The effects of an aging population on health care
Globally, the world is experiencing an increase in aging population. In 2017, the number of people aged 60 and above was 962 million globally, and this number is expected to rise to 2.1 billion in 2050 (United Nations , 2017). With an expected population of 2 billion under the age of 15 by 2050, there will be an equal number of elderly and young in the world (Harper, 2014).
In the Southeast Asia region most of the countries have experienced an increasing trend in life expectancy since the 1950s, with slight differences between countries. Coupled with decreasing fertility rates, the problems that come with aging population has exacerbated in the region. With sharp decreases in fertility rate in Singapore and Thailand, to below the replacement rates. Singapore experienced one of the sharpest decreases in fertility rate from 6 children per woman in 1957 to 2.1 in the mid-1970s (the lancet). In 2017, the fertility rate in Singapore dropped even further to 1.16 (Ong, 2018).
Over the decades many of the countries in the Southeast Asia region have successfully brought down rates of communicable diseases, like tuberculosis over the years. However, non-communicable diseases (NCD) are on the rise, these include cardiovascular diseases and cancer (Chongsuvivatwong, et al., 2011). NCDs are responsible for 55% of deaths in South east Asia (Nusser, 2017) and 71% of death globally (World Health Organisation, 2018). 23% of the total global burden of disease occurs among people aged 60 years and older, and the leading contributors are attributed to NCDs (Prince, et al., 2015).
As the population demographic ages, more and more people will be carrying chronic diseases into their silver years. As healthcare system was more geared towards treating individual communicable diseases in the past, there needs to be a shift in the healthcare system to manage chronic diseases (Nusser, 2017).
Although there has been an increase in the number of years for life expectancy, however, the quality of life in these added years cannot be assured. There is little evidence that older people are experiencing better health than their parents at a similar age (Beard, et al., 2016). Due to chronic diseases, there is a large and increased proportion of morbidity and mortality among the older people worldwide. The longer-term costs of disability and morbidity as compared to mortality have resulted in the burden of diseases.
However, rather than just trying to manage and treat chronic diseases, governments need to put in place measures that will help to prevent people from developing NCD. If primary prevention is encouraged among adults aged below 60 years, it will improve health in successive cohorts of older people (Prince, et al., 2015). However, steps will also need to be taken to alleviate the burdens of the current population already diagnosed with diseases. Hence, there should be a shift in focus in the healthcare industry to not only support but also prevent chronic diseases.
Using Singapore as a case study for developed countries, we will look at how the aging population is affecting the healthcare system and how the country is planning to tackle it. The budget that Singapore has set aside for healthcare has more than doubled in the past 8 years, from 4 million in 2010 to 10 million in 2018. Finance Minister Heng Swee Keat expects it to increase by another 3 billion by 2020 (Khalik, 2017). The reasons cited included an aging population as well as improvements in technologies.
A common problem faced in aging populations are shrinking workforces and Singapore is no exception. To cope with this labour shortage, 1 in 4 physicians currently hired in Singapore are non-natives (Singapore Business Review , 2015). According to the Ministry of Health, a further 10,000 workers will need to be recruited by 2020 for the eldercare sector alone (Chuan, 2016). Technology is another method that is being used to tackle the lack of manpower. For example, bed transporter technology has been introduced at Changi General Hospital (CGH), effectively lessening the number of people required to move a patient onto the bed from 2 to 1 (Khalik, 2017).
Most basic healthcare services are being provided for and taken care of in Singapore, through subsidies and national governmental schemes, such as Community Health Assist Scheme (CHAS). Under CHAS, the elderly aged 69 and above in 2014, are entitled to subsidy for chronic illnesses (Government of Singapore, 2018). However, subsidies only help to ease the burden of chronic diseases after people have been diagnosed. Hence, CHAS also include heavily subsidised or free medical screenings for the elderly to prevent chronic diseases. These subsidies will eventually also be extended to the ‘Merdeka generation”, those born in the 1950s.
Finally, the Health Minister of Singapore, Gan Kim Yong, is encouraging a shift in the healthcare sector. From being hospital centric to community based centric (Channel NewsAsia, 2016). This means that general practitioners (GPs) that are operating in clinics are to be the first point of contact and to prevent people from developing chronic conditions. As the current healthcare models in Singapore will generally steer people to seek for help at the hospital, causing a heavier workload among specialist services (Ng, 2016). The second shift that Mr Gan recommended is to move from healthcare to health, encouraging a healthier lifestyle is the key to prevention.
In conclusion, if a country has an aging population it should not only seek to implement a healthcare system that will solve the pressing needs of the aging population. They should seek to take a longer term view, preventing the subsequent cohorts of elderly from developing such diseases.
Beard, J. R., Officer, A., de Carvalho, I. A., Sadana, R., Pot, A. M., Michel, J.-P., … Chatterji, S. (2016). The World report on ageing and health: a policy framework for healthy ageing. Lancet (London, England), 387(10033), 2145–2154.
Bonita, R., Dans, A., Firestone, R., Ng, N., Varghese, C., & Tai, E.-S. (2011, February). The Rise of Chronic Non-Communicable Diseases in Southeast Asia: Time for Action. The Lancet.
Channel NewsAsia. (2016, April 13). A 'paradigm shift' needed in approach to ageing and health: Gan Kim Yong. Retrieved from Channel NewsAsia: https://www.channelnewsasia.com/news/singapore/a-paradigm-shift-needed-in-approach-to-ageing-and-health-gan-kim-8110692
Chongsuvivatwong, V., Phua, K., Yap, M., Pocock, N. S., Hashim, J., Chhem, R., . . . Lopez, A. (2011, January 25). Health and health-care systems in southeast Asia: diversity. Lancet, pp. 429-437.
Chuan, T. Y. (2016, November 6). 10,000 more healthcare workers needed in next 3 years. Retrieved from The Straits Times: https://www.straitstimes.com/singapore/health/10000-more-healthcare-workers-needed-in-next-3-years
Government of Singapore. (2018). Overview . Retrieved from Pioneer Generation package: https://www.pioneers.sg/en-sg/Pages/Overview.aspx#eligib%E2%80%8Ble
Harper, S. (2014, October 31). Economic and social implications of aging societies. Science., pp. 587-591.
Khalik, S. (2017, December 7). Spending on healthcare expected to rise sharply. Retrieved from The Straits Times: https://www.straitstimes.com/politics/spending-on-healthcare-expected-to-rise-sharply
Ng, K. (2016, November 26). The Big Read: Beyond a jobs boost, healthcare sector needs a new model of care, say experts . Retrieved from Today: https://www.todayonline.com/singapore/big-read-beyond-jobs-boost-healthcare-sector-needs-new-model-care-say-experts
Nusser, H. (2017, May 10). The key to fighting chronic disease in South-East Asia - young people. Retrieved from World Economic Forum: https://www.weforum.org/agenda/2017/05/we-need-to-recruit-south-east-asia-s-youth-in-the-fight-against-chronic-disease/
Ong, J. (2018, March 1). Singapore’s fertility rate at new 7-year low of 1.16: Josephine Teo. Retrieved from Channel NewsAsia: https://www.channelnewsasia.com/news/singapore/singapore-total-fertility-rate-new-low-1-16-10002558
Prince, M., Wu, F., Guo, Y., Robledo, L., O'Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet.
Singapore Business Review . (2015, November 27). More foreigners are being hired by Singapore public hospitals as labour crunch deepens. Retrieved from Singapore Business Review : https://sbr.com.sg/healthcare/news/more-foreigners-are-being-hired-singapore-public-hospitals-labour-crunch-deepens
United Nations . (2017, June 21). World Population Prospects: The 2017 Revision. Retrieved from United Nations: https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html
World Health Organisation. (2018, June 1). Noncommunicable diseases. Retrieved from World Health Organisation: http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases