Age and infirmity no longer automatically go together. But the rapidly-growing millions who make up today's "grey generation" pose a real challenge for the future of healthcare.
When it comes to exercise, Keizo Miura could teach the younger generation a thing or two. At the age of 99, he decided to ski down Mont Blanc's celebrated Vallee Blanche.
Could he be a senior citizen?
There was more to come on his 100th birthday, when 170 friends and four generations of his family joined him in a mass ski descent at the Snowbird resort in Utah. His exploits made headlines, and when he celebrated his 101st birthday in March 2005, he was still skiing.
In the meantime, not to be outdone, his son Yuichiro became the oldest person to scale Mount Everest, at a mere 70 years old.
A shrinking younger population
The Miuras may not be exactly typical of the new generation of retired people, but they illustrate the incontrovertible fact that across the world, millions are living longer and more healthy lives.
Inevitably, however, millions of others are not so active and will need increasing healthcare. Many currently rely on the state to provide that, but a shrinking younger population in many countries means fewer people of working age contributing to national economies. The question is who will pay for public healthcare in future: the state, the individual, or the younger generation through taxes? And what's the best way to provide that care?
Private healthcare costs deter the lower-paid
It's a problem that spans continents and ideologies. Simply transferring the responsibility from the state to the individual has not proved to be the answer. In the US, for example, the high cost of private insurance deters many lower-paid employees from taking out cover. The US Census Bureau estimates that 45 million Americans (or about 15% of the population) have no health coverage, either through private insurance or through government programs such as Medicare and Medicaid, which are restricted to the elderly, disabled and certain poor groups.
How do we pay for it?
In some states, the figure for uninsured adults is far higher than the national average - over 30%, for instance, in Texas, according to a study commissioned by the Robert Wood Johnson Foundation. The reason is not difficult to find. Private plans can cost USD 10,000 a year (approximately 8,300 Euros or GBP 5,500). As a Foundation spokesman observed: "There is no way for a pot-washer in the back of a restaurant to afford that."
The Organization for Economic Cooperation and Development (OECD) admits that attitudes vary widely among the 30 countries it represents. Some governments don't see private health insurance as an important or desirable part of their health systems, others consider it a pillar.
In any event, private health insurance doesn't necessarily shift the cost from public systems, because privately financed hospitals often focus on a limited range of "niche" services. This leaves public health programs responsible for more expensive treatments or for sections of the population that need more resources.
Challenges for individual countries
Transferring the burden to today's workforce via their contributions and taxes will not solve the long-term problem, either. Many countries have falling birthrates, a shrinking younger generation, and perhaps a particular challenge.
China, for example, has a rapidly growing elderly population and far fewer young people because of the state's former strict one-child-per-family policy. It's estimated that by 2050, no fewer than 438 million Chinese (29% of the population) will be older than 60.
In the UK, the high cost of living - and housing in particular - means that younger people find it difficult to save for retirement. The poor performance of some investments and collapse of some company pensions funds has also been a deterrent.
Some countries, however, have found a way. More than 20 years ago, Singapore introduced obligatory medical savings accounts for its citizens as a way of not only covering medical expenses but also contributing to housing costs and pensions. Employer and employee each pay 20% into a central fund administered by the government, which invests in the capital market and guarantees a minimum of 2.5% interest. Funds can be inherited.
In 10 of the 30 countries belonging to the Organization for Economic Cooperation and Development (OECD), at least 30% of the population has private health insurance. These nations are Australia, Austria, Belgium, Canada, France, Ireland, New Zealand, Netherlands, Switzerland and the US. Company health insurance schemes often contribute to an even higher proportion (as in the US, Canada, France).
More countries, however, have a negligible proportion of their population with private insurance, or a percentage somewhere between that and 30%. In the negligible category are the Czech Republic, Hungary, Iceland, Japan, Norway, Poland, Slovak Republic and Sweden. Countries in between are Denmark, Finland, Germany, Greece, Italy, Korea, Luxembourg, Mexico, Portugal, Spain, Turkey and the UK.1
1 Source: OECD policy brief, September 2004
