Vous êtes sur la page 1sur 16

Indu Bhushan, Patricia Moser and Vivian Francisco

Hic Sunt Dracones (Here


are dragons): Prospects of
runaway health care cost in
the graying emerging
economies of Asia
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not
necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of
Governors, or the governments they represent. ADB does not guarantee the accuracy of the data
included in this paper and accepts no responsibility for any consequence of their use. Terminology
used may not necessarily be consistent with ADB official terms.
Economic and
Demographic
Information, 2012
Peoples
Republic of
China
Indonesia

Viet Nam
Population (million) 1,351 247 89
Population , >65 (%) 8.7 5.1 6.6
Old-age Dependency Ratio
(% of working-age
population)
11.8

7.8

9.3

GDP per capita (constant
2005 US$)
3,348

1,732

986

Health expenditure per
capita, PPP (constant 2005
international $, 2012)
480

150 233

Background
Source: UN, Department of Economic and Social Affairs. World Population Prospects: The 2012 Revision
http://esa.un.org/wpp/Excel-Data/population.htm (accessed 4 April 2014) and World Bank, World Development
Indicators online database http://data.worldbank.org/data-catalog/world-development-indicators (Accessed 30 May
2014).



Demographic Shifts
0
20
40
60
80
100
120
140
160
0
-
4
5
-
9
1
0
-
1
4
1
5
-
1
9
2
0
-
2
4
2
5
-
2
9
3
0
-
3
4
3
5
-
3
9
4
0
-
4
4

4
5
-
4
9
5
0
-
5
4
5
5
-
5
9
6
0
-
6
4
6
5
-
6
9
7
0
-
7
4
7
5
-
7
9
8
0
-
8
4
8
5
-
8
9
9
0
-
9
4
9
5
-
9
9
1
0
0
+
I
n

M
i
l
l
i
o
n
s

Age Group
PRC
2010
2030
2050
0
5
10
15
20
25
30
0
-
4
5
-
9
1
0
-
1
4
1
5
-
1
9
2
0
-
2
4
2
5
-
2
9
3
0
-
3
4
3
5
-
3
9
4
0
-
4
4

4
5
-
4
9
5
0
-
5
4
5
5
-
5
9
6
0
-
6
4
6
5
-
6
9
7
0
-
7
4
7
5
-
7
9
8
0
-
8
4
8
5
-
8
9
9
0
-
9
4
9
5
-
9
9
1
0
0
+
I
n

M
i
l
l
i
o
n
s

Age Group
Indonesia
2010
2030
2050
0
1
2
3
4
5
6
7
8
9
10
0
-
4
5
-
9
1
0
-
1
4
1
5
-
1
9
2
0
-
2
4
2
5
-
2
9
3
0
-
3
4
3
5
-
3
9
4
0
-
4
4

4
5
-
4
9
5
0
-
5
4
5
5
-
5
9
6
0
-
6
4
6
5
-
6
9
7
0
-
7
4
7
5
-
7
9
8
0
-
8
4
8
5
-
8
9
9
0
-
9
4
9
5
-
9
9
1
0
0
+
I
n

M
i
l
l
i
o
n
s

Age Group
Viet Nam
2010
2030
2050
Total population by five-year age
group (million)
Source: UN, Department of Economic and Social Affairs.
World Population Prospects: The 2012 Revision
http://esa.un.org/wpp/Excel-Data/population.htm
(accessed 4 April 2014)


Demographic Shifts
0
50
100
150
200
250
300
350
PRC Indonesia Viet Nam
I
n

M
i
l
l
i
o
n
s

2010
2030
2050
Total population, 65 years and over (million, percent)
Source: UN, Department of Economic and Social Affairs. World Population Prospects: The 2012 Revision
http://esa.un.org/wpp/Excel-Data/population.htm (accessed 4 April 2014)
0
5
10
15
20
25
30
PRC Indonesia Viet Nam
I
n

P
e
r
c
e
n
t

2010
2030
2050
PRC
Indonesia
Viet Nam
USA
0
5
10
15
20
25
30
35
40
2010 2015 2020 2025 2030 2035 2040
P
e
r
c
e
n
t

Demographic Shifts
Source: UN, Department of Economic and Social Affairs. World Population Prospects: The 2012 Revision
http://esa.un.org/wpp/Excel-Data/population.htm (accessed 1 July 2014).
Old-age dependency ratio (ratio of population aged 65+ per 100 population 15-64)
Speed of Population Aging
Share in total population (percent)
The shares of elderly population rose more steeply in PRC and Indonesia than in Viet Nam where rapid
increase happened instead in the 15-64 age group in 1995-2012. The share of elderly population in Viet Nam
will begin to climb and at rate faster than in two other countries only in years after 2015.
0
5
10
15
20
25
30
35
1
9
9
5
1
9
9
7
1
9
9
9
2
0
0
1
2
0
0
3
2
0
0
5
2
0
0
7
2
0
0
9
2
0
1
1
2
0
1
5
2
0
2
5
2
0
3
5
2
0
4
5
2
0
5
5
2
0
6
5
2
0
7
5
2
0
8
5
2
0
9
5
Model Forecast
P
e
r
c
e
n
t

65 years and over
Viet Nam PRC Indonesia
0
10
20
30
40
50
60
70
80
1
9
9
5
1
9
9
7
1
9
9
9
2
0
0
1
2
0
0
3
2
0
0
5
2
0
0
7
2
0
0
9
2
0
1
1
2
0
1
5
2
0
2
5
2
0
3
5
2
0
4
5
2
0
5
5
2
0
6
5
2
0
7
5
2
0
8
5
2
0
9
5
Model Forecast
P
e
r
c
e
n
t

15-64 years
Viet Nam PRC Indonesia
Source: UN, Department of Economic and Social Affairs. World Population Prospects: The 2012 Revision
http://esa.un.org/wpp/Excel-Data/population.htm (accessed 4 April 2014)
Speed of Population Aging
7
8
9
10
11
12
13
14
1860 1880 1900 1920 1940 1960 1980 2000 2020 2040
P
e
r
c
e
n
t

o
f

p
o
p
u
l
a
t
i
o
n

a
g
e
d

6
5
+

Time required or expected for percentage of population aged 65 and over to rise from 7 to
14 percent
The proportion of elderly people is rising faster in developing countries
than in the developed world.
Source: Adapted from Kinsella K. He W. An Aging World: 2008. Washington DC: National Institute on Aging and U.S.
Census Bureau, 2009.
Determinants of Health Care Cost
Income
Morbidity levels
Technology
Other factors (including
health system coverage and
efficiency)
Health Care Costs
Health expenditure per capita, PPP (constant 2005 international $)
health care expenditures has risen significantly in recent years
Source: World Bank, World Development Indicators online database http://data.worldbank.org/data-catalog/world-
development-indicators (Accessed 30 May 2014)
PRC
Indonesia
Viet Nam
0
100
200
300
400
500
600
1995 1997 1999 2001 2003 2005 2007 2009 2011
2
0
0
5

i
n
t
e
r
n
a
t
i
o
n
a
l

$

Effects of Aging and Population Growth on
Health Expenditure
MODEL
Health expenditure per capita= f (GDP per capita, % of
population 65 and over)
Country Intercept
GDP per
capita
% of
popn 65
and over
R2 N
PRC -6.5717 0.6718 3.3591 0.9945 18
t-stat -17.2381 3.1092 3.5160
Indonesia -12.8105 1.7461 2.9778 0.9580 18
t-stat -12.9965 9.0666 5.8503
Viet Nam -6.3863 2.1172 -1.4211 0.9861 18
t-stat -6.2581 21.8896 -1.8121
Notes: N refers to number of time series observations from 1995 to 2012
when data for health expenditure per capita is available. Regression
coefficients and t-values in gray are insignificant.

Health expenditure per capita tends
to increase with GDP per capita and
population aging in PRC and
Indonesia

Health spending in Viet Nam,
however, is influenced only by
income. The share of elderly
population in Viet Nam is relatively
stable during the period when
regression was done. In contrast,
those for PRC and Indonesia have
been rising more steeply.

Population aging measured by % of
population aged 65 and over has
higher impact on health spending
than GDP per capita.
Original estimates
Effects of Aging and Population Growth on
Health Expenditure
MODEL
Health expenditure per capita= f (GDP per capita, % of
population 65 and over)
Country Intercept
GDP per
capita
% of
popn 65
and over
R2 N
PRC -6.5717 0.6718 3.3591 0.9945 18
t-stat -17.2381 3.1092 3.5160
Indonesia -12.8105 1.7461 2.9778 0.9580 18
t-stat -12.9965 9.0666 5.8503
Viet Nam -8.1110 1.9754 0.9841 18
t-stat -20.6084 32.4840
Notes: N refers to number of time series observations from 1995 to 2012
when data for health expenditure per capita is available.

Health expenditure per capita tends
to increase with GDP per capita and
population aging in PRC and
Indonesia

Health spending in Viet Nam,
however, is influenced only by
income. The share of elderly
population in Viet Nam is relatively
stable during the period when
regression was done. In contrast,
those for PRC and Indonesia have
been rising more steeply.

Population aging measured by % of
population aged 65 and over has
higher impact on health spending
than GDP per capita.
Preferred solution: Viet Nam model excludes elderly
population.
Health care cost in 2030
Viet Nam estimates excludes elderly population.
PRC, 6780
Indonesia, 5828
Viet Nam, 3071
0
1000
2000
3000
4000
5000
6000
7000
8000
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
2
0
1
1
2
0
1
2
2
0
1
3
2
0
1
4
2
0
1
5
2
0
1
6
2
0
1
7
2
0
1
8
2
0
1
9
2
0
2
0
2
0
2
1
2
0
2
2
2
0
2
3
2
0
2
4
2
0
2
5
2
0
2
6
2
0
2
7
2
0
2
8
2
0
2
9
2
0
3
0
H
e
a
l
t
h

e
x
p
e
n
d
i
t
u
r
e

p
e
r

c
a
p
i
t
a
,

P
P
P


(
2
0
0
5

i
n
t
e
r
n
a
t
i
o
n
a
l

$
)

Health expenditure, total (% of GDP)
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010 2011 2012 2030
P
e
r
c
e
n
t


PRC
Indonesia
Viet Nam
We do not knowHere are dragons
Probably the real impact will not be as
severe, since both demand and supply
curve might shift
Demand: morbidity compression might
attenuate demand
Supply: Health systems improvement might
bring in efficiency

Will these Malthusian predictions come
true?
No research to support this hypothesis in these
countries: we are in uncharted territories
However, two factors might need to be considered
Increase in elderly population outweighs any
potential morbidity compression
Morbidity compression might not happen in
emerging economies, since todays elderly
population experienced
poor nutrition in their childhood
environmental insult during adulthood
Will Morbidity Compression Attenuate the
Increase in Health Costs?
The three Asian Countries are likely to see large
increase in their health care costs, which can
become unaffordable
Population aging will be one key factor in this
increase
Much more research is needed to understand the
likely impact of aging process on health care costs
New models of health care costs need to be
developed
Need to start working on this issue NOW

CONCLUSION

Vous aimerez peut-être aussi