Reforms In Eldercare Are Necessary
In recent years, India's demographic dividend has attracted worldwide attention due to its ability to fuel economic growth and provide economical talent to the rest of the world. Despite this sounding positive and potentially attracting international investors to the country, the rapidly expanding senior population seems to have been overlooked. In its recent India Ageing Report, the United Nations Population Fund (UNFPA) predicted that India's elderly population would rise to 158 million by 2025.
With life expectancy rising, coupled with a healthy economy and improved healthcare access, the senior population is expected to continue to grow steadily for the next several decades. By the end of the century, senior citizens are expected to make up 34 per cent of India's population. This is a issue requiring urgent attention of the Government.
It is disappointing to find no mention of the aging population in the Economic Survey 2020-21. Throughout the document, it becomes clear that the DoEA (Department of Economic Affairs) is overwhelmed by the healthcare challenges facing our country, and that eldercare is still neglected.
Among 60-year-olds, the life expectancy is 12.9 years, which is lower than in other major industrialized and developing nations. Our older population is found in rural areas with 40 per cent living in poverty and 73 per cent uneducated. Surprisingly, nearly 90 per cent of them have no official social security (i.e., no PF, gratuity, pension etc.). Heart disease, smoking, and cancer account for 73 per cent of deaths among the elderly. Patients over the age of 65 account for 20 per cent of doctor visits, 30 per cent of hospital days and 50 per cent of bedridden days. As a result, our seniors require a variety of services in underserved locations.
At approximately three to four percent, India has one of the lowest hospitalization rates in the world. The average for middle-income countries is eight to nine percent, while OECD countries average thirteen to fourteen percent (OECD Statistics). In India, low hospitalization rates imply a lack of access to and utilization of healthcare.
India continues to have a shortage of healthcare professionals, whether physicians, nurses or midwives. In metropolitan cities of India, the private sector provides around 74 per cent of outpatient care and 65 per cent of hospitalization care. In an unregulated private sector market, there is knowledge asymmetry, which leads to failures.
India was ranked 145th out of 180 countries in terms of healthcare quality and accessibility (Global Burden of Disease Study 2016). India continues to underperform in comparison to other Low and Lower Middle Income (LMIC) countries, despite progress in healthcare access and quality. Just a few Sub-Saharan countries, few pacific islands, Nepal and Pakistan were ranked below India.
India ranks 179th out of 189 countries, in terms of the precedence given to health in government budgets. State healthcare spending is very variable across states and is not entirely explained by the state's revenue level.
To improve accessibility and affordability, the economic survey suggests that government expenditures on healthcare be increased. Our healthcare system and strategies should also be modified.
The PM-JAY (PM Jan Arogya Yojana) has shown significant results in the short period since it was introduced in 2018. Around 50 crore Indians are covered under the scheme, which gives annual coverage of up to five lakhs rupees.
It is true that healthcare needs a lot of improvement. The rate of senior population growth in India must be closely monitored by policymakers. PM-JAY and other initiatives that aid the marginalized are good, but they do not address the larger challenge of eldercare.
A strong primary care system must be put in place in order to provide geriatric care to the people. Policy considerations must put the social security of the elderly as well as their constructive engagement at the forefront. The proper infrastructure needs to be designed and invested in while keeping this demographic in mind.
The economic survey few years ago explored the issue of aging in depth. Prodded by the industry bodies, recently we are seeing recognition of this issue by both Niti Ayog & Ministry of Social Justice & Women Empowerment. I strongly encourage the government to move forward with this initiative, given the gravity of the situation.
Present demographic trends, coupled with growing urbanization and lifestyle changes, have resulted in many challenges for India's elderly. To enhance the quality of life of the elderly, we need a coordinated effort from a number of sectors.
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