Long-term care is a growing component of health care spending but how much is spent or who bears the cost is uncertain, and the measures vary depending on the source used. We drew on regularly published series and ad hoc publications to compile preferred estimates of the share of long-term care spending in total health care spending, the private share of long-term care spending, and the share of residential care within long-term care. For each series, we compared estimates obtainable from published sources (CIHI [Canadian Institute for Health Information] and OECD [Organization for Economic Cooperation and Development]) with our preferred estimates. We conclude that using published series without adjustment would lead to spurious conclusions on the level and evolution of spending on long-term care in Canada as well as on the distribution of costs between private and public funders and between residential and home care.

Surveys of chronic health conditions provide information about prevalence but not incidence and the process of change within the population. Our study shows how “age dynamics” of chronic conditions – the probabilities of contracting conditions at different ages, of moving from one chronic condition state to another, and of dying – can be inferred from prevalence data for those conditions that can be viewed as irreversible. Transition probability matrices are constructed for successive age groups, with the sequence representing the age dynamics of the health conditions for a stationary population. We simulate the life path of a cohort under the initial probabilities, and again under altered probabilities, to explore the effects of reducing the incidence or mortality rate associated with a particular condition. We show that such surveys of chronic conditions can be made even more valuable by allowing the calculation of the transition probabilities that define the chronic conditions aging process

Even though reliable data are scarce, it appears that the continent of Africa has some of the highest mortality rates in the world. Estimates of crude death rates are of the order of seventeen per 1000 population, as compared to eleven for Asia and nine for Latin America (Kurian, 1984: 19). This study provides an analysis of the determinants of mortality in a part of Ethiopia, an area called Legeambo. While this area is small, it is similar in many important respects to other parts of rural Africa: the standard of living is low, access to sources of water for drinking, cooking, and bathing is difficult, and medical services are all but nonexistent. It is also similar to other areas in terms of its high rate of mortality. It differs from most other areas, however, in that a detailed survey of all households was undertaken recently. In consequence, a data base is available for this area, and it supports the analysis which follows, making possible a limited assessment of mortality experience. The first section describes the survey and the resultant data base. A multivariate analysis of the data is reported in the second section, and some concluding remarks and a comment on policy implications are provided in the third section.

Applying an employment-income-based procedure for determining retirement, we analysed a large longitudinal data file of Canadian personal income tax returns for individuals to determine who has retired and to assess how successful they are in maintaining their incomes after retirement. The methodological approach may be of interest for possible application in other countries that have suitable data. Our main conclusions are as follows. First, in the two years immediately after retirement, the after-tax income replacement ratios average about two thirds when calculated across all ages of retirement. Second, the ratios tend to increase with the age of retirement. Third, the ratios increase with years in retirement, at least in the first few years. Finally, income replacement ratios are highest in the lowest income quartile and generally decline as income increases; within each quartile, the replacement ratios are higher for those who retired later than for those who retired earlier.

The aging of the population is expected to result in substantial increases in the costs of maintaining health care and pension programs, and that is a source of widespread concern. However, a proper assessment requires that attention be given to all categories of government expenditure, including education and others associated with younger age groups, and not just those associated with the older population. It requires also that privately provided goods and services be considered, since their costs must be charged against the same national income as publicly provided ones. Beyond that, it is important to recognize that population change affects not only the demand side of the economy, but also the supply side — the economy's productive capacity. An important conclusion is that while other influences will no doubt play a role, demographic effects by themselves are likely to cause government expenditure (all categories, all levels of government combined) to increase by no more than the rate of growth of the population, and by less than the rate of growth of the gross domestic product. Taking public and private costs together, and assigning appropriate weights to different age groups, the overall “dependency ratio” can be expected to remain at its current low level for another decade and a half or two decades, and then to rise as the baby boom generation retires in large numbers. However, the projected future ratio never reaches the levels of the 1950s and 1960s. Although the overall “burden” of population aging is manageable, major adjustments will be required in the coming decades, especially in the area of federal/provincial cost sharing. For the most part, though, the effects of population aging are predictable, slow, and some time off.

The baby boom generation is now well into middle age, and over the next few decades will reach old age. As the boom generation grows old the costs of maintaining existing social support systems will rise, and the ability or willingness to sustain those systems has been called into question. In this paper we discuss a number of issues related broadly to population aging in Canada and the associated social “costs,” including the costs of public services. We conclude that while population-related cost increases should be expected, and reallocations of resources required, the overall increases should be of manageable proportions.

Canada's demographic situation in the future will differ substantially from what we have known in the past. Unless there is an early return to high fertility the average age of both the population and the labour force will increase substantially, while the overall dependency ratio will be low by historical standards. Our analysis suggests that up to about 2010 population change will have less of an impact on the real (i.e., constant—price) level of aggregate government expenditures than on the size of the real gross national product However, we can anticipate compositional changes in government expenditures as a result of population change: very large increases in the real social security costs, lesser (but still large) increases in health costs, and a reduction in education costs. Finally, a relatively large portion of the aggregate expenditure increases will be at the federal government level.

This paper is concerned with questions relating to demographic change (population growth and aging) and its implications for operating a publicly funded health care system in a Canadian setting. It provides an assessment of how prospective population changes alone would affect the share of health care costs in total national income in Canada over the next several decades; it provides also an analysis of how actual patterns of hospital service provision changed in Ontario over the last decade in response to budgetary restrictions in a period of rising demand for services. Finally, a case is made for viewing health care as an integrated system; a description is provided of a set of computer-based models that have been developed to facilitate analysis of the health care system, and illustrative projections are discussed.

Micro-data from a 1984 survey of adult education in Canada are used in the study. The data for persons 65 years of age and over are analysed using probit techniques. Prior level of education is found to be of considerable importance in determining the probabilities that elderly people will make use of adult education facilities. It is argued that future elderly population cohorts will have higher average education levels than present ones and that their members will therefore be more likely to take courses. Projections of increases in course enrolment by persons 65 and over are made for the next quarter century, based on the results of the probit analysis and projections of the population.

Population aging has become a subject of widespread popular and academic interest. In providing an assessment of the extent of aging that is in prospect, this paper makes available a number of projections of the age-sex distribution of the Canadian population for the 45-year period 1996 to 2041 and comparisons with the previous 45-year period. The projections combine assumptions relating to fertility, mortality, and migration so as to produce future populations characterized as “medium,” “old,” “young,” “high immigration” and “low immigration”. Supplementary calculations include growth rates, for both the total population and selected age groups, and various types of dependency ratios, including ones with a range of age-differentiated weights. It is concluded that substantial aging of the Canadian population appears virtually certain but, based on the demographic evidence, the “dependency burden” is likely to remain below the peak levels attained during the baby boom.

In this article we analyse the rates at which those admitted to hospital with acute myocardial infarction (AMI) receive aggressive treatment, assess how those rates have changed over time, and ask whether there is evidence of age discrepancies. Estimates made on the basis of data from an administrative database that includes discharges from all acute care hospitals in Ontario for selected years, from 1995 to 2005, indicate that there are strong and persistent age patterns in the application of medical technology. Results showed that to be true even after controlling for the higher rates of co-morbidities among older patients and variations across hospitals in practice patterns.

Canadians expect the same access to health care whether they are rich or poor, and wherever they live, often without direct charge at the point of service. However, we find that the private cost of long-term care differs greatly across the country, and within provinces, we find substantial variation, depending on income level, marital status, and, in Quebec alone, on assets owned. A non-married person with average income would pay more than twice as much in the Atlantic provinces as in Quebec, while a couple with one in care would pay almost four times as much in Newfoundland as in Alberta.

Sixty-five has long been used to define the beginning of “old age”. Yet it is clear that the definition is arbitrary, and with continuing reductions in mortality and morbidity rates it will become increasingly inappropriate as time passes. We consider how the definition might be modified to reflect changes in life table probabilities, and how the future numbers and proportions in “old age” would be affected. In a similar manner, we consider also the redefinition of the “oldest old” from a current definition of 85 and over.

Since the prevalence of many chronic health conditions increases with age, we might anticipate that as the population ages the proportion with one or more such conditions, and the cost of treatment, would rise. How much would the overall prevalence of chronic conditions increase in a quarter century if age-specific rates of prevalence did not change? How much would the requirements for health care resources increase? How much difference would it make to those requirements if people had fewer chronic conditions? The overall prevalence rates for almost all conditions associated mostly with old age would rise by more than 25 per cent, and health care requirements would grow more rapidly than the population – more than twice as rapidly in the case of hospital stays – if the rates for each age group remained constant. Even modest reductions in the average number of conditions at each age could result in substantial savings.

Because the concept of retirement is prominent in both popular thinking and academic studies, it would be helpful if the notion were analytically sound, could be measured with precision, and would make possible comparisons of patterns of retirement over time and among different populations. This paper reviews and assesses the many concepts and measures that have been proposed, summarizing them in groupings that reflect non-participation or reduced participation in the labour force, receipt of pension income, end-of-career employment, self-assessed retirement, or combinations of those characteristics. It concludes that there is no agreed measure and that no one measure dominates. Instead, new proposed measures continue to take account of additional refinements as new data sets become available, thereby further restricting possible comparisons. The confusing array of definitions reflects the practical problem that underlies the concept of retirement: It is an essentially negative notion, a notion of what people are not doing – namely, that they are not working. A more positive approach would be to focus, instead, on what people are doing, including especially their involvement in non-market activities that are socially productive, even if those activities do not contribute to national income as conventionally measured.