The Well-Being of the Elderly in Asia: A Four-Country Comparative Study

13. Making the Choices: Policies and Research for the Coming Years

Chapter 13 MAKING THE CHOICES: POLICIES AND RESEARCH FOR THE COMING YEARS Albert I Hermalin One of the major goals for this volume, set out in Chapter 1, was to discern the policy and program challenges that emerged from the trends and interrelationships observed in the course ofour analyses. As noted at the outset, officials in Asia have been prescient in sensing the potentially major effects of population aging and much ofthe research in the region has been prompted by this awareness. More generally, the worldwide phenomenon of population aging has generated a number of policy-oriented forums and reports, focusing either on specific issues like health or retirement programs , or tackling a wider spectrum of possible consequences. Recently the World Bank (1994), OECD (1998), Marmor and De Jong (1998), United Nations (1999), United Nations (2000), Mason et al. (2001) have examined this area. Our own attempt to identify major policy issues, while informed by these sources, will be drawn largely from the framework set out earlier in this volume and by the findings from our analyses, and will be more constrained than these specialized studies. To this end, this concluding chapter summarizes the major findings and the conclusions that flow from our framework and analyses; identifies major areas of uncertainty facing policymakers, centering on future family dynamics and economic growth; reviews the broader strategies available to policymakers; and discusses the research needed to assist policy and program development and to reduce areas of uncertainty. 543 544 The Well-Being ofthe Elderly in Asia Major Findings and Their Implications This section highlights the major findings ofthe previous chapters, with special emphasis on the level of well-being on each dimension, changes over time where these are available, and the factors associated with the differential outcomes. As illustrated in Chapter 12, the differential effects of the sociodemographic characteristics, combined with knowledge oftrends in the distribution of these characteristics, allow researchers and policymakers to anticipate some ofthe changes that will occur to future cohorts ofolder people. As each ofthe prior analytic chapters contains a fairly detailed summary, this overview will be selective, painting a broad picture, utilizing references to the more detailed tables, and emphasizing those aspects with major relevance for policy and future research. Demographic Trends The demographic, socioeconomic and policy background provided in Chapters 2 and 3 have several important implications. Most directly, the demographic projections ofthe rate and nature ofpopulation aging facing East and Southeast Asia, and the four focal countries, indicate that there will be rapid increases in the numbers and proportions at older ages, particularly among the oldest-old (those aged 80 or over). In East and Southeast Asia combined, those 60 or older will be almost three times larger in 2030 than 1995, and those 80 or older will be almost four times larger over the same span (Table 2.2). The magnitude ofthese changes will place great strain on general health and community facilities serving the elderly and will necessitate particularly rapid expansion in personnel and services dealing with chronic diseases and the needs of those at advanced ages. The demographic changes will also require close attention to assessing how well the retirement and health care programs now available to the large working age population will perform as this generation retires in the coming years. Chapter 3 is partially reassuring on this count in demonstrating that the countries under study have been initiating and modifying their basic social welfare programs for some time, with major modifications still underway in some countries. At the same time, significant gaps in coverage and implementation remain in a number ofinstances and these will require continued efforts. Additional discussion of these important policy levers is taken up in the final section of this chapter. Chapter 2 also demonstrates that there are important trends in dependency ratios underway that have implications for future policy. In East Asia, the total dependency ratio (the ratio of those under age 15 and 65 or over to those aged 15-64) declined substantially between 1960-65 and 1990-95 but Policies and Research for the Coming Years 545 will remain rather level over the next 35 years; in Southeast Asia the decline between 1960-65 and 1990-95 was modest, but sharper declines are projected over the next 35 years (Table 2.3). Table 2.4 shows that among the four focal countries, the total dependency ratio is projected to continue to decline...