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