We have new devices and imaging machines that provide better outcomes and information. AICD saves lives, but it is not cheap. MRI machines make diagnoses at a very high cost. You can think of other important examples.

I thought the Japanese had a cheaper version of the MRI machines in their system? It was in that T.R. Reid book.

In Canada we are at a crossroads. We have an aging and increasingly demanding population. The group that is now staring down old age (yes baby-boomers, that’s you) have a policy of denial about their own health and mortality. Clearly Canada cannot afford the projected increase in health costs we are facing, but the will to address any of these problems is almost entirely lacking.

That’s a problem in pretty much all of the 1st World countries – the elderly part of the population is rapidly growing in absolute numbers, and often in terms of a percentage of the population as well.

I’m not sure how we’ll deal with it in the long-term, either, aside from phasing out the whole idea of “guaranteed retirement” upon a certain age (complete with state pensions and special state-funded health insurance). That would at least ameliorate some of the tax drain that the retired elderly will be imposing.

1) We have no strategy for caring for elderly debilitated patients in Canada. They end up occupying hospital beds for months at very high cost, before suitable disposition can be arranged. The overcrowding in the hospital resulting from this has a number of significant hidden costs that are never accounted for.
2) We do not really ration anything in Canada. Sure we use wait times as a proxy for rationing, but if your willing to wait it out you can get whatever therapy or test you’d like. Doctors in Canada have GIVEN UP trying to ration within our system in the face of increasing patient demands.
3) Drug costs are astronomical. Our elderly populations medications are covered by the government (ie. the population). However, there is not an evidence based strategy to prescribing. I routinely see patients with advanced dementia on expensive medications for which there is no evidence, likewise with palliative cancer patients on hopeless and expensive chemo regimes.
4) Medication creep. It is not uncommon to see an elderly person on 20 to 30 different medications. The meds start as a trial and then become a permanent fixture in the regime, they are rarely reviewed and rarely stopped. The most frequent offenders are PPIs, sleepers, antihypertensives, and statins. Often the debilitated old patient will magically wake up a bit once a couple of hundred dollars are trimmed from their monthly pills.

In Canada we are at a crossroads. We have an aging and increasingly demanding population. The group that is now staring down old age (yes baby-boomers, that’s you) have a policy of denial about their own health and mortality. Clearly Canada cannot afford the projected increase in health costs we are facing, but the will to address any of these problems is almost entirely lacking.

We can already do more than we can afford for people. The 2 solutions are either more rationing (we already have some rationing) or better prevention through lifestyle changes (more walking, eat more vegetables, drink less pop, eat less meat).