Population ageing and national healthcare systems sustainability. A review of world practices

By 2050, the proportion of people over 60 years of age worldwide is expected to be 22 %, and the number of people over 80 is expected to triple by that time, reaching 426 million. Population aging threatens the sustainable functioning of national health care systems, since the increase in the proportion of the elderly population is accompanied by increased costs for the health care system and a decrease in the availability of medical care for other age groups. Based on the analysis and synthesis of data from foreign publications on the impact of population aging on the sustainability of the functioning of national healthcare systems, proposed measures and models of medical care that take into account changes in the age structure of the population are systematized. Analysis of foreign publications made it possible to identify the following challenges for the healthcare system associated with the aging population: rising costs of providing medical care, the need to increase emphasis on preventive measures, increasing prevalence and severity of chronic non-communicable diseases and comorbidity, inequality in access to medical care, expressed in territorial (regional), age and gender aspects, as well as determined by the socio-economic status of a person. Experts suggest that the most obvious and realistic solution to the problem is active prevention of chronic diseases and more intensive monitoring of the health status of the population. Digital solutions that provide disease prevention and remote monitoring of the health status of the elderly population, based on the use of machine learning technologies, artificial intelligence and telemedicine technologies, are identified as promising areas for limiting healthcare costs.

1. Lopreite M., Misuraca M., Puliga M. An analysis of the thematic evolution of ageing and healthcare expenditure using word embedding Socio-Economic Planning Sciences. 2023; 87 (part B): 101600. https://doi.org/10.1016/j.seps.2023.101600

2. Lopreite M., Zhu Z. The effects of ageing population on health expenditure and economic growth in China: A Bayesian-VAR approach. Soc Sci Med. 2020; 265: 113513. https://doi.org/10.1016/j.socscimed.2020.113513

3. Orlicka E. Impact of population ageing and elderly poverty on macroeconomic aggregates procedia economics and finance. 2015; 30: 598–605. https://doi.org/10.1016/S2212-5671(15)01272-1

4. Maresova P., Mohelska H., Kuca K. Economics aspects of ageing population. Procedia Economics and Finance. 2015; 23: 534–538. https://doi.org/10.1016/S2212-5671(15)00492-X

5. Kiniorska I., Brambert P., Kaminska W., Kopacz-Wyrwal I. Aging of the society the European perspective. Bulletin of Geography. Socio-Economic Series. 2023; 60: 81–100. http://doi.org/10.12775/bgss-2023-0017

6. Cylus J., Al Tayara L. Health, an ageing labour force, and the economy: Does health moderate the relationship between population age-structure and economic growth? Soc Sci Med. 2021; 287: 114353. https://dx.doi.org/10.1016/j.socscimed.2021.114353

7. Kumlin S., Stadelmann-Steffen I. How Welfare States Shape the Democratic Public. Cheltenham. UK: Edward Elgar Publishing, 2014. P. 352. https://doi.org/10.4337/9781782545491

8. Lindh T., Malmberg B. European union economic growth and the age structure of the population. Econ. Change Restruct. 2009; 42: 159–187. https://dx.doi.org/10.1007/s10644-008-9057-1

9. Börsch-Supan A., Hunkler C., Weiss M. Big data at work: age and labor productivity in the service sector. J. Econ. Ageing. 2021; 19: 100319. https://dx.doi.org/10.1016/j.jeoa.2021.100319

10. Bloom D.E., Chatterji S., Kowal P., et al. Macroeconomic implications of population ageing and selected policy responses. Lancet. 2015; 385(9968): 649–657. https://dx.doi.org/10.1016/S0140-6736(14)61464-1

11. Tang B., Li Z., Hu S., Xiong J. Economic Implications of Health Care Burden for Elderly Population. Inquiry. 2022; 59. https://dx.doi.org/10.1177/00469580221121511

12. Kalseth J., Halvorsen T. Health and care service utilisation and cost over the life-span: a descriptive analysis of population data. BMC Health Serv Res. 2020; 20(435). http://dx.doi.org/10.1186/s12913-020-05295-2

13. Pereira M.A., Marques R.C., Ferreira D.C. An incentive-based framework for analyzing the alignment of institutional interventions in the public primary healthcare sector: The portuguese case. Healthcare. 2021; 9(7): 904. https://doi.org/10.3390/healthcare9070904

14. Amiri A., Ventelou B. Granger causality between total expenditure on health and GDP in OECD: Evidence from the Toda–Yamamoto approach. Economic Letters. 2012; 116(3): 541–544. https://doi.org/10.1016/j.econlet.2012.04.040

15. Vogel E., Ludwig A., Börsch-Supan A. Aging and pension reform: extending the retirement age and human capital formation. J. Pension Econ. Finance. 2017; 16(1): 81–107. https://dx.doi.org/10.1017/S1474747215000086

16. Aksoy Y., Basso H.S., Smith R.P., et al. Demographic structure and macroeconomic trends. Am. Econ. J. Macroecon. 2019; 11: 193–222. https://dx.doi.org/10.1257/mac.20170114

17. Axelrad H. Early retirement and late retirement: comparative analysis of 20 European countries. Int. J. Sociol. 2018; 48(3): 231–250. https://dx.doi.org/10.1080/00207659.2018.1483004

18. Rudnicka E., Napierała P., Podfigurna A., et al. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020. 139: 6–11. https://dx.doi.org/10.1016/j.maturitas.2020.05.018

19. Álvarez-Gálvez J., Jaime-Castillo A.M. The impact of social expenditure on health inequalities in Europe. Soc Sci Med. 2018; 200: 9–18. https://dx.doi.org/10.1016/j.socscimed.2018.01.006

20. Kowal P., Chatterji S., Naidoo N., et al. Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol. 2012; 41(6): 1639–1649. https://dx.doi.org/10.1093/ije/dys210

21. Ma D., Zhou K., Xu J., et al. Industrial structure upgrading, population aging and migration: An empirical study based on Chinese provincial panel data. PLoS One. 2023; 18(10): e0291718. https://dx.doi.org/10.1371/journal.pone.0291718

22. Ahamed F., Shahrestani S., Cheung H. Internet of Things and Machine Learning for Healthy Ageing: Identifying the Early Signs of Dementia. Sensors (Basel). 2020; 20(21): 6031. https://dx.doi.org/10.3390/s20216031

23. Liu L., Stroulia E., Nikolaidis I., et al. Smart homes and home health monitoring technologies for older adults: A systematic review. Int J Med Inform. 2016; 91: 44–59. https://dx.doi.org/10.1016/j.ijmedinf.2016.04.007

24. Mbau R., Musiega A., Nyawira L., et al. Analysing the Efficiency of Health Systems: A Systematic Review of the Literature. Appl Health Econ Health Policy. 2023; 21: 205–224. https://dx.doi.org/10.1007/s40258-022-00785-2

25. Kuzior A., Kashcha M., Kuzmenko O., et al. Public Health System Economic Efficiency and COVID-19 Resilience: Frontier DEA Analysis. Int J Environ Res Public Health. 2022; 19(22): 14727. https://dx.doi.org/10.3390/ijerph192214727

26. Tavakoli I.M., Mostafaee A. Free disposal hull efficiency scores of units with network structures. European Journal of Operational Research. 2019; 277(3): 1027–1036. https://doi.org/10.1016/j.ejor.2019.03.023

27. Kowalik J., Markowicz I. An Evaluation of Economic Efficiency of Health Care Entities. Procedia Computer Science. 2022; 207: 1649–1656. https://doi.org/10.1016/j.procs.2022.09.222

28. Bloom D.E., Canning D., Hu L., et al. The Contribution of Population Health and Demographic Change to Economic Growth in China and India. J Comp Econ. 2010 Mar 1; 38(1): 17–33. https://doi.org/10.1016/j.jce.2009.11.002

29. Akazili J., Adjuik M., Chatio S., et al. What are the Technical and Allocative Efficiencies of Public Health Centres in Ghana? Ghana Med J. 2008; 42(4): 149–155.

30. Bulamu N.B., Kaambwa B., Ratcliffe J. Economic evaluations in community aged care: a systematic review. BMC Health Serv Res. 2018; 18(1): 967. https://doi.org/10.1186/s12913-018-3785-3

31. Chen S., Wang C. Impacts of the population ageing on the effects of the nationwide emission trading scheme in China Science of The Total Environment. 2023; 887: 164127. https://doi.org/10.1016/j.scitotenv.2023.164127