Ageing in Asia: Beyond the Astana Declaration Towards Financing Long-term Care for All; Comment on “Financing Long-term Care: Lessons From Japan”

Document Type: Commentary

Authors

1 Graduate School of Public Policy, Nazarbayev Unversity, Nur-Sultan, Kazakhstan

2 Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore

3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Abstract

The Astana Declaration on primary healthcare in 2018 was the attempt to revive the ideals of the World Health Organization (WHO) Alma-Ata Declaration 40 years later, together with a call for the political will to provide adequate financing at acceptable quality of care. This approach is taken to achieve the past ideals of Health for All, given the new challenges of universal health coverage. The economic case for primary healthcare is justified against the growing demand due in part to the growing costs of chronic conditions and the rise of ageing population, other than the supply-side factors of the healthcare industry. Past healthcare systems have evolved greater roles of the state versus the market, but few have involved the Third Sector or civil society in more integrated ways to provide and finance long-term care (LTC) with population ageing. From the extremes of the communist state to capitalist free markets, an optimal public-private system has to reach a balance in access, cost and quality for health and LTC. Recent studies of health and LTC have distilled newer developments in public-private mixes of provision, financing and regulation, in response to the needs of fast-ageing Asian societies. While Japan was the oldest country in the world, other countries in Asia have caught up and are now acknowledged where innovative models of integrated eldercare under economic limits, hold great promise of their transferability to the rest of ageing societies. Besides other forms of integrated LTC delivery with traditional systems, newer forms of financing like savings funds and superannuation have been developed, with participation from government, industry and civil society. There is much to learn from the new Asian models of financing, using appropriate technology and social innovations, and integrating health and social systems for LTC.

Keywords


  1. The Lancet. The Astana Declaration: the future of primary health care? Lancet. 2018;392(10156):1369. doi:10.1016/s0140-6736(18)32478-4
  2. Hone T, Macinko J, Millett C. Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? Lancet. 2018;392(10156):1461-1472. doi:10.1016/s0140-6736(18)31829-4
  3. WHO/UNICEF. A Vision for Primary Health Care in the 21st Century: Towards UHC and the SDGs. WHO/UNICEF; 2018.
  4. Ikegami N. Financing long-term care: lessons from Japan. Int J Health Policy Manag. 2019;8(8):462-466. doi:10.15171/ijhpm.2019.35
  5. Ostrom E. Governing the Commons: The Evolution of Institutions for Collective Action. Cambridge: Cambridge University Press; 1990.
  6. Putnam RD, Leonardi R, Nonetti R. Making Democracy Work: Civic Traditions in Modern Italy. Princeton, NJ: Princeton University Press; 1993.
  7. Phua KH, Financing health and long-term care for ageing populations in the Asia-Pacific region. In: Philips DR, ed. Ageing in the Asia-Pacific Region: Issues, Policies and Future Trends. London: Routledge; 2000:93-112.
  8. Phua KH, Sheikh K, Tang SL, Lin V. Health Systems of Asia: Equity, Governance and Social Impact. Soc Sci Med. 2015;145:141-144. doi:10.1016/j.socscimed.2015.10.027
  9. Phua KH, Goh LG, Yap MT. Ageing in Asia: Contemporary Trends and Policy Issues. Singapore: World Scientific; 2019.
  10. Smullen A, Phua KH. Comparing the Health Care Systems of High-Performing Asian Countries. Asia Pac Policy Stud. 2015;2(2):347-355. doi:10.1002/app5.76
  11. Chongsuvivatwong V, Phua KH, Yap MT, et al. Health and health-care systems in southeast Asia: diversity and transitions. Lancet. 2011;377(9763):429-437. doi:10.1016/S0140-6736(10)61507-3