Ageing in the Twenty-First Century: - HelpAge International

Chapter 2: A fresh look at evidence – Advancing health into old age
Health-care expenditure
Health-system financing underlies all these issues.
Health-care costs might be expected to increase due to
population ageing as, in general, health-care
expenditures in old age tend to be higher than among
other age groups. However, a large share of these costs is
not associated with age per se, but is incurred in the year
or years just prior to death. Consequently, the increase
in health-care expenditure might be caused by an
increasing number of people reaching older ages. 151
The cost implications of ageing societies, not only for
health budgets, but also for long-term care, particularly
of the oldest old, are already provoking fierce debate in
countries where the demographic transition is well
advanced. In developed countries, where curative, acute
care and long-term care services are widely available,
utilization of these services is growing, and contributing
to increased costs. A transition from a home-based to
a market-based system will probably lead to very high
costs of long-term care of older persons. 152 However,
other factors, such as technological advances and
growing affluence, play a much larger role. 153
Little is known of the health costs associated with ageing
in developing countries, but the rising incidence and
the lack of treatment of diseases such as hypertension
may give rise to significant treatment costs later in life.
Prevention, early detection and effective management
programmes are low-cost options for developing
countries to manage and contain health-care costs
associated with population ageing. 154 Overall, the
expansion of the health-care industry associated with
rapid ageing can provide attractive opportunities for
investment and labour income. 155
Voices of older persons
Many of the older persons who took part in
consultations for this report said that they had noticed
a marked increase in the availability of health facilities.
However, they had varying opinions about provision of
services and the attitude of health workers. While some
were satisfied with the attention they received, others
reported long waiting times or being treated with
disrespect. All participants, except those in Northern
and Western Europe and Canada, said that drugs in
government facilities were often unavailable and that
the prices were high.
Self-help clubs for healthy ageing
As with many emerging economies, Viet Nam is
experiencing rapid growth of its older population
accompanied by a rise in non-communicable diseases.
Many older people and their families struggle with low
incomes and poor overall health. HelpAge International
and partners including the Vietnam Women’s Union,
Vietnam Association of the Elderly and the Center for
Aging Support and Community Development have
supported the establishment of 483 intergenerational
self-help clubs. Each club has 50-70 members, about
70 per cent of whom are older people, 70 per cent
women and 70 per cent poor or near-poor.
The clubs are supported to manage their own activities
and become financially sustainable. For example, they
support livelihood activities and organize social and
cultural events, exchanges and physical exercise.
They run health education sessions including nutrition
awareness, prevention of non-communicable diseases
and self-care. They organize home visits by volunteers
and regular health check-ups, as well as distributing
publications and training materials on health care and
entitlements.
Source: Tran Bich Thuy, HelpAge International, Viet Nam
(personal communication, 17 July 2012).
“I went to the health centre to schedule an appointment
with a cardiologist there. They are prioritizing those over
60, so I got my appointment. This is something good.” Brazil
“Medical services are better now and more accessible.”
Ukraine
“There is a polyclinic with a special geriatric unit that treats
people of 75 years and above. This is a big improvement as
older people suffer from a lot of non-communicable
diseases and need a lot of medication.” Moldova
“The work of health extension workers in educating people
on doorsteps, community discussion on health issues, and
the start-up of health insurance … did not exist 10 years ago
and are signs of improvement.” Ethiopia
“The Government has tried to help us by introducing the
LEAP programme [Livelihood Empowerment Against
Poverty], at least it has taken care of some of the problems
we face as older people with regards to money.” Ghana
“The Government has done a lot to teach us about health
and hygiene, especially through media campaigns.”
Bangladesh
“There are media campaigns to talk about health and
programmes on television to learn about AIDS and other
health issues.” Cambodia
“Health professionals from health posts come to this place
on the 16th of each month for health check-ups of older
people.” Nepal
68 Ageing in the Twenty-First Century: A Celebration and A Challenge