Do baby boomers use more healthcare services than other generations? Longitudinal trajectories of physician service use across five birth cohorts.
OBJECTIVE
In light of concerns for meeting the provision of healthcare services given the large numbers of ageing baby boomers, we compared the trajectories of primary care and specialist services use across the lifecourse of 5 birth cohorts and examined factors associated with birth cohort differences.


METHODS
Longitudinal panel.


METHODS
Canadian National Population Health Survey (1994-2011).


METHODS
Sample of 10 186 individuals aged 20-69 years in 1994-1995 and who were from 5 birth cohorts: Generation X (Gen X; born: 1965-1974), Younger Baby Boomers (born: 1955-1964), Older Baby Boomers (born: 1945-1954), World War II (born: 1935-1944) and pre-World War II (born: 1925-1934).


RESULTS
Use of primary care and specialist services.


RESULTS
Although the overall pattern suggested less use of physician services by each successive recent cohort, this blinded differences in primary and specialist care use by cohort. Multilevel analyses comparing cohorts showed that Gen Xers and younger boomers, particularly those with multimorbidity, were less likely to use primary care than earlier cohorts. In contrast, specialist use was higher in recent cohorts, with Gen Xers having the highest specialist use. These increases were explained by the increasing levels of multimorbidity. Education, income, having a regular source of care, sedentary lifestyle and obesity were significantly associated with physician services use, but only partially contributed to cohort differences.


CONCLUSIONS
The findings suggest a shift from primary care to specialist care among recent cohorts, particularly for those with multimorbidity. This is of concern given policies to promote primary care services to prevent and manage chronic conditions. There is a need for policies to address important generational differences in healthcare preferences and the balance between primary and specialty care to ensure integration and coordination of healthcare delivery.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Mayilee
M
Canizares
Krembil Research Institute, University Health Network, Toronto, Ontario, Canada Institute for Work and Health, Toronto, Ontario, Canada.
Monique
M
Gignac
Institute for Work and Health, Toronto, Ontario, Canada Institute for Clinical Evaluative Science, Toronto, Ontario, Canada.
Sheilah
S
Hogg-Johnson
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Richard H
RH
Glazier
Krembil Research Institute, University Health Network, Toronto, Ontario, Canada Institute for Clinical Evaluative Science, Toronto, Ontario, Canada.
Elizabeth M
EM
Badley
BABY BOOMERS; BIRTH COHORT; MULTIMORBIDITY; PRIMARY CARE; SPECIALTY CARE
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