3
should avoid cash reimbursements in favor of in-kind service, and
should ensure the adequacy of both the number and quality of
care providers by setting national standards. Japan and Korea
are two of the only countries in the world to publicly provide
LTC services.
John Campbell
of the University of Michigan and
Soonman Kwon
, Dean of the School of Public Health at Seoul
National University, described the programs in the two countries
and implementation challenges, which include controlling costs,
integration with health care service provision, determining
eligibility, and maintaining standards of service quality.
Winnie
Yip
of the University of Oxford characterized Asian health care
systems as being quite heterogeneous, often with mixed financing
sources and fragmented service delivery. She argued that effective
health care provision requires more integrated services in which
primary health care providers deliver basic services and case
workers coordinate care delivery by multiple formal and informal
caregivers to better meet the health care needs of the elderly.
Albert Park
, Director of HKUST IEMS, provided evidence that
the health expenditures of rural Chinese actually decline at older
ages despite deteriorating health, suggesting that many rural
elderly are not receiving adequate care despite the expansion of
government-subsidized rural health insurance.
Alfred Chan Cheung-ming
, a member of Hong Kong’s Aging
Commission and a Professor of Social Gerontology at Lingnan
University, described the Hong Kong government’s responses
to the challenges of population aging. He explained that the
Hong Kong government seeks to establish an integrated care
system with the family as core, the neighborhood providing
support, and the government providing supplementary assistance.
The government supports projects to engage the family and
community to integrate formal and informal care, with the goal
of establishing a sustainable old-age care system that does not
dramatically increase public burdens.
Designing sustainable
p e n s i o n a n d s o c i a l
protection systems that
d o n o t c re a t e s t ro ng
wo r k d i s i nc en t i v e s t o
stop working is a key
policy challenge.
Atsushi
S e i k e
, C h a i r m a n o f
Japan’s Council for the
P r o m o t i o n o f S o c i a l
Security System Reform
and President of Keio
Un i v e r s i t y, d e l i v e r e d
a k e y n o t e s p e e c h i n
which he stressed the
need to establish a life-
long active society and recognize the necessity of implementing
reforms that eliminate mandator y retirement and work
disincentives associated with pension payment rules, allow more
flexible wage determination, and protect older workers from
age discrimination.
Robert Palacios
, the World Bank’s pension
team leader, grouped countries into three categories of pension
systems. For those with defined contribution systems (Indonesia,
Malaysia, Singapore), sustainability is not a concern but adequacy
of pensions may be an issue. For those with defined benefit
systems (China, Korea, Japan, Philippines, Thailand), the main
challenge is sustainability, with debates frequently arising on how
best to adjust program parameters. Finally, countries without
national pension systems (Myanmar, Laos, Cambodia) must avoid
the mistakes of other countries (e.g. unsustainable financing)
and overcome capacity limitations.
John Piggott
, Director of
Australian Institute for Population Research, shared some lessons
from Australia’s experience. The Australian system emphasizes
needs instead of rights, and Prof. Piggott supports means testing
for social protection and required savings as policy options. A
panel discussion invited
Worawet Suwanrada
, Dean of the
College of Population Studies from Chulalongkorn University,
and
Mitchell Wiener
and
Dewen Wang
of the World Bank
to discuss the country-specific challenges faced by Thailand,
Indonesia, and China.
A session on Demographics and Growth featured presentations
by
Andrew Mason
, one of the leaders of the National
Transfer Accounts project and Professor at the University of
Hawaii, and
Thomas Flochel
and
Maurizio Bussoli
of the
World Bank. Finally, the session on Elderly Well-being included
a keynote speech by
James Smith
of RAND Corporation on
the well-being of China’s elderly, an overview talk by
John
Giles
of the World Bank, and six presentations on the situation
of the elderly in East and South-east Asia. Three related
presentations by
Jinkook Lee
of USC and
Chulhee Lee
of
Seoul National University,
Yasuyuki Sawada
of the University
of Tokyo, and
Xiaoyan Lei
of Peking University examined the
mental well-being of the elderly in Korea, Japan and China,
where suicide rates are among the highest in the world.
Examining comparable HRS-type longitudinal data sets, they
found that the very
high rates of elevated
depressive symptoms
in Korea and China are
associated with poor
health, low education,
economic vulnerability
(especially in Korea),
f a m i l y s u p p o r t ,
and social activity.
P r e s e n t a t i o n s o n
S o u t h - e a s t A s i a n
countries were made
by
Firman Witoelar
,
R e s e a r c h D i r e c t o r
of SurveyMETER on
I n d o n e s i a ,
J o h n
Knodel
of the University of Michigan on Myanmar, Thailand,
and Vietnam,
Angelique Chan
of National University of
Singapore, and
Tengku Aizan Hamid
, Director of the
Institute of Gerontology from Universiti Putra Malaysia.
Video recordings and other
conference materials are available at
Angelique Chan (left) • Robert Willis (middle) • Bryce Hool (right)
Andrew Mason
James Smith
