“Boom, Bust & Echo”: The Prophecy of the Health Care Crunch

Article by Sandra Ketchen , Spectrum Health Care President & CEO

I recently dusted off my copy of “Boom Bust & Echo” written in 1996 – all these years later, still a fascinating read. Author David K. Foot touted demographics as “the most powerful and most underutilized tool we have to understand the past and to foretell the future”. His premise was that two-thirds of everything in the world, from retail trends and the real estate market, to the kind of food people buy can all be explained by demographics. While Foot couldn’t have predicted the technological innovations that led to the invention of the iPhone, he certainly nailed it when he said that “retailers that prosper in the changing marketplace of the coming years will be those who succeed at adopting customer service as a way of life”. Look no further than your nearest Apple Store or their virtual service model for a prime example of this.

This book is really about one generation in particular that has materially influenced economic and social change in Canada. The Baby Boomers, born between 1947 and 1966, due to their sheer numbers, have always been drivers of change. And now, just as Foot prophesized, the second decade of the new century has seen our health care system confronted with a sharp increase in demand, just as the baby boomer generation enters its senior years. We are at the beginning of the ‘Health Care Crunch’ in Canada, and it’s only the tip of the iceberg. Certainly, this health system crunch has been accelerated by COVID, but we’ve known it was coming for decades.

The oldest Baby Boomer turns 77 this year. Over the next 10 years, as the health of this generation starts to fail, the system will face down a wave of demand far beyond what we experience today.?Ballooning costs will follow the scramble to cope —unless we act now to make needed changes to the health care system. Part of the solution was prescribed for us in Foot’s writing. He foresaw the need for care to move into the home “because there is no greater way to deliver high-quality care to older patients”. For Foot, this meant returning to the days of doctors making house calls. Today we know home care at scale can be provided by PSWs and nurses in collaboration with primary care doctors and other parts of the health system to create a circle of care around the patient. And remember, this generational cohort will have high expectations for quality of life. They will want to stay in their homes as long as possible, assisted by technology, caregivers, family and friends.?

Foot also foresaw the need to re-evaluate healthcare funding models. While there will always be some fee for service payment models within the health system, Foot noted that a population-based approach is much more appropriate for a country with an older population. This type of model promotes continuous care and wellness– and not treating each complaint as an isolated phenomenon.?

The evolution towards an integrated care model is very much what Foot described back in 1996 when he said “a medical practice that is appropriate to a mature population involves a partnership between patient and physician aimed at maintaining good health through a healthy lifestyle. It also requires the contributions of other specialists, including pharmacists, nutritionists, physiotherapists, nurses and home care specialists”—all of which are more likely to occur under a population health approach. And today we have the technology to connect this care to make it more efficient, effective and sustainable.

A transformed home care system with prioritized funding will be the only way to cope with the coming wave of care needs – and we know that people, especially the Baby Boomers, want to stay in their homes as long as possible.?There are no other choices left to make –the writing has been on the wall (and in Foot’s book) since 1996.?We are excited to be at the forefront in designing this transformation!?