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Universal Health Coverage and

Population Ageing

John Beard

Extra years of life after age 65, UK,1991-2011

Source: Kingston et al, The Lancet 2017

Men (4.7 extra years)

Women (4.1 extra years)

0.2

2.4

0.2

1.3

Extra years no dependency

Extra years low dependency

Extra years medium dependency

Extra years high dependency

Extra years of life after age 65, UK,1991-2011

Men (4.7 extra years)

Women (4.1 extra years)

Source: Kingston et al, The Lancet 2017

1.7

1.7

0.3

0.9

Extra years no dependency

Extra years low dependency

Extra years medium dependency

Extra years high dependency

0.2

2.4

0.2

1.3

Extra years no dependency

Extra years low dependency

Extra years medium dependency

Extra years high dependency

Extra years of life after age 65, UK,1991-2011

Source: Kingston et al, The Lancet 2017

Men (4.7 extra years)

Women (4.1 extra years)

Projected increase number of people 65+ and percentage increase

Kingston et al, Lancet 2017

Increase 2015-2025 Increase 2015-2035

Independent 1,170,000 (17.5%) 2,747,000 (41%)

Low dependency 885,000 (24.8%) 2,014,000 (56.5%)

Medium dependency 190,000 (27.4%) 426,000 (66.6%)

High dependency 163,000 (25.1%) 400,000 (61.5%)

Care home beds needed

71,215 (32.3%) 189,000 (85.7%)

World Report on Ageing and Health

"Healthy Ageing - the

process of developing

and maintaining the

functional ability that

enables wellbeing in older age."

Opportunities to foster Healthy Ageing

Global Strategy and Action Plan on Ageing and Health

Commitment to action on Healthy Ageing Age-friendly environments Health systems aligned to the needs of older populations Systems for long-term care Better measurement, monitoring and research

Expenditure on ageing populations

Disease burden 2000 and development assistance

0m

200m

400m

600m

800m

1,000m

1,200m

1,400m

1,600m

1,800m

0-14 years 15-49 years 50+ years

DALY 2000

Spending 2013

Source: Skirbekk 2017

0m

200m

400m

600m

800m

1,000m

1,200m

1,400m

1,600m

1,800m

2,000m

0-14 years 15-49 years 50+ years

DALY 2030

Spending 2013

Source: Skirbekk 2017

Disease burden 2030 and development assistance

Universal Health Coverage is essential but what is it? How to get there??

Wrist-worn device or phone

Gait/mobility Cognitive Mood Social Sensory Cardiovascular Respiratory

Health care: goal of integrated systems to provide chronic care as close as possible to the older person Long-term care – systems that support informal caregivers, regulate private providers, fill gaps for needy Age-friendly environments – change attitudes to ageing and older people, build age-friendly communities Consensus on measures, better surveillance, more appropriate research

Universal Health Coverage is essential but what is it? How to get there??

Wrist-worn device or phone

Gait/mobility Cognitive Mood Social Sensory Cardiovascular Respiratory

Health care: goal of integrated systems to provide chronic care as close as possible to the older person Long-term care – systems that support informal caregivers, regulate private providers, fill gaps for needy Age-friendly environments – change attitudes to ageing and older people, build age-friendly communities Consensus on measures, better surveillance, more appropriate research

Health care costs by age relative to

country average, EU

Source: Health Expenditures by Disease and Conditions

(HEDIC) 2016

Source: Spijker and MacInnes, 2013

UK "Dependency" Projections

Universal Health Coverage is essential but what is it? How to get there?

Wrist-worn device or phone

Gait/mobility Cognitive Mood Social Sensory Cardiovascular Respiratory

Health care – integrated systems to provide chronic care as close as possible to the older person Long-term care – systems that support informal caregivers, regulate private providers, address inequities, provide high quality institutional care Age-friendly environments – change attitudes to ageing and older people, build age-friendly communities Consensus on measures, better surveillance, more appropriate research

Enabling communities to look after themselves

Universal Health Coverage is essential but what is it? How to get there?

Wrist-worn device or phone

Gait/mobility Cognitive Mood Social Sensory Cardiovascular Respiratory

Health care – integrated systems to provide chronic care as close as possible to the older person Long-term care – systems that support informal caregivers, regulate private providers, fill gaps for needy Consensus on measures, better surveillance, more appropriate research Age-friendly environments – change attitudes to ageing and older people, build age-friendly communities

contribute to and not be left behind by The RIGHT to

Source: Lutz et al 2005

Its not just the quantity

Population 20-65 by level of education (millions)

Mortality and Development

Source: Beard et al, The Lancet, 2016

Source: Lutz et al 2008

Different demographic views 2000-2050

Source: Lutz et al 2008

Different demographic views 2000-2050

Source: Lutz et al 2008

Dependency or contribution?

Income and consumption across the life course, South Korea

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

0 10 20 30 40 50 60 70 80 90+

Tho

usa

nd

s

Age

Per Capita Values, Local Currency (Thousands)

Consumption Labor Income

Source: NTA, Jon Cylus

Variations in how consumption over age 65 is financed in Europe

-20

0

20

40

60

80

100

120

AUT2010

FIN2006

FRA2011

DEU2008

HUN2005

ITA2008

SVN2010

ESP2008

SWE2003

GBR2007

%

Labor Income Private Transfers Public Transfers Asset-Based Reallocations

Source: NTA, Note: Negative shares (mainly for net private transfers) mean that older people give more financial assistance to others (e.g. to their children) than they receive.

A large share of tax revenues come from non-labour sources, OECD countries, 2015

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% linked to goods, wealth, estates etc. % linked directly to income (from labour and non-labour) % linked directly to labour

Participation in paid employment and FTE informal caregiving among the 55+, selected

European countries

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

PT GB NL PL BE FR FI ES IE DE CZ CH IL SI LT NO AT DK SE EE HU

Employed (55+) Informal carers (FTEs)

Source: Jon Cylus analysis of ESS 2014

Contributions/Public Expenditure UK 2010

Wrist-worn device or phone

Gait/mobility Cognitive Mood Social Sensory Cardiovascular Respiratory

Total Expenditure (pensions,

other welfare and healthcare) £136 billion.

Contributions

taxation £45 billion

other direct financial £10 billion.

spending £76 billion

social care/volunteering £44 billion

Net contribution £39 billion

(£77billion by 2030)

Source: Guillemard et al

Extra years of life after age 65, UK,1991-2011

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5 4.7

4.1

Years

Kingston et al, Lancet 2017

Extra years of life after age 65, UK,1991-2011

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5 4.7

1.7 1.7

0.3

0.9

4.1

Years

Kingston et al, Lancet 2017

Extra years of life after age 65, UK,1991-2011

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5 4.7

1.7 1.7

0.3

0.9

4.1

0.2

2.4

0.2

1.3

Years

Kingston et al, Lancet 2017