Healthy Ageing 5: RHC Forum on Ageing Market and Geriatric Care

I am half a century old already and will soon become a “dual citizen” in a few years. That is, a Filipino citizen and senior citizen J. This plus the politics of government interventionism in the name of “helping” the senior citizens slowly get my interest on the literature of ageing.

Last October 29, 2013, I attended a forum by the Retirement and Healthcare Coalition (RHC) on the Ageing Market at Diamond Hotel, Manila.

The speakers and their topics were the following:

“Overview of the Philippine Ageing Market”

Dr. Miguel Ramos, Director, National Center for Geriatric Health (NCGH)

“The Geriatric Market from a Hospital's Point of View”

Dr. Liza Manalo, Head, Palliative Care Unit of The Medical City's Cancer Center

“The Geriatric Market from a Hospital's Point of View”

Dr. Marc Evans Abat, Head, Center for Healthy Aging of The Medical City's

Center for Wellness and Aesthetics

“Developing Aged Care Facilities in the Philippines”

Dr. Mary Jean Guno, Managing Director, Home Health Care

“The Philippine TeleGeriatric Project”

Davidson B. Teh, Program Coordinator

AIM Dr. Stephen Zuellig Center for Asian Business Transformation,

Asian Institute of Management

“PHI - 'Human Touch' Public Private Partnership Project”

Marc Daubenbuechel, Executive Director of RHC

Four of the six speakers, from left: Dr. Marc Abat, Davidson Teh, Dr. Mary Guno, and Marc D.

The Philippines has about 7 million elders aged 60 years old and above in 2011, and this sector is projected to increase up to  nearly 14 million (NCGH estimate) or nearly 20 million (RHC estimate) in 2040, a big number. The more substantial presentation came from Dr. Ramos of the NCGH. Among the information he shared were the following.

From 7 million in 2011 to 8 million by 2016-17 and further up to nearly 14 million by 2040.

Major diseases that affected the elderly in the Philippines as of 2007 were arthritis, hypertension and cataracts.

His presentation was substantial, lots of useful macro data of the senior citizens sector.

Marc D. spelled out the Philippine Health Initiative (PHI) and the geriatric needs. According to him, these are the strengths and weaknesses of the Philippine geriatric market.

The Germans and other Europeans are interested in tapping some Filipino healthcare talents to help take care of their ageing population. But they require highly-trained Filipino health professionals.

The Philippines has a unique role in the global geriatric market because it has a big and generally young population with an average age of only about mid-20s. Thus it can help supply the necessary healthcare professionals to countries with high elderly population like those in Europe.

The PH government since more than a decade ago has embarked on price intervention by legislating mandatory price discounts to the elderly by various private enterprises. It is 20 percent forced discount for the senor citizens in all drugstores, hospitals, restaurants, fare in airlines, bus lines and shipping line, etc. Another 12 percent VAT that private enterprises absorbed from suppliers but cannot be passed to senior citizens makes the forced discount at 32 percent or nearly one-third the price of various goods and services.

Price intervention is price dictatorship. It is an ugly characteristic by many governments. I believe that the law on benefits for senior citizens should be drastically amended, if not abolished. Let the private enterprises offer discounts or other privileges to the elderly on their own as a result of competition among themselves. Or if such forced discounts must continue, then it should apply only to the poor, not to all senior citizens including the richer ones.

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See also:

Healthy Ageing 2: World Congress on Healthy Ageing, March 08, 2012
EMHN 10: Forum on Asia's Ageing Societies, Bangkok, October 08, 2013 

Healthy Aging 3: GCOA-EMHN Policy Dialogue in Bangkok, October 24, 2013 

Healthy Ageing 4: GCOA-EMHN Meeting in Bangkok Last October, November 15, 2013

Healthy Ageing 4: GCOA-EMHN Meeting in Bangkok Last October

This is the continuation of my earlier article, GCOA-EMHN Policy Dialogue in Bangkok last month, on the Global Coalition On Aging (GCOA) - Emerging Markets Health Network (EMHN)  Policy Dialogue on Aging, held on October 23, 2013 at Plaza Athenee Bangkok, Thailand.

There were about 16 of us from eight different countries. The resource speaker was Dr. Anindya Mishra, a faculty member of the Indian Institute of Technology (IIT), Roorke India. He gave  a 30 minutes presentation entitled “Social and Economic Challenges of Ageing in Asia: Special Focus on India.”

Among the points raised by Dr. Mishra in his presentation were the following:

·         Elderly in India, 8.95% of population in 2011, 108.33 M individuals

·         Healthcare (HC) for elderly is problematic, no geriatric specialists, there is shortage of qualified medical staff especially in rural areas

·         Most female elderly are widows or without children, have feelings of social isolation

·         Government HC programs compete with other sectors, that HC for elderly are sidelined, there is minimal public spending

·         There is a cultural expectation that children should take care of their elderly

·         Rise of old age homes, but there is not much choice in Homes for Elderly

·         Two options for the elderly – be independent from children, or continue the culturally prescribed care

·         On cultural expectation, forcing children to take care of their elderly alienates them

·         Migration of many young people to the big cities or other countries leave ageing parents behind, they develop an “empty nest” syndrome

·         Absence of emotional support and caregivers, the elderly are vulnerable to crimes and abuse by other people

·         Emigrant elderly, if they join their kids to their new work elsewhere, difficulty in adjustment with new culture, values and language

·         Active and healthy ageing must be promoted

Market Responses include (a) People saving, preparing for elderly/ ageing life; (b) retirement communities are growing; middle and upper class are looking for retirement homes someday, Indian real estate companies now are slowly developing retirement communities. Estimated demand of 312,000 elderly homes, there is a supply of only 10-15,000 new homes a year.

Key challenge is that the State cannot shoulder the entire responsibility  and hence, civil society, hospitals and philanthropic organization can step in

An open forum immediately followed. Among the key messages that arose from the participants were the following:

1. The one-child policy in China, other government-sponsored population control policies are  wrong.

2. Governments healthcare policy of one or single payer system like in UK is problematic too, not only clouds personal responsibility, also heavy fiscal burden.

3. Ageing is sometimes used by the government to further intervene in the pricing of private players in the sector. One example is the expanded senior citizens discount under RA 9994, where senior citizens (60 years old and above), rich and poor alike, must be given 20 percent discount in their food purchases in formal restaurants, in their purchases of medicines, vitamins and supplements, hospitalization, and so on.

4. Free market principles and healthcare competition can better respond to the ageing problem in many countries. Give the adult children and the elderly more options for their healthcare and retirement. A single provider system like government will not be able to provide flexible solutions to emerging problems.

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See also:

Healthy Ageing 1: The Caregiver Village, February 13, 2012 
Healthy Ageing 2: World Congress on Healthy Ageing, March 08, 2012 
EMHN 10: Forum on Asia's Ageing Societies, Bangkok, October 08, 2013 

Healthy Aging 3: GCOA-EMHN Policy Dialogue in Bangkok, October 24, 2013

Healthy Ageing 1: The Caregiver Village

I am starting a new thread in healthcare, on Healthy Ageing and Caregiving, focus on household, private and civil society practices. My parents are ageing, my father is 84 years old, my mother is turning 78 and she has Alzheimer's disease, her physicians in Bacolod City confirmed this just two weeks ago to my elder sister, who is the main caregiver for both on top of her regular office work on weekdays.

My mother when she was bed ridden for nearly two weeks due to frequent allergies and asthma last June 2011. My father and elder sister, the main caregiver, beside her. We were cheering her up and beat self pity, she has been complaining that her health is "hopeless."

My other sister here in Makati is the main financier for my parents' daily needs plus hospitalization when they become very ill. I chip in limited amount and it's not even regularly, when one of them has to run to the doctor again, or for some medications. Caregiving for the elderly and ageing parents here in the Philippines still rest mainly on the children and/or grandchildren, not on the government.

A reader of my blog wrote me late last year about their group, the Caregiver Village in the US, http://www.caregivervillage.com/social-media/ Here is the situationer that they give:

The societal problem:

Despite millions of government dollars and hundreds of dedicated websites, family caregivers are in trouble.  With over 60 million family caregivers in the U.S. alone, many caregivers become sick (with nearly twice the rate of chronic illnesses as their non-caregiving peers); they’re depressed (40-70% report significant feelings of depression), they face a significantly increased risk of stroke, and they’re frustrated, unable to find resources or solutions they need to help with the enormous burden thrust upon them. They’re also costly to our economy accounting for an estimated $33.6 billion in lost productivity.   

The caregiver’s problem:

Family caregivers are exhausted, stressed to the point of illness and frustrated by their isolation.Caregiver Village’s virtual village creates a close knit community where caregivers can discover a sense of deep personal satisfaction – and escape – from the hard, intense work of family caregiving; while simultaneously learning how to handle their stress and building online connections with people in exactly the same situation as them.

And so they put up the Caregiver Village, which I think it's a very good initiative. I am not sure if the "family caregivers" they are referring here are actual family members, or caregivers hired by the government to take care of the sick and elderly in private households. I would assume that like the experience of my elder sister in the province, they are referring to family members-caregivers.

I can relate with their situationer above. My sister would be texting me from time to time asking for prayers or other help as she's getting nervous and panicky sometimes.

In the US and other rich countries, I know that there are plenty of "Home for the Aged" which are mainly government-funded, a few are run by private charities and foundations. Here in the Philippines, those homes are still few because of cultural practices and social expectations of the children mainly taking care of their ageing parents. This still falls on the category of "healthcare as personal responsibility".

There is a growing trend here in the Philippines of "retirement villages" catering to more affluent elderlies, like the returning Filipinos from abroad, or targeting old and rich/pensioner Koreans, Japanese, Europeans, etc. These are sea-side villages with a modern clinic or small hospital, or at least near the more modern hospitals. There they can enjoy fresh air, tropical climate and a clean beach resort.

Healthy ageing is something that many of us would aspire for. Ageing 60s, 70s, 80s or older and still relatively healthyand not bed ridden yet. Sharing more information on healthy and more active lifestyle, perhaps not too active that might court bad physical injuries, that's something that we can at least do.
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See also the last issues of the other healthcare threads in this blog:

1. Healthcare Competition 14: Centralization vs. Deregulation of Healthcare, December 31, 2011
2. IPR and Medicines 20: Scherer Paper on Pharmaceuticals R&D, January 10, 2012
3. PhilHealth Watch 11: Hospital Bill Deductions (b), January 19, 2012
4. Drug Price Control 24: Forcing Drug Firms to Report Payment to Doctors, January 24, 2012
5. Lifestyle Diseases 15: Preventing Metabolic Syndrome, January 27, 2012
6. RUM 3: On Combining Drug Molecules and Alaxan FR, February 03, 2012
7. Generic Drugs Asia 5: 24 Years of Generics Act, February 09, 2012