Comment and discussion: Live Long and Prosper: Aging in East Asia and Pacific

Transcription

1 Thailand Development Research Institute Comment and discussion: Live Long and Prosper: Aging in East Asia and Pacific Worawan Chandoevwit 15 January

2 Outline Elderly: distribution and poverty Pension Health 2

3 Distribution of population by region % Distribution of population in 1990 and 2015 North Northeast Central South Bangkok % Municipality Non-municipality age in 1990 age 65+ in 2015 Source: NSO, LFS quarter 3 3

4 Thailand s poverty by age group is not flat. 35 Poverty headcount (%) % Income Poverty (2006) Expenditure Poverty (2006) Income Poverty (2011) Expenditure Poverty (2011) Source: NSO, SES Note: Using TDRI s food and non-food poverty line 4

5 Rural/Urban Expenditure Poverty (%) % Rural (2006) Urban (2006) Rural (2011) Urban (2011) Source: NSO, SES Note: Using TDRI s food and non-food poverty line 5

6 Pension Thailand started contributory DB pension in Eligible contribution period is 15 years which is about the time to reach aged society. 6

7 Mandatory pension started s

8 Recent pension system development Thailand promoted coordination between social pension and contributory pension design (same direction as recommended in the report). Expected fiscal burden of social pension (elderly cash transfer) will be high. NSF (2011) promotes saving for retirement on voluntary basis. However, registration into the system is still low. 8

9 Now that we have Workers in the formal sector GPF- DC CS-DB SS-DB Voluntary provident funds DC Social pension Workers in the informal sector and people not in LF. NSF- DC 9

10 Portability Adequacy Sustainability Policy questions 10

11 Pension Sustainability Hong Kong Singapore Malaysia South Korea Indonesia Taiwan China India Japan Thailand * Scale from 1 10: 10 minor need for reforms, 1 high need for reforms Source: Allianz Asset Management, International Pensions 11

12 Pension Adequacy Overall ranking Pillar I Pillar II / III Non pension wealth Spending needs Transition from work Japan South Korea Taiwan Singapore Thailand China Hong Kong Malaysia India Indonesia Note: the numbers refer to overall ranks of (sub-)indicators Source: Allianz International Pensions

13 First pillar: adequacy vs. sustainability Adequacy: Pension System Adequate Moderately adequate Not adequate Sustainability Not sustainable Moderately sustainable Sustainable NZL NL FI N O AT HU LU P T DE ES BR M T FR IT JP C Y S I C H D K US SE LV CA RO B E BG CZ LT S K T R G R U K AU EE H R RU PL KR I E H K SG ID CL MX M Y T W CN IN TH Source: Allianz International Pensions

14 Health Public health utilization by income decile and by age shows that it mildly increases with age. UC patients have to pay out-of-pocket for some treatment. Not everything is free. 14

15 OP utilization in ! 0.9! 0.8! 0.7! 0.6! 0.5! 0.4! 0.3! 0.2! 0.1! 0! 0! 0! SS (age 65)! SS (age 45)! 10! 1,400! 20! 2,130! 30! 2,900! 40! 3,600! 50! 4,500! 60! 5,570! UC (age 45)! 70! 7,075! 80! 9,500! UC (age 65)! 90! 13,570! CS (age 65)! CS (age 45)! Income! Percentile! 100! 600,000! Source: Ammar Siamwalla using HWS

16 IP utilization ! 0.9! 0.8! CS! SS! 0.7! 0.6! 0.5! UC (age 45)! UC (age 65)! 0.4! 0.3! 0.2! 0.1! 0.0! 0! 0! 10! 1,400! 20! 2,130! 30! 2,900! 40! 3,600! 50! 4,500! 60! 5,570! 70! 7,075! 80! 9,500! 90! 13,570! 100! Income! 600,000 Percentile!! Source: Ammar Siamwalla using HWS

17 OOP for UC eligible 2013 B/person/visit! 10,000! 1,000! 100! OP! (Log Scale)! Use UC! Don t use UC! 10! 1! 10! 20! 30! 40! 50! 60! 70! 80! 90! 100! Percentile! Source: Ammar Siamwalla using HWS

18 OOP for UC eligible 2013 B/person/episode! 100,000! 10,000! 1,000! 100! 10! IP! (Log Scale)! Don t use UC! Use UC! 1! 10! 20! 30! 40! 50! 60! 70! 80! 90! 100! Percentile! Source: Ammar Siamwalla using HWS

19 HCE in 365 days before date of death UC CS Die in hospital 64, ,445 Die outside hospital 44,590 68,637 Type of Disease Diabetes Mellitus 38,774 60,384 Hypertension 25,233 28,527 Heart disease 47, ,896 CVD 43,239 80,752 Cancer 61, ,998 19

20 Trend of Cancer in Thailand, Source: HITAP 20 3

21 Policy questions Need more investigation, what is the major cause of HE increase in the future? Is it ageing population or inefficient use of resources or others? Palliative care should be an option for patients at the end of life. LTC will be in high demand. Preparation for workforce and LTC system are rather slow. Need more active health literacy promotion policy to prevent people from NCD which become costly to the health system. 21