Health and care more than a family affair

Ageing  populations will force all countries  to examine long-term care and  forge a new societal infrastructure, writes Joachim Breuer, president of the International Social Security Association

Very often, it is argued that only countries with a certain level of economic development are able to achieve universal health coverage. However, recent data from the International Social Security Association shows that economies at different levels of development can achieve universal models of health services by combining mandatory contributory programmes with subsidised programmes for certain groups of society and voluntary programmes.

In 2016, the People’s Republic of China received the ISSA’s Award for Outstanding Achievement in Social Security for its unprecedented extension of coverage. In addition to extending pensions and other forms of social protection, China increased its national health insurance coverage from 317 million people in 2005 to more than 1.3 billion people in 2015, reaching more than 95% of the population.

The example of China and other ISSA members shows that providing adequate and comprehensive universal health coverage is a complex challenge: improved access must be matched to healthcare services with predictable quality, delivered by a suitably qualified and sufficiently staffed workforce.

An important part of China’s solution was to make use of new technologies in order to improve the performance of social security administrations through streamlined workloads. Coincidentally, this helped lower administrative costs. Platforms for information and communications technologies and mobile technologies helped reduce errors, identify fraud and improve benefit adequacy by supporting contribution collection and the calculation and delivery of benefits.

Smartcard solutions or mobile front-office applications improved access to services and bridged remaining coverage gaps, especially for rural and informal economy workers. In order to make the services sustainable, the Chinese government installed preventive measures and rehabilitation programmes aimed at reducing absence at work and at ensuring high productivity throughout all age groups.

The investments necessary for establishing and maintaining such a system must not be underestimated. It is crucial to offer universal access to medical services in order to cushion the impact of demographic change, which will – sooner or later – challenge the financial sustainability of numerous economies. Population ageing will force us to also focus on long-term care.

Compared to achieving ‘standard’ healthcare solutions, establishing a coherent and comprehensive infrastructure for long-term care is more like the vast underwater mass of an iceberg than the small part that is visible above the water’s surface.

The World Health Organization predicts that the number of people aged over 80 years will triple between 2000 and 2050. Even if they are healthier, the expenses for pensions and care will rise with the number of people who depend on the benefits.

Long-term care is not only costly in terms of finances. It also requires the human resources necessary for providing adequate services for a significant number of people – many of whom will require assistance for decades. For most of human history, it has been customary to organise this assistance within families but changes in the nature of career paths, family structures and caring responsibilities have considerably affected the number of family carers. A growing number of elderly people live alone and rely on the support of caring institutions.

Yet ISSA studies inform us that only a handful of countries offer long-term care financed by social insurance contributions.

This development jeopardises the financial stability of countries. It also affects social peace, as masses of people who have worked and contributed to the prosperity of their country, discover they do not have adequate access to financial or medical benefits at the age of retirement. Such prospects serve the expectations of neither the older nor younger generation.

We need to find ways to balance the extra expenses of a greying society. This is the point where we can close the circle to universal health coverage: more and healthier people, who contribute to social protection schemes during their active years, will reduce the burden of costly long-term care.

The ISSA, with more than 320 members from over 150 countries, promotes excellence in social security schemes through training programmes, research and innovation. ISSA’s commissions and conferences gather the technical knowledge and experience of a vast number of experts working in ISSA’s member institutions.

This unique pool of expertise allows the ISSA to detect trends in social protection and provide best practice examples for supporting members in coping with their challenges. The ISSA shares this expertise, for instance at G20 or BRICS meetings.