Eldercare reforms are necessary

When I glanced through the Economic Survey 2020-21, I was disappointed that I could not find any discussion on the growing elderly population. I went deeper into the document, I realised that the DoEA (Department of Economic Affairs) has been overwhelmed with the basic healthcare issues that our country is facing and hence eldercare is still taken backstage.

India was ranked 145th out of 180 countries on quality and access to healthcare (Global Burden of Disease Study 2016). Despite improvements in healthcare access and quality, India continues to underperform in comparison to other Low and Lower Middle Income (LMIC) countries. Only a few sub-Saharan countries, some pacific islands, Nepal and Pakistan were ranked below India.

India ranks 179th out of 189 countries in prioritization accorded to health in its government budgets. The state expenditure on healthcare is highly variable across states and is not fully explained by the income level of the state.

India has the highest levels of “Out of Pocket” (OOP) expenditures in the world. An increase in public health expenditure from the current levels to three per cent of GDP can reduce the OOP expenditure from 60 per cent currently to about 30 per cent. This has been demonstrated by China, Indonesia, the Philippines, Thailand and Pakistan as well. An increase in life expectancy has a positive correlation to per-capital public health expenditure.

At three to four per cent, the hospitalisation rates in India are among the lowest in the world. The average for middle-income countries is 8-9 per cent and 13-17 per cent for OECD countries (OECD Statistics). Low hospitalisation rates reflect lower access and utilisation of healthcare in India.

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India is still low on healthcare human resources be it doctors or nurses/midwives. Around 74 per cent of outpatient care and 65 per cent of hospitalisation care is provided through the private sector in urban India. There is information asymmetry which leads to failures especially in an unregulated private sector market.

The economic survey clearly recommends an increased public spend on healthcare to improve accessibility and affordability. It also recommends a redesign of our healthcare system and approaches towards it.

In the short span of time since its introduction, the PM-JAY in 2018 (PM Jan Arogya Yojana) has demonstrated positive outcomes. About 50 crore Indians are benefitting from the scheme which provides for the cover of up to five lakhs per annum.

A lot needs to be done in the healthcare domain in general. But the rate of growth of the older population in India warrants urgent attention from policymakers. Initiatives such as PM-JAY which benefits the marginalised are welcome, however, these initiatives don’t solve the larger eldercare issues.

According to the earlier report, it is estimated that by 2041, the population would touch 151 crores, of which about 24 crores would be 60 and above (approximately 16 per cent).

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Healthy life expectancy at the age of 60 now stands at 12.9 years (12.5 years for males; 13.3 years for females), and it is lower than that of other major developed and emerging economies

A comprehensive policy document will need to be released covering various aspects that can be dealt with by both the centre and states. This should take into account both the healthy and the sick of this population.

Geriatric care needs to be taken to the grassroots levels starting from preventive care and a robust primary care system. Social security of these elderly besides their productive engagement must form the core of policy thinking. Development and investment in appropriate infrastructure development keeping this population in mind is very important.

While the economic survey of 2018-19 dealt with the issue of ageing in detail, we haven’t seen much in this direction thereafter. Considering the enormity of the issue on hand, I urge the government to accelerate work in this direction.

(The author is co-founder of a geriatric care specialist brand providing supportive, nursing, rehabilitative, palliative and memory care for the elderly, in Bengaluru)