Recently released Census data showed that, for the first time ever, seniors now outnumber children in Canada. These changing demographics present a unique challenge to the sustainability of the Canadian health care system that will have pressing implications for public spending, the labour market, and housing and institutional infrastructure.

In 2016, Canada’s total health expenditures reached an estimated $228 billion—representing more than 11 per cent of GDP. This figure is estimated to consume between 44 and 55 per cent of provincial and territorial revenues moving forward. Added to unmet needs that currently exist in Canada’s health system, pressures to deliver the care Canadians want and expect will continue to increase.

“As the country’s aging population rapidly increases, the gap between government budgets and Canada’s health care needs continues to widen,” said Louis Thériault, Vice-President, Industry Strategy and Public Policy, The Conference Board of Canada. “But, health care sustainability is more than a funding matter. The road to sustainability must also include disease prevention efforts, health and wellness promotion, and a redesign of elements of the current health system.”

Launched in 2011, The Conference Board of Canada’s Canadian Alliance for Sustainable Health Care (CASHC) has been examining some of the key challenges facing the Canadian health care system, including aging Canadian seniors, unmet care needs, labour requirements, sedentary behaviour, workplace health and wellness, and health system design to develop forward-looking qualitative and quantitative analysis and solutions to make the health system sustainable. CASHC’s research compendium, A Road Map to Health System Sustainability, synthesizes key findings from CASHC’s extensive research program and provides recommendations for achieving health system sustainability.

Future Care for Canadian Seniors series estimates that 2.4 million Canadians age 65+ will require paid and unpaid continuing care supports by 2026. By 2046, this number will reach nearly 3.3 million. Spending on continuing care for seniors is forecast to increase from $28.3 billion in 2011 to $177.3 billion in 2046. Canada’s aging population will affect more than just public and private expenditures and go beyond clinical care. As more and more Canadians retire, labour shortages in specific areas of the health system will become more pronounced. A necessary shift from acute to home, community, and long-term care will also put pressure on existing institutional infrastructure and on caregivers who must reduce their work hours or leave the workforce.

Managing Mobility: Transportation in an Aging Society research found that Canada is ill-prepared to keep an aging population moving and that seniors who cannot meet their transportation needs are at risk of declining health and quality of life.

While the aging population is top of mind, it is not the only threat to the sustainability of the health care system. A rise in chronic diseases among Canadians highlights the need for effective disease prevention and health promotion initiatives. CASHC found that getting just 10 per cent of Canadians with suboptimal levels of physical activity to exercise more and reduce sedentary behaviour would yield a GDP increase of nearly $1.6 billion by 2040 and a cumulative $2.6 billion reduction in health care spending on hypertension, diabetes, heart disease, and cancer. Its Moving Ahead series identifies cost-effective, scalable, and sustainable interventions to improve healthy active living at home, in the workplace, and in educational institutions.

Investments in workplace health and wellness initiatives can have an impact beyond health care system sustainability. Programs for smoking cessation, mental health, and disability management can also directly benefit Canadian employers. One CASHC report revealed that in 2010, the total economic burden of smoking to business and society was $11.4 billion. CASHC’s Healthy Brains at Work series drew attention to the impact of mental health on the Canadian economy, with approximately $51 billion per year in lost productivity, health care, and quality of life reductions.

Adequately resourcing a health system that provides the service levels Canadians expect (reduced wait times, more Canadians having a primary care provider, increased mental health services) will require some reconfiguration. The misalignment in Canada’s current system is resulting in inefficiencies such as inappropriate hospital admissions and care, medical errors, variations in practice, and clinical waste. As labour demand for the continuing care sector is expected to outpace general labour force growth, designing an efficient and sustainable health system must include finding ways to optimize inter-professional primary care teams, rethink existing institutional infrastructure, and adopt innovative approaches and technologies.

While progress on health reform and health system efficiencies is happening, these changes are not keeping pace with the pressures of growing demand. CASHC’s Road Map highlights both the research progress that has been made over the past five years and what work still needs to be done.

“Moving forward, CASHC will play an important role in helping to advance the changes needed to achieve a more sustainable health system,” added Thériault.

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