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Health Serv Res. 1989 October; 24(4): 435–459.
PMCID: PMC1065578

The long good-bye: the great transformation of the British Columbia hospital system.


Much is made of the "threat" an aging population poses to North American health care systems. In this article, we present hospital utilization data from British Columbia over the period 1969-1985, which reinforce our earlier (Barer, Evans, Hertzman, et al. 1987) conclusion: it is not aging per se that poses the threat; rather, it is what we are choosing (through our health care system) to do to and with our elderly. In 1969, British Columbia hospital patients over 65 years of age and staying longer than 60 days accounted for 12.5 percent of all days; by 1985/86, they were accounting for 39 percent. Furthermore, in 1985/86, 1 patient in 200 was using one-quarter of all patient days and dying at the end of the process, and 2 patients in 100 (who stayed over 60 days whether discharged alive or dead) were accounting for almost one-half of all days.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Barer ML, Evans RG, Hertzman C, Lomas J. Aging and health care utilization: new evidence on old fallacies. Soc Sci Med. 1987;24(10):851–862. [PubMed]
  • Evans RG. Illusions of necessity: evading responsibility for choice in health care. J Health Polit Policy Law. 1985 Fall;10(3):439–467. [PubMed]
  • Fries JF. The compression of morbidity. Milbank Mem Fund Q Health Soc. 1983 Summer;61(3):397–419. [PubMed]
  • Newman TB, Browner WS. The epidemiology of life and death: a critical commentary. Am J Public Health. 1988 Feb;78(2):161–162. [PubMed]
  • Valvona J, Sloan F. Rising rates of surgery among the elderly. Health Aff (Millwood) 1985 Fall;4(3):108–119. [PubMed]
  • Verbrugge LM. Longer life but worsening health? Trends in health and mortality of middle-aged and older persons. Milbank Mem Fund Q Health Soc. 1984 Summer;62(3):475–519. [PubMed]
  • Wilkins R, Adams OB. Changes in the healthfulness of life of the elderly population: an empirical approach. Rev Epidemiol Sante Publique. 1987;35(3-4):225–235. [PubMed]

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