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UBC Theses and Dissertations

Projecting health care system outcomes due to lifestyle changes O’Brien, Richard Michael


Health promotion has been identified as a practical inexpensive strategy to reduce hospital costs in Canada. Unfortunately there is a dearth of information about this, and also the actual impact of improved lifestyles on health status, illness and death. In fact, there is even an apprehension that by avoiding premature mortality the numbers and needs of the elderly will increase dramatically, resulting in cost increases. This thesis attempts to resolve this issue by projecting hospital use by Canadians and resultant cost savings or increases based on assumptions concerning improvements in lifestyles. Four steps were required: first, mortality rates were reduced based on assumed improvements in lifestyles; second, a population model was chosen to project population for the short-term (25 years) and long-term (500 years to stable state); third, hospital utilization rates were reduced consistent with reductions in mortality; and fourth, future hospital use and costs were calculated and their burden on society determined. The overall effect of improving lifestyles was a decrease in age-specific mortality rates especially for males and the elderly. Reducing premature mortality resulted in both slight increases in both the stable population's total size and proportion of elderly in the population. The dependency ratio remained relatively constant. Age-specific hospital use decreased, but increases in the number of elderly offset this decrease so that there was a slight overall increase in use and associated costs. This resulted in only slight per capita costs increases for the productive (20-64) age groups. Therefore, the thesis has determined that health promotion by itself will not have a significant effect in either increasing or decreasing costs of hospital care in the long term. However, health promotion was identified as a viable strategy which at very little expense will postpone a significant proportion of premature mortality, allow more persons to reach old age, and result in a more vigorous population. The increased numbers of elderly and their impact on the structure and components of the health and illness care system were identified. Future research into the question of cost effectiveness of health promotion would require a much improved data base, especially in the area of morbidity and hospital care. However, it was suggested that more productive research efforts might seek to identify optimal methods of modifying and improving lifestyles, such as long-term demonstration projects with evaluation components. There was sufficient evidence found to conclude that health promotion should be advanced as a viable and necessary component of the Canadian health care system.

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