NEAT Working Group on
Healthcare System amid Population Ageing in East Asia

Final ReportTokyo
19th July 2017

1. Background
In East Asia, as exemplified by the institutionalization of ASEAN+3 (APT) in 1997,
East Asia Summit (EAS) in 2005 and the establishment of ASEAN Community in 2015,
regional cooperation and integration have steadily advanced in such areas as economy,finance, education and disaster prevention. Worthy of note is the burgeoning economic
interdependence attained through establishment of intra-regional supply chain which
parallels with the rapid economic growth. Under the circumstances, question as to how tomaintain and promote health of the people and how to develop co-operation in the area ofhealthcare, which themselves are to uphold economic growth of the region, should beregarded as an indispensable agenda for sustainable development in the region, let alone acommon issue for humanity at large.
In light of this, one urgent issue is advancement of healthcare amid population
ageing in East Asia. Due to a sharp decline in birth rate as well as improved public healthand advances in medicine, APT countries have been experiencing a rapid population
ageing, which is expected to accelerate in years to come. Ageing makes huge impacts on
healthcare system either directly or indirectly through changes in socioeconomic factors.
Therefore, it is vital for APT countries to take urgent action to make their healthcare system
responsive to the challenges of an ageing society.

2. Objective
In this context, this WG is to observe and analyze the impacts of population
ageing upon healthcare and to consider ways in which APT countries can establish andfurther develop healthcare systems to respond to population ageing. The WG identifies
challenges with possible solutions, and aims to present policy recommendations to the APT
Summit from the standpoint of Track II diplomacy. It must be acknowledged that standardsof healthcare system and issues at stake greatly vary within the region, and that there aresome countries where infectious diseases such as tuberculosis are still a great concern while
the others have already institutionalized Universal Health Coverage (UHC). And yet,
population ageing has been to a different extent a common interest for the East Asiancountries; and they are equally responsible for offering an equitable and adequate
healthcare system for the populations, although politics, economy and culture of each1country are reflected onto it. That calls for thorough reconsideration of the existing
healthcare system and comparative researches within the region so as to enhance thesystem per se, which will benefit the countries involved in terms of enhancing theirpolitical preparedness.

3. Challenges
Upon tackling with the issues of healthcare amid population ageing, followings
are the common key challenges that the region encounters now;
The first challenge is to establish and maintain sustainable UHC. Indeed, likeJapan, some East Asian countries have embraced UHC before population ageing came tohave detrimental effects in societies. The others, however, stand long before they can fully
adopt the system. Meanwhile, population ageing has been proven to be the cause of theincrease of medical care expenditure along with the advancement of medicine, and has anegative impact on economic growth. Therefore, those that have not yet achieved UHC will
be required to face the thorny problem of institutionalizing the system under population
aging that inevitably accompanies the increase of medical care expenditure and slower
economic growth. The countries where UHC has already been in place as well have toreconsider the ways in which they can keep UHC in good shape.
Second challenge concerns healthcare system itself amid the unprecedented
population ageing. The main focus of healthcare system has been on infectious diseases
prevention and acute care. However, the ageing inevitably requires more attention tolifestyle-related diseases, rehabilitation medicine, and chronic care management. In thisrespect, it must call for the idea ‘ageing in place’ which, in simple terms, suggests theelderly living and coping with certain inevitable health problems not in hospitals but at
home. That well pictures the ideal of ageing society where healthcare system and thewelfare of the elderly are placed side by side, creating a new approach to ‘home’ for theelderly.
Thirdly, there is a challenge of securing enough human resources for thehealthcare sector. Unlike a public pension scheme which essentially is a financial mattersolely dealing with income transfer, the management of healthcare system requiresconsiderations to both the financing and service delivery. Hence, it is important to secure anumber of highly qualified healthcare professionals who engage in the system. Besides, it
2must also be noted that, in some countries, there is a significant regional disparity as to thenumber of those who are engaged in healthcare. In this respect, improving effectivenessand efficiency while promoting fairness in healthcare delivery system with enhanced use ofICT is an important policy agenda.

4. Discussions at the Working Group meeting
Twenty three experts from APT countries and the sponsoring organization, theJapan Forum on International Relations (JFIR), took part in a working group meeting inTokyo on 18 – 19 July 2017 which was organized in a keynote address and three sessions.
In the keynote address, the Director of the WG explained prospects ofdemographic change and its impact on healthcare by introducing the case of Japan, andshared the aforementioned key challenges while presenting the agenda of following threesessions.
In Session I “Universal Health Coverage (UHC) under Population Aging”, it
was noted that common concern is as to how to accommodate the escalation ofhealthcare cost due to the ageing as well as medical advancements, and how to finance
it. The WG discussed the issues such as different financing models for UHC (e.g. social
insurance model, tax based model), and possible sources of revenues including VAT,earmarked tax, or copayment. It was also pointed out that the management of
non-communicable diseases (NCDs) from the early stage of life was essential not only
from the perspective of health promotion, but also from fiscal as well as economicperspectives. The WG stressed that APT countries should enhance information sharing
and comparative study on UHC, with careful attention to differences in socioeconomiccondition and economic development stage of each country.
In Session II “Bringing Health and Social Services in Better Integration amidPopulation Aging”, the WG discussed the importance of developing well-designed national
strategy on the integration on health promotion, prevention and social services, as well as“good practice” of such integration that could be a model to be followed, whichaccommodate the changing disease patterns to non-communicable, chronic diseases due topopulation ageing. It is pointed out that capacity building of providers of healthcare andsocial services is essential for achieving integrated and comprehensive care and support for
the elderly.
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In Session III “Human Resources for Elderly Care and Utilization of Technology”:
the WG discussed various issues and challenges for providing quality care for the elderly,
from adapting to the changing nature of extended family and community support,
securing human resources for care services, to enhancing productivity by utilizing
advanced technology such as ICT, AI or medical robot, among others. The WG raised theimportance of monitoring and supervising care service provision to guarantee the quality
as well as human rights of the elderly. The importance of care coordination between
health/social services providers and family caregivers was also pointed out. The WG
shared their views on potential roles of ICT to secure access to quality healthcare in ruraland remote areas in each country.

5. Policy Recommendations
Based on the discussions above, the Working Group on “Healthcare System amidPopulation Ageing in East Asia” summarized the following policy recommendations:

1.

Strengthen healthcare system so as to provide quality services effectively andefficiently in response to growing health needs in an ageing society. To realize an equitable
and affordable access to healthcare services for all people, accelerate efforts to attain
Universal Health Coverage (UHC) in the countries striving for it, and take necessary steps
to enhance the sustainability of UHC in the countries where it is already in place.
Meticulous planning on both service delivery and finance is of the utmost importance inworking on UHC.

2.

Further enhance information sharing and evidence-based comparative study on

UHC and ageing-related policies, taking into account the different contexts among APT
countries in terms of healthcare system, demographic trend toward ageing, political,
economic and sociocultural environment, among others. In particular, the countries thathave already achieved UHC and entered an aged society should proactively provide other
APT countries with their experiences and policy lessons.

3.

Further promote medical research and service provision for rehabilitation, chroniccare and dementia, etc. that will inevitably gain in importance with the progress of ageing,4

in addition to developing acute curative care in order to keep abreast of medicaladvancements.

4.

In order to extend healthy life years and enhance well-being of the people, takestrong measures against non-communicable diseases from early stages of life, including
enhancement of healthy lifestyle and encouragement of prevention, in addition tocontinued efforts addressing communicable diseases, amid a drastic transition of disease
patterns due to ageing and changing lifestyles such as dietary habit, and vigorously
promote elderly persons’ social participation.

5.

Establish comprehensive and integrated healthcare system through enhanced

cooperation with related policy areas such as long-term care, social welfare and housing sothat elderly persons can live in their own homes and community regardless of their healthcondition and ability level. Realizing such a system involves close communication as wellas integrated and cooperative efforts from the planning phase to implementing phase ofpolicies among different ministries and agencies at the central level, and between central
and local governments as well as public and private sectors.

6.

Secure sufficient human resources for health and long-term care services in termsof both quality and quantity to address increasing needs for healthcare of good quality.
Regional disparities in distribution of human resources for health and personal careservices such as maldistribution between urban/rural or affluent/deprived areas should bereduced in a planned manner.

7.

Enhance productivity in health services as well as equity of the access tohealthcare by promoting the utilization of advanced technologies such as ICT, AI, medicaland nursing care robots as well as making the most of big data under growing constraints
in both health human resources and financing, so as to establish more effective, efficientand equitable healthcare system.

[END]

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List of Participants
Cambodia
HAK Sithan
Deputy-Director of Preventive Medicine Department, Ministry of Health

China
MA Jixiang
Deputy Director, National Center for Non-communicable Disease Control and Prevention,
China Center for Disease Control and Prevention
MIAO Ji
Research fellow, Institute of Asian Studies, China Foreign Affairs UniversityJapan[WG Members]*Director of the WG
SHIMAZAKI Kenji *Professor, National Graduate Institute for Policy Studies
AKASHI Hidechika
Director, Department of Global Network and Partnership Bureau of International HealthCooperation, National Center for Global Health and Medicine

KOBAYASHI Yasuki
Professor, Graduate School of Medicine, the University of Tokyo

NAKAMURA Shintaro
Senior Advisor on Social Security, Japan International Cooperation Agency

ONO Taichi
Professor National Graduate Institute for Policy Studies[The Japan Forum on International Relations]
ISHIGAKI Yasuji
Trustee, JFIR
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WATANABE Mayu
Senior Executive Director, JFIRKIKUCHI Yona
Senior Research Fellow, JFIR

Korea
SEO Bo Kyung
Assistant Professor, Yonsei University

LaosSommana RATTANA
Chief Deputy of Local Hospital Division, Department of Health Care,
Ministry of Public HealthMalaysia
Muhammed ABDUL KHALID
Chief Economist, DM Analytics Malaysia / Visiting Adjunct Fellow, Centre for Policy
Research and International Studies (CenPRIS) , Univ Sains Malaysia

MyanmarKhin Maung NYO
Adviser, Myanmar Institute of Strategic and International Studies (Myanmar)

Philippines
Michael Ralph ABRIGO
Fellow, Philippine Institute for Development Studies

Singapore
Phua Kai Hong
Visiting Professor, Nazarbayez University

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Thailand
Thaworn SAKUNPHANIT
Program Director, Health Insurance System Research Office (HISRO),Health System Research Institute (HSRI)

VietnamDANG Thi Viet Phuong
Deputy Head, Department of Social Security and Social Works Institute of Sociology,
Vietnam Academy of Social Sciences
In Alphabetical Order of Country NameASEAN Secretariat
FERNANDO Ferdinal
Assistant Director of Health Division, ASEAN Secretariat

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