With six reviews of the health system currently underway, health minister Sussan Ley is investigating ways to create a “sustainable” Medicare and a stronger health system. One of the main concerns is that our ageing population is putting too much of a strain on the health system.
Like other OECD countries, Australia’s population is ageing due to lower fertility rates and increased life expectancy. The proportion of Australians aged 65 years and over increased from 12.4% in June 2000 to 14.7% in June 2014 (an 18% proportional increase), and the Australian Bureau of Statistics expects it to reach 18.6% by 2030.
We decided to investigate these concerns using data from the Bettering the Evaluation and Care of Health (BEACH) program – Australia’s longest running study of general practice activity. The results are published today in our annual report.
We found that older Australians use far more primary care health resources and the proportion they are using is increasing over time. However, having these patients managed in general practice lowers overall health care costs by reducing expensive specialist and hospital visits.
Proportion of health resources older patients use
First, we compared the proportion of GP health resources older people used in 2014–15 with the proportion they accounted for in the population.
In 2014–15, people aged 65+ years accounted for 14.7% of the population, but for:
- 27.8% of all GP encounters (1.9 x more than their proportion of the population)
- 28.7% of all GP clinical face-to-face time (x2.0)
- 35.0% of all problems managed (x2.4)
- 35.8% of all medications used (x2.4)
- 30.8% of all imaging and pathology tests ordered (x2.1)
- 32.2% of all referrals made (2.2 x more than their proportion of the population).
So overall, they used about twice as many health resources as the average Australian.
Next we looked at how these proportions had changed from 2000–01 to 2014–15. We found the proportion accounted by people aged 65+ increased from:
- 22.8% to 27.8% (a 22% relative increase) of all GP-patient encounters
- 23.9% to 28.7% (a 20% relative increase) of all face-to-face GP clinical time
- 26.9% to 35.0% (a 30% relative increase) of all problems managed in general practice
- 28.2% to 35.8% (a 27% relative increase) of all medications used
- 24.9% to 30.8% (a 24% relative increase) of all imaging and pathology tests ordered
- 24.2% to 32.2% (a 33% relative increase) of all referrals made.
All these relative increases were larger than the 18% relative increase in the proportion of the population aged 65+.
We also found that older people had more diagnosed chronic conditions than younger people. Having multiple diagnosed chronic conditions increases both the complexity of the patient’s care and the resulting health resource use.
We found that 60% of people aged 65+ in the population had three or more diagnosed chronic conditions and one-in-four had five or more.
One-third of older patients at GP encounters were living with chronic pain. This was nearly always treated with medication.
Older patients were taking more medications (just over five on average) which is known to increase the risk of adverse drug reactions.