Kerala Chief Minister V. D. Satheesan has announced plans to establish a dedicated government department for the elderly to carry out new schemes to support senior citizens. Though he has not given details of the programmes, he mentioned that it would be modeled on the Japanese system.
The main features of the Japanese model are mandatory long-term care insurance (LTCI), public pension scheme, medical care system for older senior citizens and community based integrated care system. These take care of 90 per cent of medical and personal care needs of people aged above 65. Many of the services reach their doorsteps. The elderly will have to get a certificate based on their level of frailty (similar to disability certificates) to obtain full medical and personal care services. Frailty and prefrailty among older people are assessed and steps to prevent progression to frailty.
Japan is the most aged country in the world. Over the last 75 years the percentage of elderly people among the population in the country has jumped from five per cent to nearly 30 per cent (more than 36 million) and is expected to plateau around 40 per cent in another decade or two.
In Kerala, about 17 per cent of the population (approximately 6.5 million) is now above 60 years of age. This is projected to cross 22 per cent by 2036.
One of the major Challenges to the Chief Minister, who also holds the Finance Portfolio, will be to secure funds for the Department and its programmes. Even a developed country like Japan is struggling to find funds for its programmes. Kerala is currently finding it difficult to pay old age pensions which is often in arrears. This puts many older people in great hardship. One thing that Mr. Satheesan should do is to make welfare pensions a priority and make its payment regular. Now, the first treasury restrictions fall on disbursement of welfare pensions. Instead, welfare pensions should have first claim on budgetary funds.
The second issue will be insurance costs. In Japan, LTCI insurance is covered by premiums paid by citizens during their working years and taxes. Insurance premiums are going up. This could ultimately become a problem for Kerala. Already, multinationals are buying up hospitals in Kerala and insurance is spreading its wings. As much of the healthcare comes under insurance umbrella, much of the competition will disappear and costs will keep going up. Government hospitals will be weakened. The State government will have to keep an eye on this while devising the schemes.
A promising alternative lies in strengthening community-based interventions. Mr. Satheesan has been liberal in granting a ₹ 3000-hike in monthly honorariums of Asha workers. He may be planning to use their services for his schemes for older people. His ultimate test will be finding sustainable funding for meaningful, long-term schemes for Kerala’s senior citizens.