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    Canada
  • United States
    United States
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    Mexico
  • Brazil
    Brazil
  • United Kingdom
    United Kingdom
  • Germany
    Germany
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    Turkey
  • Israel
    Israel
  • South Africa
    South Africa
  • China
    China
  • Korea
    Korea
  • Japan
    Japan
Brazil
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Brazil

Healthcare & Wellness

Although below the regional average, the longevity and healthy life expectancy of Brazilians have increased significantly over the past decade, partly thanks to the improvements in the country’s healthcare system. By introducing a dual healthcare system in 1988, Brazil guaranteed the right to free healthcare for all citizens through the Unified Health System (SUS) and allowed for the parallel existence of a private healthcare system. However, major gaps exist when it comes to older citizens in both medical and long-term care. To address this, the government is working to address the needs of older patients while also improving the broader Brazilian healthcare system.

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China
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China

Healthcare & Wellness

Improving healthcare and wellness of older adults is another priority on China’s aging policy agenda. Broadly, China has been undertaking a major reform of its healthcare system, including expanding the coverage of universal basic health insurance, increasing the function of primary care, and intensifying the focus on healthy lifestyle promotion across the society. Through the reform, the government is seeking to boost the health of the general population and to contribute to improved health in older adults for in the future.

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Canada
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Canada

Healthcare & Wellness

Canada is a global leader in longevity, although it has a larger gap between lifespan and healthspan than its peers. In light of the rising healthcare demand from an aging population and limitations on the healthcare system, both the federal and provincial governments have focused on supporting home-based care and increasing support for informal caregivers. Meanwhile, efforts are underway to improve the hospital environment so that it is friendly for older adults.

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Germany
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Germany

Healthcare & Wellness

The super-aged population in Germany has a high healthy life expectancy, with three-quarters of those age 65 and older reporting that they still feel fit. However, the prevalence of chronic conditions and psychological conditions like dementia is growing and driving demand for long-term care (LTC) to increase substantially. Germany is an early mover in requiring LTC insurance and is also working to strengthen home-based care and to widen the scope of beneficiaries, with particular emphasis on the population with dementia. Policies have also endeavored to improve the quality and affordability of care. The government is also focused on ensuring that older adults in underserviced rural areas have access to the same quality of care as in urban areas, leveraging e-health technology.

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Israel
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Israel

Healthcare & Wellness

Both life expectancy and healthy life expectancy in Israel are among the highest in the world and continue to extend. As in most other countries, however, the increase in “healthspan” tends to lag behind “lifespan.” In response, the government has focused on supporting home and community care services. As in many countries, Israel’s LTC system is highly fragmented in terms of care providers, regulation, and financial responsibilities, resulting in service gaps, duplication, inefficient incentives, and inadequate investment in prevention and rehabilitation. However, reform has been put on hold, partly due to budgetary concerns.

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Japan
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Japan

Healthcare & Wellness

Already the global leader in longevity, the share of people age 80 and older among the senior population will increase by more than one-third to 42 percent by 2050. Japan is one of the very few countries in the world to require long-term care insurance (LTCI). To keep up with the healthcare needs of the aging population and to ensure fiscal sustainability, the Japanese government has constantly adapted its LTCI program to enable older people to lead more independent lives and to support family caregivers. In particular, the government has increasingly focused on home- and community-based care and prevention programs.

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Korea
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Korea

Healthcare & Wellness

Life expectancy of Korean older adults has increased significantly but has outpaced improvements in health. In an attempt to address this gap and improve the health of the older population, the government has adopted proactive, preventive approaches, including subsidizing regular checkups and promoting healthy lifestyles. More recently, the government has strived to supportlife quality and wellness of older adults by building a long-term-care benefit system, with a latest reform in 2016 aimed at improving the system’s efficiency, service coverage, and quality. To take advantage of the country’s advanced IT infrastructure, the government is seeking to harness the power of digital technology and accommodate older people’s rising demand for healthcare.

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Turkey
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Turkey

Healthcare & Wellness

Both the lifespan and healthspan of older adults in Turkey have improved significantly over the past decade, thanks in part to the country’s impressive reforms to its healthcare system, achieving universal healthcare insurance coverage while reducing private health expenditure. The government is also paying greater attention to quality of medical care, evidenced by its recent moves to tighten regulation of prescription drugs and to curb overuse of medicines. In the face of rising care needs of the aging population, the Turkish government has prioritized family-centered care, providing support primarily through financial subsidies. However, there are significant gaps in meeting the needs of the middle-class aging population.

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South Africa
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South Africa

Healthcare & Wellness

Life expectancy and healthy life expectancy for older adults have both improved in the last decade in South Africa, although they are still lower than both the regional and global averages. The government has made reforming the healthcare system its primary focus in order to provide the entire population with better-quality healthcare, but there are still very limited resources available for long-term care (LTC). In order to make up for this, some NGOs have begun to provide health and LTC services for older people in the provinces and municipalities in which they operate, as well as transportation services so that they have easier access to medical facilities.

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Mexico
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Mexico

Healthcare & Wellness

Mexico’s older population has a life expectancy and a healthspan that are above both the global and regional averages. However, unlike most OECD countries, they have actually fallen in recent years due to high levels of obesity and conditions stemming from poor diets and lack of access to quality nutrition resources. This has led to an increasing need for long -term care among the growing population of older adults, but the financial burden of care is higher than anywhere else in the OECD. The country has no formal system to provide long-term care and does not provide support for informal family caregivers.

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United Kingdom
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United Kingdom

Healthcare & Wellness

Technology also holds promise to help address one of the UK’s greatest challenges: the increase in healthcare and long-term care demand alongside declining budget allocations and increased austerity. These dynamics are putting pressure on older adults and informal caregivers. In response, the government is increasing funding transfers and allowing for local tax hikes to help fill the growing gaps in funding for local governments. Recognizing that much more will be needed, in 2016, the British government launched a major technology initiative aimed at leveraging technology to help cut costs and balance budgets in the face of an aging population. Related initiatives are just getting off the ground but hold promise for public-private collaborations between the National Health Service (NHS) and industry to develop and deploy technologies that will help reduce costs and enable older adults to age in place longer and more comfortably.

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United States
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United States

Healthcare & Wellness

While older Americans’ lifespans have improved over the past decade, they remain below the average for high-income countries. A range of factors are contributing to America’s relatively poor and deteriorating health outcomes, including education, income, job security, food insecurity, and the social safety net. Given the high cost and growing healthcare demand, there remains an acute need for improved healthcare coverage. While federal health insurance programs for older adults do exist, they only cover a portion of costs. Demand for healthcare and long-term-care services has been increasing and is expected to rise rapidly in the coming decades. Medicaid is the only program that provides financial support for long-term care, and future funding is tenuous.

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Healthcare & Wellness

In 2016, the World Health Organization (WHO) announced that since 2000, average global lifespans had extended by a full five years – the fastest rise since the 1960s. While there remain tremendous variation by country, and inequality within countries across different gender, ethnic, and socio-economic groups, people across the globe are generally living longer. But underlying this good news is a knotty policy challenge. Healthy life expectancies or healthspans – the number of years one can expect to live in good health – are extending at a markedly slower pace in most countries. This growing gap fuels fiscal concerns and policy debates over rising costs – how can societies best meet the healthcare and long-term care needs of today’s older adults, and  improve the health outcomes of future generations? Three consistent patterns regarding older adult care are emerging across countries, including: a shift toward home- and community-care to support aging in place; a sweeping focus on promoting healthy lifestyles in future generations, and growing interest in leveraging digital technology to improve access and the efficiency and quality of care.

The global population age 80 or older will more than double to reach 4.3 percent by 2050. The largest percentage will be in Japan, where every two in five older people will be age 80 or older.

photo of a an older male patient reviewing x-rays on a digital device with a doctor and a family member

Healthcare System

Coupled with the widening gap between lifespans and healthspans is a significant divergence in older-age health across countries. Uneven access to and quality of healthcare are among the contributing factors. Universal healthcare coverage is crucial to addressing the healthcare challenges facing older adults. Although UN Member States agreed to work toward UHC by 2030 as part of the Sustainable Development Goals, growing fiscal concerns challenge their commitment. The most remarkable progress has been seen in emerging market countries, with a focus on providing financial protection and expanding access to preventive and primary care. Around the world, information and communication technology could play a pivotal role in promoting universal health coverage. With rapid expansion in the adoption of digital technology – particularly mobile devices – and substantial advancement in areas like sensors and cloud computing, eHealth promises to become an essential component of the health system.

Each year, 100 million people around the world are pushed into poverty, and 150 million suffer financial catastrophe because of out-of-pocket healthcare expenditures, and the older population is among the most vulnerable. Yet one in four countries does not have a national policy or strategy for universal healthcare.

Between 1990 and 2015, at least 73 countries adopted eHealth policies or strategies, with nearly two-thirds of the adoption occurring in the last five years. More than 90 percent of these policies and strategies include objectives that address how eHealth can contribute to universal healthcare. However, a lack of funding and infrastructure are among the biggest barriers to promoting eHealth.

Change in Healthy Life Expectancy at Age 60 (2000-2015) vs. Healthcare Access and Quality Index in 2015

Change in Healthy Life Expectancy at Age 60 (2000-2015) vs. Healthcare Access and Quality Index in 2015

(Sources: WHO; GBD 2015 Healthcare and Access Quality Collaborators; FP Analytics)

Long-Term Care

Unlike healthcare, which governments often deem to be a core component of social policy, long-term care (LTC) receives much less public attention and spending, and the provision of LTC varies widely. LTC generally refers to the care of people with or at risk of a significant and ongoing loss of physical capacity to function in their daily activities, both at home and within dedicated facilities. While a looming fiscal challenge, there are models emerging around the world for cost-effective LTC, with an increasing focus on supporting aging in place. Early progress is also being made in countries that are already grappling with a shrinking labor force and a rising dementia crisis, providing valuable experience for the rest of the world.

Turkey’s Caregiver Service Program

Turkey introduced the Caregiver Service Program in 2007 to subsidize caregiving for low-income older adults and their families. The program was designed to compensate family members for the financial loss associated with leaving a job to care for an older relative and to create an incentive for women to enter the labor force as external caregivers. Family members or external caregivers dedicating at least eight hours per day to caregiving receive a monthly wage. Those with incomes no higher than two-thirds of the minimum wage are eligible for external caregivers, and in families living at this limited income level, relatives can receive the subsidy. The monthly wage/subsidy is subject to adjustment every six months and stood at TRY 881 (approximately USD 280) as of the second half of 2016, or just over half of the minimum wage. Even though the subsidy is only half of the minimum wage, it is believed by experts to be an incentive for caregivers, who are usually women not active in labor force, hence helping to both increase women’s labor participation and improve care for the aging population.

(Sources: OECD; FP Analytics)

Life-Course Health Promotion

While access to healthcare and long-term care is crucial for today’s older people, health promotion across the entire population benefits future generations and facilitates the sustainability of health and LTC systems in an era of rapid aging. Promoting healthy lifestyles is a proactive, cost-effective approach to address the spread of noncommunicable diseases, a growing major health threat around the world. Government action is on the rise in this area, although significant variability suggests that more work needs to be done.

Globally, the prevalence of NCDs among the population ages 15 through 64 is increasing – between 1990 and 2015, this group saw the NCD-related disease burden rise by 54 percent. Obesity is a leading factor in the growing risk of NCDs. Its occurrence has more than doubled globally since 1980.

Ninety-three percent of 160 countries responding to a 2015 WHO survey reported to have established a unit or department in the Ministry of Health responsible for NCDs, up from 88 percent five years ago, but this varies significantly by region and focus area.

Germany Strengthens Health Promotion

The most successful models for promoting healthy lifestyles combine a top-down policy push with specific goals and measures, dedicated budgets, and promotion of cross-sector collaboration. Germany stands out with enactment of the Act to Strengthen Health Promotion and Preventive Healthcare in 2015. The law requires the allocation of half a billion euros – a nearly 75 percent increase from the previous budget – from health insurance and nursing funds each year. At least three-fifths of the budget will be used in health promotion within schools, municipalities, workplaces, and nursing homes, including diet, exercise, stress reduction, and addiction prevention. To ensure effective implementation, the law also emphasizes collaboration across government actors and on federal and local levels to identify joint goals and approaches.

Key Takeaways

Meeting the healthcare and wellness needs of today’s older adults and working to promote healthy lifestyles in younger generations are twin challenges that require an immediate, redoubled commitment from governments around the world. As in other areas of aging policy, fiscal constraints threaten to force short-term, siloed approaches that produce larger costs and threaten the long-term competitiveness and prosperity of societies. While no country has cracked the code for healthy aging, it is clear that there are manifold opportunities to achieve greater efficiency and improved well-being:

 
  • Promotion of preventive care and a healthy lifestyle is a proactive, cost-efficient solution to close the gap between lifespans and healthspans across generations.
  • Supporting caregiving, by ensuring the flexibility to allow family members to provide short-term care while remaining active in the labor market, and creating incentives to increase the formal caregiving labor force will both be vital to accommodate rising demand for LTC outside of costly institutional settings.
  • Technology, such as eHealth and robotics, promises to be an integral element of health and long-term care. It offers an opportunity to expand access and lower costs, as well as drive economic growth and competitiveness for those countries and companies that effectively seize it.

Percentage of Age Group 80+ of the Older Population (65+)

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