Does health care support independence or threaten it : a population based, person specific analysis of patterns of use by seniors Evans, Robert G., 1942-; Barer, M. L.; Hertzman, Clyde, 1953-; Sheps, Samuel Barry; Kazanjian, Arminée, 1947-
Major Findings 1 During the 1980s, decreasing rates in hospital use occurred even though rates for the elderly were continuing to increase. During the 1990s, downsizing has affected all age groups, the elderly included. Day surgery has increased dramatically, but there is no clear pattern of a transfer of care from inpatient to outpatient services. 2 Over this same period, age-specific per capita expenditures on physicians continued to increase, mostly because of increased spending on specialists. These increases occurred because a slightly larger proportion of BC's population was referred to specialists, they were more likely to see a larger number of specialists than in the past, and they were being provided with more expensive services (after adjusting f for fee increases). 3 People who died in hospital accounted for an increasing proportion of total hospital care, but only because their use was declining at a slower rate than non-decedents. In the mid-1990s, people who died were as likely to use facility-based care as their counterparts in the 1980s, but had shorter lengths of stay. They were far more likely to use community-based services such as homemaker care and doubled their use of pharmaceuticals. Despite claims to the contrary, only a small fraction of the increase in pharmaceutical costs can be explained by hospital downsizing. 4 Those who lost independence were also affected by downsizing, with those in the mid-1990s using fewer facility-based services. More importantly, patterns of care prior to loss of independence suggest a relatively rapid transition, which indicates either that there may have been unmet needs prior to the loss of independence, or that many people went through this transition because of a 'traumatic' event.
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