Demography of Indian aging, 2001-2051

India is the second largest country in the world, with 72 million elderly persons above 60 years of age as of 2001, compared to China's 127 million. One of the objectives of this paper is to assess the emerging scenario of elderly for the first half of the 21st century. According to projections, the elderly in the age group 60 and above is expected to increase from 71 million in 2001 to 179 million in 2031, and further to 301 million in 2051; in the case of those 70 years and older, they are projected to increase from 27 million in 2001 to 132 million in 2051. Among the elderly persons 80 and above, they are likely to improve their numbers from 5.4 million in 2021 to 32.0 million in 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health services and pension and social security payments. Mobilizing resources for geriatric care and providing sufficient maintenance for the elderly will emerge as a major responsibility for heath-care providers and pension economists.     

Aging in Asia: A cultural,socio-economical and historical perspective

Asia has about 60% of the world population and population aging is occurring more rapidly in Asia than in Western countries. The group aged 65 years and above will increase from 207 million in 2000 to 857 million in 2050, a staggering increase of 314%. The diversity in economic, demographic, religious, cultural and geo-political factors in Asia is unparalleled by any other continent, and is, in part, contributory to the rapid rise in population aging. By 2050, those under 15 years old will have shrunk from 30% in 2000 to 19%, while those aged 65 years and above will increase from 6% to 18%. In addition, the gender divide still persists with 100 elderly women to 70 elderly men. These projected demographic changes pose three major challenges: 1) how best to address the rising population of the group aged 65 years and above, 2) how to address the shrinking population of the young as well as the working adults, and 3) how to address the problems arising from the disproportionate increase in older women than men. From now to 2050, it will be expeditious for each country in Asia to look into ways of reversing the decline in total fertility rates (TFRs) and restore to replacement levels. If not, at least introduce measures to halt its free fall. Due to the complexity of factors that have influenced the fall in TFRs in Asia, it will be a daunting task to reverse this fall. There is no “single size fits all” solution to this complex problem. Research work in this short-term strategy in addressing the aging population is urgent. In the longer term, the East-West Centre have suggested four modalities, 1) establish policies and programmes that enhance traditional Asian systems of family support for the elderly; 2) introduce policy reform that encourages the elderly who are still capable of remaining in the work force; 3) create institutions and systems that support high levels of personal saving; and 4) formulate public programmes, including pension schemes and national healthcare systems. We need to work while there is time.     

Demography of ageing

The world's elderly population, 60 years and older, reached 251.6 million by 1950, 488 million by 1990 and, according to United Nations projection estimates, it will reach 1205.3 million in 2025. These figures mean an increase of 144% between 1950 and 1990 and of 146% between 1990 and 2025. Asia accounted for the highest number of elderly persons: 49.2%, in 1990, Europe reported 19%, Africa 6.3%, and Latin America 6.5%. On the other hand, over the next 35 years, the European region figure will decrease to 12%, while other regions will show increased percentages: 58% for Asia and around 8% for Africa and Latin America. Fertility and mortality decreases in developing countries will result in the elderly population constituting 12% of the total population in the year 2025. In this same year, Latin America will have the same high proportion of elderly persons as the world will have in the year 2020. On the other hand, some of the developed regions, such as Northern America and Europe, will reach figures around 27%. Below the average value for these regions in the year 2025 will be the former Soviet Union with 20% and Oceania with 19.2%. Another way to confirm population aging is by computing the median age of a population. Thus, while in 1950 the world median age was 23.4 years, it increased up to 24.2 years in 1990, and is estimated to be 31.1 years by the year 2025. Developed regions show higher population aging than the less developed ones. In fact, in 1990, developed countries had a median age of 33.7 years and developing countries had a median age of 22 years. While the median age will be 40.7 years for developed countries in the year 2025, it will only be 29.7 years for less developed countries. Nevertheless, this relatively high median age indicates that the aging process has already started in less developed countries.     

Population Ageing in Japan: A Brief Survey

During the next fifty years, the absolute number of elderly in Japan will increase while the absolute number of children and persons in the working age groups will decline. The main cause of this demographic trend is low fertility, which can in turn be traced mostly to delayed and foregone marriages. Absent policy measures and sociocultural change to reduce young women's opportunity costs of marriage and childbearing, it is difficult to imagine this demographic situation changing. Policy makers have stressed the importance of keeping elderly workers in the labour force. However, the problem is not elderly labour force participation per se (which is already very high for a country with Japan's per capita income) but rather the relatively low productivity of elderly workers, who are often employed part-time, work informally in private unincorporated enterprises, etc. Reforms to Japan's public pension system, which is essentially financed on a pay as you go basis with benefits linked to wages, have not been very effective to date. Official projections call for steep increases in the payroll contribution rate. In contrast to the pension system, the Japanese health system has managed to deliver high-quality care at a relatively low cost as measured by health spending as a proportion of GDP. More must be done, however, to expand the availability of long-term disabled elderly. The article concludes with a few observations elicited for European policy makers.     

Old age pension and intergenerational living arrangements: a regression discontinuity design

China launched a pension program for rural residents in 2009, now covering more than 300 million Chinese. This program offers a unique setting for studying the ageing population, given the rapidity of China’s population ageing, traditions of filial piety and co-residence, decreasing number of children, and dearth of formal social security, at a relatively low income level. This paper examines whether receipt of the old-age pension payment equips elderly parents and their adult children to live apart and whether parents substitute children’s time involved in instrumental support to them with service consumption. Employing a regression discontinuity design to a primary longitudinal survey conducted in Guizhou province of China, this paper overcomes challenges in the literature that households eligible for pension payment might be systematically different from ineligible households and that it is difficult to separate the effect of pension from that of age or cohort heterogeneity. Around the pension eligibility age cut-off, results reveal large and significant reduction in intergenerational co-residence of the extended family and increase in service consumption among elderly parents.     

Social Security Reform Ideas in Japan

Abstract

Japan has a complex social security system. This article discusses the demographic and economic situation in Japan as background for understanding the setting in which the social security system functions. Japan has a three-pillar system for retirement income. The first pillar is the social security pension plan; the second pillar is the voluntary occupational pension plan; and the third pillar is personal savings, including the personal pension plan. The most important part of the retirement income system is the social security pension plan, which paid benefits accounting for 64% of the total income of elderly households in 1998. The five Employees' Pension Plans are established on a compulsory social insurance basis. Most large Japanese employers have a mandatory retirement age. Over 90% of all employees, including public sector ones, must retire from their career jobs at age 60.     

Nursing Home Ownership

Abstract

Following the Second World War, the idea of the life course with distinct periods of education, work, and retirement became popular as a result of the alliance of interests of unions and management, with politicians seizing the opportunity to accommodate them. These “social partners” implemented benefit rules and created practices for using old age and disability to ease the exit of older workers. Although justifiable at the time, now those rules and practices hinder individual and employer incentives to invest in human capital and work environments that enable older workers to remain in the workforce. The article argues that the workforce environment of the coming half-century, which is relevant for persons born around 2000, is much different from that a hundred years earlier, which determined the opportunities for people born around 1900. People are healthier and live much longer and work environments are friendlier. The article argues that it is no longer justifiable to subsidize exit from the workforce around the age of 60 for healthy workers, especially in view of the coming labor shortage in Europe. It also argues that the introduction of the principles of the Swedish NDC pension reform in Europe would provide possibilities for flexible exit from the workforce and remove impediments to labor mobility in Europe, which are embedded in many of Europe's present pension arrangements.     

Live to 70 Years and Older or Suffer in Silence: Understanding Health Insurance Status Among the Elderly Under the NHIS in Ghana

Ghana has introduced a National Health Insurance Scheme (NHIS). Embedded in the NHIS is a policy to exempt poor and vulnerable groups from premiums and user fees. There has been some debate as to why the start-off age for exemption among the elderly is 70 years. Ghana has a shorter life expectancy than middle- and high-income countries and its current age of retirement is 60 years. This study explores the financial and social implications of continuing to charge premiums to people aged 60 to 69 years. Based on the analysis of data from a representative household survey, it is recommended that the exemption policy should be expanded to include all vulnerable elderly persons, regardless of age.     

Immigrants in the Old‐Age Pension System: The Case of Sweden

The article investigates incomes and especially state pensions 2008 among elderly immigrants who arrived in Sweden before 1970. At age 70 and above, the level of state old‐age pension for immigrant men was nearly the same and for immigrant women somewhat higher than for natives with similar characteristics. At age 65–66 the state pension was lower for immigrants than for their native counterparts. The differences in pensions for immigrants of different ages are probably due to changed rules in the Swedish state old‐age pension system from 2003. The new rules have hit different age groups in different ways. The gaps are partially levelled out when other incomes are included. The extent to which levelling occurs varies greatly between different immigrant groups. For immigrants who have arrived during the last decades, the future state old‐age pension outcomes are expected to be worse.

Policy Implications

• The Swedish Pensions Agency should set up a register of pensions from abroad. This will tell us to what extent old‐age pensions from the home country compensate for low old‐age pensions from the Swedish system.
• Better integration on the labour market is a powerful measure for reducing the risk of future low pensions among immigrants. This is a challenge for Swedish integration policy.
• To what extent can other parts of the Swedish welfare system in the future compensate individuals with low old‐age pensions?

     

Caregiving and cost of health care for later life families

In the future, the number of families providing care for elderly relatives as well as the costs associated with health care will continue to increase. The caregiving triad—individual, family and government—will need to balance the resources to meet the needs of the elderly. Public policy changes can assist older persons and their families as they address caregiving in the later years.     

Aging in the United States Today

Summary

As the demographics of aging change in the United States, the number of persons over the age of 65 will continue to grow. By 2030, one in every five persons will be over the age of 65. Several factors are important when considering the reality of these demographic changes. First, successful aging, given new medical technologies, is more probable today than it was for our parents and grandparents. Second, the range of diverse populations within the aging communities has become recognized. Third, generational differences impact who cares for the elderly. Fourth, baby boomers, who will soon turn 65, will likely have a huge impact on society. And lastly, spiritual matters are important as we approach and enter old age.     

World and regional labour force trends and prospects

Changes in fertility during 1970-1985 will not have any effect on the composition of the world work force until 1985 because the people who will be of working age at that time have already been born. However, fertility for this period will directly influence the size of the age group 15-30 in the year 2000. Moreover, fertility trends for this period will have an indirect effect on participation of women in the labor force. The number of people in the labor force has proportionately followed total population. Just as total population is projected to increase in the single decade 1970-1980 by an amount equal to its size in 1750, so the labor force will increase by 360 million during the 1980's (its original size in 1750). By the end of the present century the world labor force may well number some 2,6000 million, reaching 3,000 million by the year 2010; 4,000 million by 2030; 5,000 million by 2070; and stabilizing at about 5,200 million by the end of the 21st century. There will be great regional variations. Increases will range from 20-35% in Europe and the U.S.S.R. to 100-120% in South Asia, Africa, and Latin America. For East Asia and North America the increases may amount to 60% by the year 2000 and 100% by 2050. In 1970 less developed regions had 2/3 the world's labor force; by 2000 they will have 3/4. In 1970 about 20% of the labor force in more developed regions were working in agriculture while in less developed regions 2/3 were so engaged. In other terms, in more developed regions 10 farmers supported 108 persons while in less developed regions 10 farmers supported only 38. According to Food and Agriculture Organization projections, by 2000 only 3.5% of the labor force in developed regions and 43.5% in less developed regions will be in agriculture. Differences in gross national product between regions is striking. In 1970 the less developed regions contained 70% of world population, 67% of the world labor force, 87% of the world agricultural labor, and produced 15% of its wealth. There are also sharp contrasts in participation in the labor force. In less developed countries more youths and older persons are in the labor force while in developed countries more women work. By the year 2000 female activity rates in more developed regions will increase for ages 20-64 and decrease for those under 20 and over 64. This will raise female participation in the labor force to 35%. In less developed regions female participation is expected to decline. The proportion of young workers is expected to increase in less developed and decline in more developed regions; the same will be true for older workers. The dependency burden will be concentrated among the young in less developed nations; in more devel oped regions there will be larger numbers of older dependents.     

Preventing Economic Hardship Among Chinese Elderly in Hong Kong

Abstract

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

A Possible Pension-Savings Paradigm for a Sustainable Future: A Developed Country Case Study (UK)

Abstract

For millennia, the percentage of the population aged sixty-five and older never exceeded 3 or 4 per cent (), while the percentage of children under the age of 5 numbered between 15 and 20 per cent. By 2050 this picture will be reversed due to various demographic mega-trends. This means that many developed nations need to rethink their assumptions regarding their existing pension-savings and accumulation paradigm and rebuild their very conceptual foundations. Some countries try infusing into the defunct current pension-savings’ model small adjustments; but what is required is an entirely new pensions funding and accumulation paradigm. The new paradigm proposed in this paper is based on ten pillars addressing the demographic and economic challenges projected ahead. Two principles guide the proposed model. One is that it must foster confidence among the citizens who will retire in mid-twenty-first century that they may have sufficient financial resources for long retirement years. The second principle is that the new pension funding system must leave them with enough available funds for social and economic development as they save for the long years of retirement.     

Future of Long-Term Care Financing for the Elderly in Korea

ABSTRACT

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.     

Social security reform ideas in Japan

Japan has a complex social security system. This article discusses the demographic and economic situation in Japan as background for understanding the setting in which the social security system functions. Japan has a three-pillar system for retirement income. The first pillar is the social security pension plan; the second pillar is the voluntary occupational pension plan; and the third pillar is personal savings, including the personal pension plan. The most important part of the retirement income system is the social security pension plan, which paid benefits accounting for 64% of the total income of elderly households in 1998. The five Employees' Pension Plans are established on a compulsory social insurance basis. Most large Japanese employers have a mandatory retirement age. Over 90% of all employees, including public sector ones, must retire from their career jobs at age 60.     

Elderly Prisoners: A Growing and Forgotten Group Within Correctional Systems Vulnerable to Elder Abuse

ABSTRACT

There are over 2.1 million people incarcerated in the nation's jails and prisons. Additionally, close to 600,000 prisoners are released annually into communities across the country. Many prisoners and those released from prisons are elderly. The purpose of this article is to examine the systemic abuse and neglect experienced by elderly prisoners while they are incarcerated and when they are released from prison. Most correctional systems have inadequate resources, processes, and personnel to manage the elderly population inside and outside of prisons. In addition to providing a definition of “elderly prisoner,” two specific problems–prison health care and prisoner re-entry–are examined in the article. The article concludes with recommendations for both policy and research on how best we can further understand and address the multiple needs and concerns faced by elderly prisoners.     

失能老年人长期护理的需求规模评估、费用测算与经济效应预测

伴随着失能风险的增加,老年人长期护理问题成为人口老龄化研究的新课题.基于CHARLS等相关数据,改进Markov模型,测算2020—2060年失能老年人长期护理需求规模及费用,并预测经济效应,结果表明:(1)老年人数量呈倒"U"形增长趋势,并于2048年左右达到顶峰,约为4.34亿人;失能老年人呈逐年上升趋势,于2060年达到1.84亿人.(2)失能老年人长期护理费用由2020年的3906.57亿元增长到2060年的44973.16亿元,增长11.51倍,其中轻度、中度和重度失能老年人长期护理费用分别增长8.92倍、15.55倍和21.17倍.(3)老年护理劳动力需求量预测显示,由90.33万人上升到228.98万人,增长2.54倍;机构养老护理型床位需求量预测显示,由241.03万张增长到553.11万张,增长2.29倍;老年护理市场直接经济增量预测显示,由3906.57亿元增长到44973.16亿元,增长11.51倍.基于此,本文提出包括坚持"以制度为基础、以服务为核心、以救助为兜底、以法律为准绳"的基本原则,建立失能动态监控机制,完善养老服务财政补贴制度等政策建议.     

High incidence of disability pension with a psychiatric diagnosis in western Sweden. A population-based study from 1980 to 1998

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidence rates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data on disability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with a psychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensions with psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings.