Single Payer Healthcare - Effect on Medical Industry

[XenaLives]

I worked for a company that was negotiating with the Chinese for technology to create an elder care robot to assist in their elder care effort.

In China one younger person may be responsible for four elders because of Mao's one child policy. They are in crisis mode but you don't hear much about it. The image below is from a 1990 journal article.

The Chinese knew this was coming, it was probably the impetus for creation of a Universal Healthcare policy.



https://www.jstor.org/stable/pdf/2949087.pdf?seq=1#page_scan_tab_contents

The living conditions described to us were worse than this:

Boxed in: life inside the 'coffin cubicles' of Hong Kong – in pictures
Coffin cubicles in Hong Kong.





https://www.theguardian.com/cities/gallery/2017/jun/07/boxed-life-inside-hong-kong-coffin-cubicles-cage-homes-in-pictures

Studies like this 2004 study do not address the issue of living conditions;
https://www.tandfonline.com/doi/abs/10.1080/13607860412331336823

This is the public face of elder care in China as of 2010:
https://confuciusmag.com/elderly-in-china

China's senior care demands continue to increase: survey
Source: Xinhua| 2018-05-20 19:03:39|Editor: Lu Hui

BEIJING, May 20 (Xinhua) -- Some 15.3 percent of China's elderly reported a need for additional care, according to a recently released report on the living condition of the country's senior citizens.

This figure has increased by 9 percentage points from 2000, according to the Survey Report on the Living Conditions of China's Urban and Rural Older Persons (2018), which was published by Social Sciences Academic Press.

The percentage of urban elderly reporting a need for care rose from 8 percent to 14.2 percent between 2000 and 2015. In comparison, the percentage in rural areas increased from 6.2 percent to 16.5 percent during the same time.

The need for care among elderly aged 80 and above displayed a sharper increase. The rate rose substantially from 21.5 percent in 2000 to 41.0 percent in 2015, while those aged 79 and below requiring care rose from 5.1 percent to 11.2 percent.

The types of care desired by elderly include at home doctor visits, housework services, health education, and psychological counselling, according to the report.

A total of 222,700 Chinese aged 60 and above from across the country answered the survey, which has been conducted every five years since 2000 by the China National Committee on Aging.

http://www.xinhuanet.com/english/2018-05/20/c_137193190.htm

Life in a ‘coffin home’: how poverty drove six elderly men in China to share a 161 sq ft room
They endure mouldy bedding, constant noise and zero personal space in Chongqing because they could not afford to live at a home for the elderly

https://www.scmp.com/news/china/society/article/2140496/life-coffin-home-how-poverty-drove-six-elderly-men-china-share

My week in Lucky House: the horror of Hong Kong's coffin homes

A general view of residential and commercial buildings in Yau Tsim Mong District, a popular location for ‘coffin homes’ in Hong Kong.

by Benjamin Haas in Hong Kong

The residents of Lucky House in Hong Kong are anything but fortunate. They are some of the poorest people in the most expensive city in the world.

In one of its 46 sq metre (500 sq ft) apartments, 30 residents live in purpose-built plywood bunk beds each with its own sliding door, colloquially known as coffins. Two rows of bunks, 16 bunks in each row – still space for two more people.

The residents are retirees, working poor, drug addicts and people with mental illnesses, mostly those unable to keep pace with the spiralling cost of housing in Hong Kong.

In many ways their home feels like a railroad sleeper car, but even more cramped and uncomfortable, and with none of the charm or romanticism that comes with train travel.

For a week I lived at Lucky House, crammed in a stuffy bunk teeming with bed bugs at night, my days spent lazing around with not much to do besides talk to the other residents, stare at my mobile phone and sleep.
more...

https://www.theguardian.com/world/2017/aug/29/hong-kong-coffin-homes-horror-my-week

Below is an excerpt from an article by a decidedly upper class British woman who doesn't want to spend over £30,000 a year for a one room cubicle. Unfortunately there are many more living in the "Dark Ages" than being cared for by devoted caregivers in sunny Italy.

About a year ago, her devoted GP advised that we consider 24/7 care – not immediately, as robbing her of autonomy would only accelerate her descent to dependence – but soon.

I couldn’t afford to buy a house with a granny flat, or convert our home, which has stairs, to accommodate my mother’s limited mobility. My brother lives abroad and travels extensively. So with my mother’s grudging approval (she is a fiercely independent spirit), he and I looked into other options. They were not good. “Domiciliary carers”, who’d visit mother at home, are expensive. If we wanted someone with a proven track record, we’d have either to rely on the local authority and top up, out of our own pocket, the assistance they offered, or turn to agencies, which charge about £20 an hour.

The alternative, a care home, was terrifyingly pricey: a single room in a London care home costs over £30,000 a year.

.....
Cost was only one concern, however. The past few years have thrown up hair-raising stories about the abuse of elderly patients in care homes, where staff have been caught on hidden cameras beating their charges, kicking and mocking them.

Viola Richter works in the Emmendinger Altenpflegeheim (care home) in southern Germany, near the country’s border with Poland. She claims the practice of Germans going east to spend their last days is set to spread, as other northern European countries face a similar care crisis prompted by a dramatic increase in the ageing population, lack of care workers and rising prices.

East European care enjoys a good reputation. “One reason,” according to Richter, “is that the concept of ageing is very different there. Because it is a family-centred society, everyone pitches in to help with elderly relatives. They may have very little autonomy, but the elderly stay at the heart of the family.” Richter has noticed that, while her fellow Germans look on her job as nothing more than “wiping bottoms”, in the east assisting the elderly is respected as a crucial contribution to the nation’s welfare.

It is true that carers, in both Britain and Germany, have low status. Madeleine Starr, head of innovation at Carers UK, thinks it “scandalous that we don’t value our care sector more”. She points out: “This is a low-skilled sector with relatively poor pay: although agency recruits can charge more, it’s not unusual for the rest to earn only the minimum wage and pay their own travel expenses on top of that.”

In Britain, the sector is also heavily regulated. A family wishing to hire a carer would be responsible for doing CRB and employment checks, as well as income tax. The state, explains Starr, is keen to formalise such arrangements, to avoid the Treasury being cheated out of taxes.

The scenario is very different in Italy, where, as Starr reports, “light touch registration” prevails. Families who hire badanti pay the equivalent of their employee’s NI contributions (contributi). The rest is about employer and employee succeeding in arrangiarsi – coming to an agreement. The badanti usually hail from eastern Europe – thousands of women from Ukraine and Bulgaria have come to Italy since the Soviet Union collapsed – and lack professional training. Italians don’t seem fussed, and I can see why. Registered nurses may offer clinical competence, but “caring” is holistic: interesting conversation, a healthy diet, a walk outside. For that, the only requirement is a compassionate individual who regards their charge as a human being rather than a tiresome burden.

Katerina Ivanova, my father’s Ukrainian carer, fits the bill admirably. Patient, good-humoured and energetic, she values her role not only for the 2,000 euros a month, but for the relationship she has forged with my father. “He can make me terribly cross,” she admits during one of our regular Skype sessions, “but the truth is, I’m very fond of him. Back home, we’d never allow an elderly man to live on his own: loneliness is more debilitating than illness.”

Katerina, who has a doctorate in chemical engineering, lives with my father in a spacious flat that costs a fraction of what it would in London. She works six days a week, and assists him with bathing and dressing. She ensures he gets out for a walk, takes his medicines daily, and eats properly (no hardship, given that she is a fabulous cook). Katerina drives him to doctors’ appointments as well as on excursions; and when we come to visit, she spoils my nine-year-old daughter with gelati and the local amaretti.

https://www.telegraph.co.uk/news/health/9780806/Cristina-Odone-Why-Im-packing-my-mother-off-to-Italy.html

A different perspective in this 2010 article from the BBC:
Elderly poverty: 'Living like something from Dark Ages'

https://www.bbc.com/news/uk-12073801

Italy is swimming upstream, they are one of the first European countries to experience the "Silver Tsunami":

More than 20% of the total Italian population is aged 65 or more. By the year 2050, this figure is expected to rise to 34% because of the country’s longer life expectancy, which is currently at 78 to 80 for men and 84 to 85 for women. In fact, about 20% of the senior citizens and 6% of the country’s total population are over the age of 80. Therefore, Italy definitely needs to focus on its elderly care as well as in-home senior care services.
Unlike the US and UK, when it comes to caring for the elderly in Italy, there is a lot of emphasis on family support. Looking after the older members of the family is regarded as a responsibility or a “social duty”, especially by the women and this also includes taking care of extended family. Normally, Italian institutions and communities only get involved if an elderly person has no family; old age homes are regarded as the “last resort” in Italian culture. Therefore, less than 1% of the senior population is currently using home care services.

However, in the recent past, the demand for elderly homecare services has increased to a great extent; yet, the supply remains fairly limited. Considerable differences can also be seen in the development and distribution of services for the elderly, particularly between the northern and southern parts of the country.


Unfortunately, there are no gated communities only for the elder, as often seen in the US. Elderly people, who are fairly fit and independent live in regular properties, with no special amenities for senior citizens.

Healthcare for the elderly

While the National Health System and the Local Health Authorities in Italy have been controlled by the municipality since 1978, care for the elderly was entrusted to communities and general practitioners that are organized by associations as well as the municipality. In fact, right up until the 1990s, the Italian authorities were oblivious to the health problems and requirements of older people. However, things began to change in 1992 with the “Objective: Ageing Persons”. The National Plan for senior citizens now aims at better coordination of medical and social services, which can be integrated within a person’s home care service system. Their framework for elderly care includes –

Home care: This consists of a service with social importance like personal care, house help, meals, as well as health importance, like medical and nursing care, which can be provided to a senior citizen within the comfort of his own home. Integrated homecare services seek to keep an older person at home for as long as possible.

Day centers: These comprise of a semi-residential structure within a district, where elderly people can spend a couple of hours each day. These centers are operational 5 days per week, 7 hours each day and can admit up to 20 elderly people. They provide not only healthcare services but also many types of social care services, like promotion of personal autonomy, job therapy, entertainment and so on.

Nursing homes: These services include residential structures that have been organized into smaller groups to provide healthcare, social care services and functional rehabilitation for those who are disabled. The support staff in nursing homes generally includes doctors, nurses, social workers and psychologist. Elderly patients staying in nursing homes may receive extensive or intensive care, depending upon their situation.

Extensive care at nursing homes for the elderly comprises of long-term rehabilitation and accommodation though hospitalization is limited to the acute stage only.

Intensive care includes rehabilitation with high medical importance as well as hospice for terminal patience. This service also provides palliative care for patients as well as their families.

Retirement for expats

Italy does not offer any kind of retiree program. In spite of the fact that Italian elderly care is not at par with countries like the US, UK and Canada, several people above the age of 65 choose to retire in Italy. Senior expats living in Italy need to obtain a retirement visa or an elective residency visa.

https://www.expatfocus.com/expatriate-italy-elderly-care

If we don't lighten the economic burden of elder care it will be causing countries around the globe tho choose between cubicle warehousing, death on the streets, or economic collapse. Not very good choices.