Healthcare spending as a proportion of GDP has almost doubled since 1990, from just over 5% to almost 10% now. Healthcare costs rise exponentially in old age. Healthcare costs per capita are relatively stable during the first five decades of life, but they quadruple over the next four decades. This means that most healthcare spending represents a transfer from the working-age generation to the retired generation. The combination of rising life expectancy and low birth rates is a demographic pincer movement for the health system. The ratio of people of retirement age to people of working age currently stands at 28 to 100. This is forecast to rise to 47 to 100 by 2064. The Office for Budget Responsibility (OBR) predicts only modest increases in NHS spending as a proportion of GDP, but this forecast is predicated on the heroic assumption that the NHS is going to double its long-term productivity growth rate. The basic problem is that the NHS is financed on a pay-as-you-go basis. The alternative would be a prefunded system that builds up old-age reserves (comparable to pension funds) for people of working age, and then draws upon them when people retire. In such a system, population ageing would be much less of a problem, because as the number of elderly people grows, the reserves accumulated in the old-age funds would grow alongside. The NHS could begin to build up a similar old-age reserve fund. This would require a one-off increase in taxes, or spending cuts in the non-healthcare budget. But it would prevent steeper tax increases (or spending cuts) in the future. While the basic idea of prefunding is simple, a lot of details would need to be worked out first, the idea of prefunding healthcare expenditure is not even part of our current healthcare debate. It should be.
{"title":"A Piggy Back for Healthcare: Why the Health System Needs Old-age Reserve Funds","authors":"K. Niemietz","doi":"10.2139/ssrn.3853070","DOIUrl":"https://doi.org/10.2139/ssrn.3853070","url":null,"abstract":"Healthcare spending as a proportion of GDP has almost doubled since 1990, from just over 5% to almost 10% now. Healthcare costs rise exponentially in old age. Healthcare costs per capita are relatively stable during the first five decades of life, but they quadruple over the next four decades. This means that most healthcare spending represents a transfer from the working-age generation to the retired generation. The combination of rising life expectancy and low birth rates is a demographic pincer movement for the health system. The ratio of people of retirement age to people of working age currently stands at 28 to 100. This is forecast to rise to 47 to 100 by 2064. The Office for Budget Responsibility (OBR) predicts only modest increases in NHS spending as a proportion of GDP, but this forecast is predicated on the heroic assumption that the NHS is going to double its long-term productivity growth rate. The basic problem is that the NHS is financed on a pay-as-you-go basis. The alternative would be a prefunded system that builds up old-age reserves (comparable to pension funds) for people of working age, and then draws upon them when people retire. In such a system, population ageing would be much less of a problem, because as the number of elderly people grows, the reserves accumulated in the old-age funds would grow alongside. The NHS could begin to build up a similar old-age reserve fund. This would require a one-off increase in taxes, or spending cuts in the non-healthcare budget. But it would prevent steeper tax increases (or spending cuts) in the future. While the basic idea of prefunding is simple, a lot of details would need to be worked out first, the idea of prefunding healthcare expenditure is not even part of our current healthcare debate. It should be.","PeriodicalId":107717,"journal":{"name":"PsychRN: Adult Development & Aging (Topic)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133518236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article assesses the roles of preferences and expectations on preparation for old age, employing unique data on French individuals aged 50+. The data do not only contain information on the general feeling to prepare for old age and on specific preparation activities in various domains, but also on risk and time attitudes, family and social altruism, and expected disability and longevity. Half of the sample reports preparing for old age. Future orientation emerges as an important predictor of preparation. While risk attitudes and altruism also matter for preparation, their effect may be less systematic across outcomes than that of general future orientation. Individuals who expect to become disabled or to live longer are more likely to prepare for old age. Policies promoting healthy aging should include messages targeting present-oriented individuals and try to make people more future-oriented.
{"title":"Preparation for Old Age in France: The Roles of Preferences and Expectations","authors":"B. Apouey","doi":"10.2139/ssrn.3070883","DOIUrl":"https://doi.org/10.2139/ssrn.3070883","url":null,"abstract":"This article assesses the roles of preferences and expectations on preparation for old age, employing unique data on French individuals aged 50+. The data do not only contain information on the general feeling to prepare for old age and on specific preparation activities in various domains, but also on risk and time attitudes, family and social altruism, and expected disability and longevity. Half of the sample reports preparing for old age. Future orientation emerges as an important predictor of preparation. While risk attitudes and altruism also matter for preparation, their effect may be less systematic across outcomes than that of general future orientation. Individuals who expect to become disabled or to live longer are more likely to prepare for old age. Policies promoting healthy aging should include messages targeting present-oriented individuals and try to make people more future-oriented.","PeriodicalId":107717,"journal":{"name":"PsychRN: Adult Development & Aging (Topic)","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124261659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-09-01DOI: 10.15678/ZP.2015.32.2.04
Andrzej Klimczuk
Polish Abstract: Starzenie sie spoleczenstw stanowi wyzwanie, ktore wymaga opracowywania i wdrazania horyzontalnej polityki spolecznej. Polityka ta powinna uwzgledniac zroznicowanie osob starszych oraz odmiennośc dzialan skierowanych do osob starszych i na wizerunek starości. Zlozonośc negatywnych konsekwencji starzenia sie sprawia, iz kluczowe jest zwiekszenie wspolpracy podmiotow publicznych, komercyjnych, pozarządowych i nieformalnych na wszystkich poziomach organizacji polityki spolecznej. Opracowanie ma na celu przyblizenie modeli wielosektorowej polityki spolecznej oraz podkreślenie mozliwości integracji uslug spolecznych. Artykul wskazuje na szanse i zagrozenia dla integracji uslug ze szczegolnym uwzglednieniem zagadnien srebrnej gospodarki, wykluczenia cyfrowego i robotycznego. W podsumowaniu wskazano na mozliwości rozwoju innowacji spolecznych oraz kierunki dalszych badan.English Abstract: Aging is a challenge that requires development and implementation of the horizontal social policy. This policy should take into account diversity of older adults and division of interventions aimed at this population and on the image of old age. Complexity of the negative consequences of aging shows that there is a need to enhance cooperation between the public sector, the commercial sector, the NGO sector, and the informal sector at all levels of social policy social policy. The article discusses models of the multisectoral social policy and possibilities of integrating social services. Conclusions include directions for further research and social innovation.
{"title":"Modele wielosektorowej polityki społecznej wobec ludzi starych i starości w kontekście zmiany technologicznej (Models of Multisectoral Social Policy Towards Older People and Old Age in the Context of Technological Change)","authors":"Andrzej Klimczuk","doi":"10.15678/ZP.2015.32.2.04","DOIUrl":"https://doi.org/10.15678/ZP.2015.32.2.04","url":null,"abstract":"Polish Abstract: Starzenie sie spoleczenstw stanowi wyzwanie, ktore wymaga opracowywania i wdrazania horyzontalnej polityki spolecznej. Polityka ta powinna uwzgledniac zroznicowanie osob starszych oraz odmiennośc dzialan skierowanych do osob starszych i na wizerunek starości. Zlozonośc negatywnych konsekwencji starzenia sie sprawia, iz kluczowe jest zwiekszenie wspolpracy podmiotow publicznych, komercyjnych, pozarządowych i nieformalnych na wszystkich poziomach organizacji polityki spolecznej. Opracowanie ma na celu przyblizenie modeli wielosektorowej polityki spolecznej oraz podkreślenie mozliwości integracji uslug spolecznych. Artykul wskazuje na szanse i zagrozenia dla integracji uslug ze szczegolnym uwzglednieniem zagadnien srebrnej gospodarki, wykluczenia cyfrowego i robotycznego. W podsumowaniu wskazano na mozliwości rozwoju innowacji spolecznych oraz kierunki dalszych badan.English Abstract: Aging is a challenge that requires development and implementation of the horizontal social policy. This policy should take into account diversity of older adults and division of interventions aimed at this population and on the image of old age. Complexity of the negative consequences of aging shows that there is a need to enhance cooperation between the public sector, the commercial sector, the NGO sector, and the informal sector at all levels of social policy social policy. The article discusses models of the multisectoral social policy and possibilities of integrating social services. Conclusions include directions for further research and social innovation.","PeriodicalId":107717,"journal":{"name":"PsychRN: Adult Development & Aging (Topic)","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131173828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Even the most cursory search of news coverage involving nursing homes reveals that horror stories are not difficult to come by. Although the grisly details of each individual horror story vary, most of them share the same general story line — through some combination of gross negligence and profound systemic failure, elderly citizens can experience disturbing conditions in nursing homes that result in suffering and sometimes death. Although egregious stories make local news headlines every so often and prompt a brief firestorm of public criticism, the everyday reality of nursing homes is much less sensationalized, and arguably even more sobering. Statistics indicate that abuse and neglect frequently go unreported, and both research and anecdotes indicate that nursing homes often fail to live up to their billing as places of care, calm, and comfort. These indications raise troubling sociological, legal, and ethical questions about how we care for one of our most vulnerable populations — the elderly. This paper analyzes nursing home failures in light of the federal regulatory regime that oversees them. Section II provides a framework for the discussion of nursing homes by describing the choices seniors have for their living arrangements. In order to establish context for the current social and legal space inhabited by nursing homes, Section III traces the historical development of the modern nursing homes, with a particular focus on the landmark laws of the 1960s that paved the way for late-twentieth century proliferation of nursing homes. With this background in mind, Section IV explores the federal regulatory regime that governs nursing homes, and Section V details the bodies and mechanisms that enforce federal rules and regulations. Section VI provides evidence and statistics regarding the prevalence of abuse and neglect in nursing homes and argues that these data evidence a troubled regulatory system. Section VII examines the Patient Protection and Affordable Care Act, which has been heralded as the most significant legislation affecting the healthcare industry in decades, and concludes that the law does not contain provisions that will serve to reduce elder abuse and neglect in any significant way. Section VIII offers recommendations to improve nursing home care in light of the foundation provided by PPACA. Section IX discusses potential blowback that these and other solutions may present and urges reformers to proceed carefully and thoughtfully before enacting any proposed reform.
{"title":"The Troubled State of America's Nursing Homes","authors":"A. Moran","doi":"10.2139/ssrn.2488514","DOIUrl":"https://doi.org/10.2139/ssrn.2488514","url":null,"abstract":"Even the most cursory search of news coverage involving nursing homes reveals that horror stories are not difficult to come by. Although the grisly details of each individual horror story vary, most of them share the same general story line — through some combination of gross negligence and profound systemic failure, elderly citizens can experience disturbing conditions in nursing homes that result in suffering and sometimes death. Although egregious stories make local news headlines every so often and prompt a brief firestorm of public criticism, the everyday reality of nursing homes is much less sensationalized, and arguably even more sobering. Statistics indicate that abuse and neglect frequently go unreported, and both research and anecdotes indicate that nursing homes often fail to live up to their billing as places of care, calm, and comfort. These indications raise troubling sociological, legal, and ethical questions about how we care for one of our most vulnerable populations — the elderly. This paper analyzes nursing home failures in light of the federal regulatory regime that oversees them. Section II provides a framework for the discussion of nursing homes by describing the choices seniors have for their living arrangements. In order to establish context for the current social and legal space inhabited by nursing homes, Section III traces the historical development of the modern nursing homes, with a particular focus on the landmark laws of the 1960s that paved the way for late-twentieth century proliferation of nursing homes. With this background in mind, Section IV explores the federal regulatory regime that governs nursing homes, and Section V details the bodies and mechanisms that enforce federal rules and regulations. Section VI provides evidence and statistics regarding the prevalence of abuse and neglect in nursing homes and argues that these data evidence a troubled regulatory system. Section VII examines the Patient Protection and Affordable Care Act, which has been heralded as the most significant legislation affecting the healthcare industry in decades, and concludes that the law does not contain provisions that will serve to reduce elder abuse and neglect in any significant way. Section VIII offers recommendations to improve nursing home care in light of the foundation provided by PPACA. Section IX discusses potential blowback that these and other solutions may present and urges reformers to proceed carefully and thoughtfully before enacting any proposed reform.","PeriodicalId":107717,"journal":{"name":"PsychRN: Adult Development & Aging (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115407147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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