The Balance of Care in an Ageing Society (BCASO)

The overall aim of BCASO is to model and quantify a range of policy scenarios on the future shape of the health sector - a focus prompted by the imminence of demographic ageing. It will do this using a computational model to represent primary care in an ageing society. New modules being developed focus on two strategic areas: the balance of care (focus, location; roles, responsibilities) and the impact of long-term, disabling and chronic conditions, particularly those affecting older people. These enhancements will provide the basis for further work on modelling policy scenarios.

The demographic shape of New Zealand is changing as birth rates decline to sub-replacement levels and life expectancy steadily increases. The outcome of the joint effect of these two processes is to greatly increase the proportion of the population in the older age groups. This has prompted debate about the likely impact of these developments on the provision of services and other supports for this sector of the community. While there is little dispute about the numbers, there is more contention about health need. Thus, for some, greater life expectancy for older people will be spent largely in good health, while for others this extended period of life is more likely to be a time of significant morbidity, disability and dependency.

It is becoming increasingly clear that the primary care sector needs to be seen in the context of the overall balance of care present in the wider delivery system. Furthermore, the conditions that are likely to be most demanding on that system are those of a long-term, disabling, chronic and potentially intractable nature, especially those affecting older people.

The primary objective is to model, using a micro-simulation approach, the impact of chronic disabling conditions on older people's use of primary health services and long-term care, and to test policy-relevant scenarios.

We have focused on older people aged 65+ years and conceptualized 2 modules: ‘illness’ and ‘disability’ with linkage between long-term illness (condition-based), disability (based on health expectancy), concomitant care (whether formal or informal), and living arrangements. Parameters for the model are being derived via analysis of the following main data sources: the National Primary Medical Care Survey 2001-2, the Australian National Health Survey 1995, the NZ Health Surveys 1996/2002, the NZ Disability Surveys 1996/2001, and NZ Census 1996/2001.

Professor Peter Davis
Roy Lay-Yee
Associate Professor Ngaire Kerse
Associate Professor David O'Sullivan
Andrew Sporle
Professor Laurie Brown

Peter Davis
Roy Lay-Yee
Gerry Cotterell
Janet Pearson
Martin von Randow
Oliver Mannion
Jessica Thomas