the last decade, with a net total of 8,500 inter- provincial migrants over the age of 65. In a population of 4.5 million, that figure is demographically negligible. To quote a 2008 BC Stats paper looking at inter- provincial migration:

“It does not appear inter- provincial migration is a significant factor in increasing the age of B. C.’ s population.”

As for international immigrants aged 65 and over coming to B. C., the numbers are “tiny,” said BC Stats executive director Angelo Coco.

So, given these facts, where does that leave B. C. when it comes to the new per capita health care funding imposed on it by the federal government?

It leaves it in the same predicament as most other provinces — struggling to control costs. And while the half- dozen health care academics and policy analysts interviewed for this column all agreed that health care for seniors was, per capita, a greater burden for health systems, and that some demographic weighting of the funding formula might ease that burden, they also suggested that care of the elderly was not the greatest reason behind rising costs in the health care system.

They cited the public’s higher expectations, the discovery of new treatments, a proclivity for more tests and scans, high pharmaceutical costs, rising salaries — and backdropping them all, the lack of political will among provincial governments to put on the brakes.

“[ The] wealth of the province or nation” wrote Craig Mitton, associate professor at the University of B. C.’ s School of Population and Public Health, “is the main driver of expenditure.

“Putting on the political brakes, so to speak, with the federal announcement in December is in my view very positive because it forces the flattening of the cost curve, which, left to their own devices, the provinces have struggled to do. The point here is that it is not aging or technology but political will that controls the rate of growth of expenditure.”

Mitton’s colleague, associate professor Kim Mcgrail, a health economist with UBC’S Centre for Health Services and Policy Research, released a 2011 study that found the expectation of a “grey tsunami” overwhelming the health system in B. C. was overblown. Rising costs weren’t driven by the numbers of seniors so much as by the kind of health care they had come to expect.

“The real increases,” Mcgrail said, “are driven by a more intensive health care, one where seniors are more quick to get tests and imaging done and where they see more specialists.”

Nor are seniors the only demographic that deserve special consideration. Prof. John O’neil, dean of Simon Fraser University’s Faculty of Health Sciences, argues that the funding formula could be amended to funnel more money to disadvantaged aboriginal populations, or the working poor, or to provinces where population levels are so low they might find it hard to maintain the level of services the richer, more populous provinces can supply.

“I think flattening the payments may bring changes to provincial budgets, but it may also bring changes in those provinces that are struggling to fund the way health care is delivered — resulting in privatization, maybe, or a two- tiered health system.”

That, O’neil said, was the real concern, where the delivery of health care fractures not along young and old, but by have and have- not.