By Brian Lee Crowley

There is controversy over whether an ageing population like New Brunswick’s actually means rising health care costs. Those who think the impact will be small are looking at how patterns of health spending have been distributed across age groups in the past. But the future will not be like that. There is a vast cultural shift going on, in which the Baby Boomers, who have been the most demanding generation in history, are retiring and are going to bring their informed-consumer mindset to health services.

How will this affect health care? People used to defer to their doctors, who controlled access to medical services. Now that old doctor-patient relationship is dying.

One of the biggest recent medical trends is patients showing up with print-outs from the Internet about their medical conditions and appropriate treatments. As Richard Bohmer, a physician and professor at Harvard says, “The increase in medical knowledge, and its widespread availability is the engine moving decision-making capability and therefore decision rights to the patient.”

According to a survey of health care consumers in Ontario, half the population appear to be “responsibility-takers” regarding their own health, and that number will only increase. Half of those surveyed believed that, in general, they have as much medical knowledge as physicians and they are the prime decision makers on their own health.

Virtually any kind of pharmaceutical product can now be purchased over the Internet from providers largely beyond government’s control. It is possible to have many kinds of diagnostic and other procedures carried out by people outside Canada. Your x-rays can be read just as easily by a radiologist in Boston or Bombay as by one in Toronto or Truro.

Increasingly surgery can be carried out in surgical booths equipped with video cameras and robotic arms, with the surgeons physically separated from their patients. Also, as medical tourism demonstrates, well-off patients are quite capable of seeking out high quality treatments in locations without queues and government-imposed controls on access to medical services they wish to get.

In Canada there are increasing reports of consumers travelling abroad for hip replacements, plastic surgery and laser eye treatment – and not just to the US, but to India, South Africa and France.

We now live in a world where you can deal with a medical services broker who can get you in to see top surgeons in exotic locations (see for example www.treatmentchoices.co.uk <http://www.treatmentchoices.co.uk/> ), and in which US hospitals take out full page ads in Canadian newspapers offering their services to patients tired of queuing. In this world, health care predicated on the notion of a closed national monopoly in which people must take what state authorities decide they should have simply cannot survive.

Tech-savvy prosperous Boomer consumers are now encountering more and more diseases associated with ageing. In the past, these diseases would simply have been accepted as a fact of life by both patients and physicians, with the objective being to manage them so as to minimize discomfort. But this will no longer be acceptable. People who have been used to getting their own way in so many other fields will not accept being fobbed off, especially when they can easily get on the Internet and become aware of the various treatments that are available for their ailments.

Many of the diseases of ageing are neurological – Parkinson’s, Alzheimer’s, etc. Ten years ago the total cost of Parkinson’s in Canada nearly 10 years ago was already estimated at $560m, and according to pharmacologist Harry Robertson of Dalhousie, Alzheimer’s cost would be 5 to 10 times that of Parkinson’s and strokes would cost more again than Alzheimer’s. The Boomers will demand, and get, a major shift of research resources into dealing with these diseases, and when new treatments emerge, they will demand to get those too, regardless of the cost.

Many diseases that not so long ago were regarded as essentially untreatable can now be controlled or even cured, but the cost is scaring public authorities to death. In some provinces effective treatments for diseases of ageing have been available for a decade, but the government refuses to approve the drugs for reimbursement.

Medicare essentially sees innovation as a cost to be funded out of current cash-flow, while consumers and companies see it as a cost-saving investment paid back over years. That’s one reason why innovation is relatively slow to be introduced in health care. Another is that organized provider groups in the system resist moving resources out of their field and into others so the supply of innovative services always lags real demand.

Boomers will demand that new treatments be found and made available, but our government health care monopoly cannot afford to do so. Bet on the Boomers to win, even if it means they have to pay a lot more out of pocket for their health care.

Brian Lee Crowley is president of the Atlantic Institute for Market Studies (www.aims.ca), a public policy think tank in Halifax. E-mail: BrianLeeCrowley@AIMS.ca

This article appeared in the Moncton Times-Transcript (www.canadaeast.com) and the Halifax Chronicle-Herald (www.herald.ns.ca) on Wednesday, June 1st, 2005.