Demographic conundrum: Caring for a young nation that’s ageing, too

India may be one of the youngest countries, with more than 60 per cent of its population below 35 years of age, but the picture is set to change dramatically in a couple of decades.

But does the recently released National Health Policy 2017 take this impending demographic change into account?

It does hint at a “future-ready” approach, say healthcare specialists, pointing to pre-paid health insurance that is a move towards ensuring affordable healthcare for the elderly, often left outside the insurance purview.

As it exists today, the health insurance system is lopsided putting the burden on the young and the old equally. “The young have the capability to pay maximum premium, which should be reduced for senior citizens. This will increase the insurance penetration. In 2020, we will be the youngest country in the world and in 2040 we will be the oldest. It is time we started planning for that,” says Sujit Chatterjee, Chief Executive of Hiranadani Hospitals.

And while the Health Policy’s focus on primary-care, especially maternal and neo-natal, is spot on, he points out that “the maximum number of diseases happen at the secondary level, which comes at a fairly reasonable cost even at big corporate hospitals. But when it comes to tertiary or quaternary level of care, there rises the problem of affordability. And the answer is pre-paid health.” The penetration of health insurance has to increase alongside government schemes, he adds. More importantly, the spread of information and awareness about preventive healthcare, which could be a big boost for a healthier society. And setting up the National Digital Health Authority (NDHA) recognises the integral role of technology in healthcare delivery.

For the younger population, information on health and preventive healthcare is easily accessible thanks to technology, but NDHA will help the elderly access information sitting in their home, says Ravi Bhandari, CEO of Ahmedabad’s Shalby Hospitals.

“So far we have talked about treatment after onset of an ailment. Now, we are talking about preventive healthcare. An alert population will spot diseases early and cure them. This way life expectancy goes up and the quality of life improves too,” he says.

More facilities require more skilled people especially in geriatric care. India’s over-60 population is about 103 million or 8.6 per cent of the total population; 8 per cent of this segment is confined to bed or home. So, there is also a growing need of palliative care, requiring culturally appropriate and cost-effective family-centered approaches.

D K Mangal, Dean - Research, IIHMR University (Jaipur), says that to make the Health Policy more effective, the perspective of looking at the health expenditure has to change — less as a social welfare spending but more as an investment in human resource.

“Health should be viewed as a resource and the spend on health should be treated as an investment and not as social welfare spending. Through all these decades, it has been viewed as a social welfare measure, rather than as an investment in human resource. It is satisfying to note that this policy document specifically committs that progressively it will achieve universal health coverage,” he adds.

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