Delta State University Teaching Hospital, Oghara, Delta State, Nigeria.
Pan Afr Med J. 2022 Dec 13;43:190. doi: 10.11604/pamj.2022.43.190.30562. eCollection 2022.
Worldwide, the proportion and absolute numbers of over 60-year-olds in the population is rising: it was 1 billion in 2019 and is expected to get to 1.4 billion in 2030 and 2.1 billion by 2050, with the progression being more pronounced in developing countries. Degenerative and non-communicable diseases are more common with ageing, which means they would become the major disease problems for countries. Long-term care poses financial risks to individuals/families and governments. These warrant urgent policy and structural adjustments of health systems in low- and middle-income countries to cater for the probable change in health needs and make their society more age-sensitive. There is the need for policymakers to begin to change focus from traditional models of healthcare delivery and give more attention to aged care and create separate financing mechanisms/programmes for the elderly, most of whom are already unemployed, to protect them from the effects of cream-skimming by private health insurers. Informed decisions on healthcare purchasing can be made using Economic Evaluation, as well as Programme Budgeting and Marginal Analysis, a presentation of discrete categories of healthcare expenditure (specialties, disease-groups, etc.) and the resources appropriated to each as an aid to reviewing subsequent resource allocation. Reforms in healthcare financing should pay particular attention to the elderly considering that technical efficiency concerns of the private sector may mean that they are discriminated against. There is need for retraining/reorientation of health workers on identification and comprehensive management of NCDs, including palliative care, in a culturally competent way, on the essence of shifting from an acute care model to a chronic care model, and on providing services to people within defined catchment areas.
全球范围内，人口中 60 岁以上人口的比例和绝对数量都在增加：2019 年为 10 亿，预计到 2030 年将达到 14 亿，到 2050 年将达到 21 亿，发展中国家的增长更为明显。随着年龄的增长，退行性和非传染性疾病更为常见，这意味着它们将成为各国的主要疾病问题。长期护理对个人/家庭和政府构成财务风险。这些都需要中低收入国家的卫生系统紧急进行政策和结构调整，以满足可能的健康需求变化，并使社会更加关注老龄化问题。政策制定者需要开始改变传统的医疗保健提供模式，更加关注老年护理，并为大多数已经失业的老年人建立单独的融资机制/计划，以保护他们免受私人医疗保险机构的“择优录取”影响。可以使用经济评估、方案预算编制和边际分析来做出明智的医疗保健采购决策，这是对医疗保健支出的离散类别（专业、疾病组等）和分配给每个类别的资源的展示，以帮助审查随后的资源分配。医疗保健融资改革应特别关注老年人，因为私营部门的技术效率问题可能意味着他们受到歧视。有必要对卫生工作者进行再培训/重新定位，以便他们能够以文化上合适的方式识别和全面管理非传染性疾病，包括姑息治疗，从急性护理模式转向慢性护理模式的本质，以及在规定的服务范围内为人们提供服务。
