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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
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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

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