Abstract
The Astana Declaration on primary healthcare in 2018 was the attempt to revive the ideals of the World Health Organization (WHO) Alma-Ata Declaration 40 years later, together with a call for the political will to provide adequate financing at acceptable quality of care. This approach is taken to achieve the past ideals of Health for All, given the new challenges of universal health coverage. The economic case for primary healthcare is justified against the growing demand due in part to the growing costs of chronic conditions and the rise of ageing population, other than the supply-side factors of the healthcare industry. Past healthcare systems have evolved greater roles of the state versus the market, but few have involved the Third Sector or civil society in more integrated ways to provide and finance long-term care (LTC) with population ageing. From the extremes of the communist state to capitalist free markets, an optimal public-private system has to reach a balance in access, cost and quality for health and LTC. Recent studies of health and LTC have distilled newer developments in public-private mixes of provision, financing and regulation, in response to the needs of fast-ageing Asian societies. While Japan was the oldest country in the world, other countries in Asia have caught up and are now acknowledged where innovative models of integrated eldercare under economic limits, hold great promise of their transferability to the rest of ageing societies. Besides other forms of integrated LTC delivery with traditional systems, newer forms of financing like savings funds and superannuation have been developed, with participation from government, industry and civil society. There is much to learn from the new Asian models of financing, using appropriate technology and social innovations, and integrating health and social systems for LTC.
Highlights
Forty years after the World Health Organization (WHO) Alma-Ata Declaration of primary healthcare, universal health for all has still to be achieved
There is no adequate coverage for the ageing population without primary healthcare as enunciated in the Astana Declaration, without adequate financing and acceptable quality of primary healthcare for all countries, and in the future.[1,2,3]
The Declaration of Astana in 2018 affirmed the commitment to continue the vision of health for all through primary care, universal health coverage, and the United Nations 2030 Agenda for Sustainable Development in pursuit of Health for All
Summary
Forty years after the World Health Organization (WHO) Alma-Ata Declaration of primary healthcare, universal health for all has still to be achieved. Recent studies were able to document contemporary trends and policy issues to provide comparisons of social care systems undergoing rapid transitions, and to offer some examples of current best practices and lessons to meet changing needs due to population ageing in Asia.[9] Fastageing, dynamic industrialising and urbanizing economies in Asia were selected for this regional comparative study – Japan, Korea, China, Hong Kong, Taiwan, and Singapore Together, they presented a kaleidoscope of experiences learnt in coping with rapidly rising numbers of ageing persons in their midst. Technology and Social Innovations Many regional trends in technology and social innovation are developing in Asian countries to act as laboratories for innovations in ageing and where several drivers such as overuse of technology and lack of co-ordination across systems, could be addressed through suitable tools, policies, regulations and incentives These include health technology assessment tools for cost control; co-ordination of care for older populations, supportive information systems, and financing mechanisms to encourage integration of services and technology. The point is made of overcoming ageism as the “largest social innovation” to enable all other innovations and policies to fall into place, and realizing a better world for all older people.[9]
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