Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-28T03:55:32.631Z Has data issue: false hasContentIssue false
  • English
  • Français

Framing the issue of ageing and health care spending in Canada, the United Kingdom and the United States

Published online by Cambridge University Press:  23 April 2014

Michael K. Gusmano  and
Sara Allin
Michael K. Gusmano*
Affiliation:
Research Scholar, The Hastings Center and Lecturer, Yale University, USA
Sara Allin
Affiliation:
Assistant Professor, School of Public Policy and Governance, University of Toronto and the Canadian Institute for Health Information, Canada
*
*Correspondence to: Michael K. Gusmano, Hastings Centre, 21 Malcolm Gordon Road, Garrison, NY, 10524 USA, Email: mkg2104@columbia.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Political debates about the affordability of health care programmes in high-income countries often point to population ageing as a threat to sustainability. Debates in the United States, in particular, highlight concerns about intergenerational equity, whereby spending on older people is perceived as a threat to spending on the young. This paper compares how the problem of health spending is defined in Canada, the United Kingdom and the United States by presenting the results of a content analysis of print media during the period 2005–2010. We found that population ageing was cited as an important source of health care cost increases in all three countries but was cited less frequently in Canadian newspapers than in the UK or US papers. Direct claims about intergenerational equity are infrequent among the articles we coded, but newspaper articles in the United States were more likely than those in Canada and the United Kingdom to claim that of high health care spending on older people takes resources away from younger people. In Canada a much larger percentage of articles in our sample either claimed that high health care spending is crowding out other types of government expenditure. Finally, we found that almost no articles in the United States challenged the view that population ageing causes health care spending, whereas in both Canada and the United Kingdom a small, but steady stream of articles challenged the idea that population ageing is to blame for health care spending increases.

Type
Special Section
Information
Health Economics, Policy and Law , Volume 9 , Issue 3 , July 2014 , pp. 313 - 328
Copyright
© Cambridge University Press 2014 

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

Abelson, J. and Collins, P. A. (2009), ‘Media hyping and the “Herceptin access story”: an analysis of Canadian and U.K. newspaper coverage’, Healthcare Policy, 4(3): e113–e128.Google Scholar
Allen, K. (2007), ‘Financial: Bernanke warns U.S. about burden of ageing population’, The Guardian, 19 January, p. 28.Google Scholar
Anderson, G. F. and Hussey, P. S. (1999), Health and Population Aging: A Multinational Comparison, New York: The Commonwealth Fund, http://globalag.igc.org/health/world/hpa.pdf [5 January 2013].Google Scholar
Angrisano, C., Farrell, D., Kocher, B., Laboissiere, M. and Parker, S. (2007), Accounting for the Cost of Health Care in the United States, San Francisco, CA: McKinsey Global Institute, http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp [accessed 7 December 2012].Google Scholar
Boothe, P. and Carson, M. (2003), What Happened to Health-Care Reform? Toronto: CD Howe Institute.Google Scholar
Brown, L. D. (1998), ‘Exceptionalism as the rule? U.S. health policy innovation and cross-national learning’, Journal of Health Politics, Policy and Law, 23(1): 35–51.CrossRefGoogle ScholarPubMed
Canadian Institute for Health Information (2012), Health Care Spending to Reach $192 Billion this Year, Ottawa: Canadian Institute for Health Information, http://www.cihi.ca/CIHI-ext-portal/internet/en/Document/spending+and+health+workforce/spending/RELEASE_28OCT10 [5 January 2013].Google Scholar
Centers for Medicare and Medicaid Services, Office of the Actuary (2012), National Health Expenditure Projections, 2012–2022. Washington, DC: CMS.Google Scholar
Cook, F. L., Marshall, V. W., Marshall, J. G. and Kaufman, J. E. (1994), ‘The Salience of Intergenerational Equity in Canada and the United States’, in T. Marmor, T. Smeeding and V. Greene (eds), Economic Security and Intergenerational Justice: A Look at North America, Washington, DC: Urban Institute Press, 91–129.Google Scholar
Day, C. L. (2011), ‘Partisan-Ideological Conflict and Aging Policy: Seeking Common Ground to Avoid Leaping into the Abyss’, Presented at the 2011 Annual Meeting of the American Political Science Association, Seattle, WA, 1–4 September.Google Scholar
Daw, J. R. and Morgan, S. G. (2012), ‘Stitching the gaps in the Canadian public drug coverage patchwork? A review of provincial pharmacare policy changes from 2000 to 2010’, Health Policy, 104(1): 19–26.Google Scholar
Entman, R. M. (1993), ‘Framing: toward clarification of a fractured paradigm’, Journal of Communication, 43(4): 51–58.CrossRefGoogle Scholar
Evans, R. G., McGrail, K., Morgan, S. G., Barer, M. L. and Hertzman, C. (2001), Apocalypse No: Population aging and the future of health care systems, SEDAP research paper 59, http://socserv.mcmaster.ca/sedap/p/sedap59.pdf [20 January 2014].Google Scholar
Foote, D. K. and Venne, R. A. (2005), ‘Awakening to the intergenerational equity debate in Canada’, Journal of Canadian Studies, 39(1): 5–21.CrossRefGoogle Scholar
Gamson, W. A. (1992), Talking Politics, New York: Cambridge University Press.Google Scholar
Gusmano, M. K. and Okma, K. (2010), ‘The Bright Side of Aging: Reframing the Debate’, Presented at the American Political Science Association Meeting, Washington, DC, 2 September.Google Scholar
Huang, B. and Priebe, S. (2003), ‘Media coverage of mental health care in the U.K., U.S.A and Australia’, Psychiatric Bulletin, 27: 331–333.Google Scholar
Hunter, J. (2010a), ‘Liberals not the first to attempt taming the beast that is health-care spending’, The Globe and Mail, 5 March, p. 3.Google Scholar
Hunter, J. (2010b), ‘Health Minister defends modest spending hikes; need to rein in annual increases in health care spending or “system will implode”’, The Globe and Mail, 4 March, p. 1.Google Scholar
Iyengar, S. (1990), ‘Framing responsibility for political issues: the case of poverty’, Political Behavior, 12(1): 19–40.Google Scholar
Kaiser Family Foundation (2010), Medicare Chartbook, http://facts.kff.org/chart.aspx?cb=58&sctn=169&p=2 [17 September 2012].Google Scholar
Klein, R. and Marmor, T. R. (2006 [1997]), ‘Reflections on Policy Analysis: Putting it Together Again’, in M. Moran, M. Rein and R. E. Goodin (eds), The Oxford Handbook of Public Policy, Oxford: Oxford University Press; Schneider and Ingram, 892–909.Google Scholar
Kotlikoff, L. J. and B., Scott (2004), The Coming Generational Storm: What You Need to Know About America’s Economic Future, Cambridge, MA: The MIT Press.Google Scholar
MacKinnon, J. C. (2004), ‘The arithmetic of health care’, Canadian Medical Association Journal, 171(6): 603–604.Google Scholar
Marmor, T. R. and Mashaw, J. L. (2006), ‘Understanding Social Insurance: Fairness, Affordability, and the ‘Modernization’ of Social Security and Medicare’, Health Affairs, 25(3): w114–w134.Google Scholar
Maxwell, J. (2008), ‘Out of the ER: finding the “right’ setting for elderly patients’, The Globe and Mail, 24 March, p. 2.Google Scholar
Mickleburgh, R. (2007), ‘Mojo no match for crisis in health’, The Globe and Mail, 16 February, p. 1.Google Scholar
Morone, J. (2005), Hellfire Nation, New Haven: Yale University Press.Google Scholar
New York Times (2010), ‘Health care and the deficit’, New York Times, 12 December, p. 7.Google Scholar
Oberlander, J. and White, J. (2009), ‘Public attitudes toward health care spending aren’t the problem; prices are’, Health Affairs, 28(5): 1285–1293.Google Scholar
Payne, G., Laporte, A., Deber, R. and Coyte, P. C. (2007), ‘Counting backward to health care’s future: using time-to-death modeling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures’, The Milbank Quarterly, 85(2): 213–257.Google Scholar
Peterson, P. G. (2000), Gray Dawn: How the Coming Age Wave Will Transform America and the World, New York: Crown Publishing Group.Google Scholar
Reinhardt, U. E. (2008), ‘Why does U.S. health care cost so much? (part III: an aging population isn’t the reason)’, New York Times, Economix: Explaining the Science of Every Day Life, http://economix.blogs.nytimes.com/2008/12/05/why-does-us-health-care-cost-so-much-part-iii-an-aging-population-isnt-the-reason/ [8 December 2012].Google Scholar
Roehrig, C. S. and Rousseau, D. M. (2011), ‘The growth in cost per case explains far more of U.S. health spending increases than rising disease prevalence’, Health Affairs, 30(9): 1657–1663.Google Scholar
Rowland, D. (1992), ‘A five-nation perspective on the elderly’, Health Affairs, 11(3): 205–215.Google Scholar
Rudiger, A. (2008), ‘From market competition to solidarity? Assessing the prospects of U.S. health care reform plans from a human rights perspective’, Health and Human Rights: An International Journal, http://www.hhrjournal.org/index.php/hhr/article/viewArticle/23/80 [30 December 2012], 10(1): 1–13.Google Scholar
Sabin, J. E. (2012), ‘Individualism, solidarity, and U.S. health care’, Virtual Mentor, 14(5): 415–418.Google Scholar
Sarafini, M. W. and Galewitz, P. (2012), ‘Aging population, costs worsen Medicare’s long-term prognosis’, The Rundown: A Blog of News and Insight, PBS Newshour, http://www.pbs.org/newshour/rundown/2012/04/aging-population-costs-worsen-medicares-long-term-prognosis.html [7 December 2012].Google Scholar
Shelton, A. M. (2010), The Impact of Medicare Premiums on Social Security Beneficiaries, CRS Report for Congress, Washington, DC: Congressional Research Services.Google Scholar
Skinner, J. (2011), ‘Understanding prices and quantities in the U.S. health care system’, Journal of Health Politics, Policy and Law, 36(4): 791–801.CrossRefGoogle ScholarPubMed
Soroka, S. N. (2011), Public Perceptions and Media Coverage of the Canadian Healthcare System: A Synthesis, Ottawa: Canadian Health Services Research Foundation.Google Scholar
Toronto Star (2008), ‘The health-care “elephant” grows’, Toronto Star, 30 March, p. 14.Google Scholar
Tuohy, C. H. (2002), ‘The costs of constraint and prospects for health care reform in Canada’, Health Affairs, 21(3): 32–46.Google Scholar
Truffer, C. J., Keehan, S., Smith, S., Cylus, J., Polsal, J. A., Lizonitz, J. and Clemens, M. K. (2010), ‘Health spending projections through 2019: the recession’s impact continues’, Health Affairs, 29(3): 522–529.Google Scholar
van Elk, R., Mot, E. and Franses, P. H. (2010), ‘Modeling healthcare expenditures: overview of the literature and evidence from a panel time-series model’, Expert Review of Pharmacoeconomics & Outcomes Research, 10(1): 25–35.Google Scholar
Vilella-Vila, M. and Costa-Font, J. (2008), ‘Press media reporting effects on risk perceptions and attitudes towards genetically modified (GM) food’, Journal of Socio-Economics, 37(5): 2095–2106.Google Scholar
Walkom, T. (2007), ‘No easy cure for health tax’, Toronto Star, 9 September, p. 6.Google Scholar
White, J. (2011), ‘Prices, volume, and the perverse effects of the variations crusade: point-counter point’, Journal of Health Politics, Policy and Law, 36(4): 775–790.Google Scholar