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Aged Care in Emerging Asia: New Demands, Evolving Responses, and Future Directions

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Handbook of Aging, Health and Public Policy

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Abstract

The confluence of rapid demographic transitions, economic imperatives, and shifting social norms gives real urgency to Asia’s efforts to develop formal aged care systems as a complement to informal care. This chapter provides an overview of evolving aged care systems across selected emerging countries in East, Southeast, and South Asia (China, Thailand, Vietnam, Indonesia, India, and Sri Lanka), looking at commonalities and differences, challenges, and issues for the future. While informal care dominates and formal systems remain nascent across developing Asia, emerging experience offers insights for further development of the sector. While there is no single “right” model of aged care across these countries, they face common challenges, including ensuring complementarity between informal care and formal systems, equity of access, promoting horizontal and vertical institutional coordination, achieving adequate but sustainable public financing, and defining the appropriate roles of the state, market providers, communities, and households. Aligning aged care with healthcare, social security, labor market, and fiscal policies will also be needed to promote policy and service delivery coherence.

O’Keefe is Director of the Ageing Asia Research Hub at the ARC Centre of Excellence in Population Ageing Research (CEPAR) and Professor of Practice at University of New South Wales Business School. Yiengprugsawan was Senior Fellow at CEPAR (at submission). The authors thank John Piggott, Elena Glinskaya, Dewen Wang, Srinivas Varadan, Ravi Rannan-Eliya, Bei Lu, Maliki, Dinar Kharisma, Giang Long, and Nalinee Chuakhamfoo.

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Notes

  1. 1.

    Aged care here includes medical, rehabilitative and palliative aged care, and social care for older people. Services include residential, community-based, and home-based care, whether publicly or privately provided. Formal aged care services are those provided with compensation from some source (public and/or private).

  2. 2.

    Several countries in Asia have legislated an obligation of adult children to care for parents in need of support, including China, India, Vietnam, and Myanmar.

  3. 3.

    Apex agencies include the China National Committee on Ageing, Thailand National Committee for the Elderly, India National Council for Senior Citizens, Vietnam National Committee on Ageing and Vietnam Association of the Elderly, Indonesia National Commission for Older Persons, and Sri Lanka National Council for Elders.

  4. 4.

    There were nearly 3000 ISHC nationwide by 2021, with around 160,000 members (HelpAge International, 2021). https://www.ahwin.org/helpage-vietnam-ishc/

  5. 5.

    https://www.asiaadvisersnetwork.com/Article/aid/49637/Asia-Pacific-A-Hub-for-Silver-Market-Opportunities

  6. 6.

    The accreditation system is more advanced at higher-income levels, with LTC hospitals in Korea, for example, subject to evaluation every 4 years by the Korea Institute for Healthcare Accreditation (Jeon & Kwon, 2017).

  7. 7.

    The comparable figure in OECD countries is 5–8%.

  8. 8.

    https://eduindex.org/2021/07/14/the-reason-behind-the-rising-number-of-old-age-homes-in-india/

  9. 9.

    Japan and Korea have more elaborated and standardized assessment systems. Japan uses a 74-item questionnaire with 7 levels of LTC need (Iwagami & Tamiya, 2019), and Korea uses a 90-item checklist with 6 levels of need, 2 of them dementia-specific (Ga, 2020).

  10. 10.

    https://data.worldbank.org/indicator/SH.MED for physician and nurse to population ratios.

  11. 11.

    Put another way, the OECD median for full-time equivalent formal aged care workers in 2014 was 4.2 per 1000 population 65 and over, while ratios in China, Thailand, and India were 1.1, 0.7, and 0, respectively (Scheil-Adlung, 2015).

  12. 12.

    This is an important efficiency issue apart from reflecting preferences of older people. Studies from Qingdao and Shanghai find major cost reductions of having older people in long-term care rather than hospital care (Lu et al., 2020; Feng et al., 2020).

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Authors and Affiliations

  1. CEPAR, University of New South Wales, Sydney, NSW, Australia

    Philip O’Keefe & Vasoontara Sbirakos Yiengprugsawan

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  1. Philip O’Keefe
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  2. Vasoontara Sbirakos Yiengprugsawan
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Correspondence to Philip O’Keefe .

Section Editor information

  1. International Institute of Migration and Development, Trivandrum, India

    . Sreerupa

  2. School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, India

    C. V. Irshad

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O’Keefe, P., Yiengprugsawan, V.S. (2023). Aged Care in Emerging Asia: New Demands, Evolving Responses, and Future Directions. In: Handbook of Aging, Health and Public Policy. Springer, Singapore. https://doi.org/10.1007/978-981-16-1914-4_150-1

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  • DOI: https://doi.org/10.1007/978-981-16-1914-4_150-1

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