SHAPING THE FUTURE HOW CHANGING DEMOGRAPHICS CAN POWER HUMAN DEVELOPMENT

FIGURE 4.9:
Per capita health-care expenditure has risen
rapidly in the region
Source: Feng 2014.
covers those who cannot afford insurance. The
Government helps keep costs low by monitoring
the prices of all drugs and medical procedures. 45
Universal health coverage has been a goal
of the international community since 2010, as
reiterated in Agenda 2030. A United Nations
General Assembly 46 resolution in 2012 urged
all governments to move towards providing all
people with access to affordable, quality healthcare
services. Realizing this goal is crucial for an
ageing population, given the higher incidence
of disease and disability.
Currently, most Asia-Pacific countries
provide public health care, but without much
emphasis on older people. Particularly in lowand
middle-income countries, health systems
are poorly designed to meet their chronic and
complex care needs. Government policy still
heavily emphasizes the care of children and
adults. While heart disease and stroke result in
the loss of many years of life, and high blood
pressure is a key treatable risk factor for these
diseases - only 4 percent to 14 percent of older
people in low- and middle-income countries
receive effective treatment. 47 They are far less
likely to receive psychological therapies for
mental illness and more likely to be prescribed
medication. 48
These tendencies raise issues of equity, suggesting
that in the move towards universality,
health systems will need to both provide a younger
population with curative interventions, and
adapt so that older people also have high-quality,
safe care, beyond the hospital setting, including
for chronic non-communicable diseases and
disabilities. 49
Inequities in access to health care also relate
to costs. Out-of-pocket health expenses can be
high, particularly for older people who are poor
and/or are no longer working. Among 13 Asian
countries and territories with 55 percent of the
region’s population, social medical insurance
schemes and out-of-pocket payments are actually
regressive in some cases, in that the wealthy pay
a smaller share of their income to fund them. 50
Asia-Pacific countries have been making
some efforts to address the health challenges
of older people—80 percent have policies,
programmes or plans backing accessible and
affordable health-care services, 51 although wide
differences prevail in implementation. Several
countries and areas have universal health-care
systems in place, with some offering free access
to public health care for all citizens, such as
Australia, Brunei Darussalam; Japan; Macao,
China (SAR); Malaysia; New Zealand; the
Republic of Korea and Singapore.
Some countries and areas, such as China;
Hong Kong, China (SAR); the Philippines and
Sri Lanka, are making efforts to reform their
health systems to reach universal coverage in
the near future, including through a deliberate
emphasis on older people. China has established
a national database and information centre for
older people that offers specialized expertise.
Other recent reforms include the National Cooperative
Medical System, a rural insurance system
to protect the health of farmers. Pilot-tested in
2003, the programme was extended and covered
802 million people by 2013. 52 The Philippines
has recently moved to universal health coverage
of older persons through its state-owned Philippine
Health Insurance Corporation (Box 4.4).
Countries have increasingly recognized
the importance of promoting self-care for older
Older people use
more health-care
services and require
more expensive
treatment
129