11. AGEING AND LONG-TERM CARE Demographic trends

Longer life expectancies (see indicators on life expectancy Although the pressure that this growing proportion of in Chapter 3) and declining fertility rates mean that older people aged 65 and 80 over will put on long-term care people make up an ever-increasing proportion of the systems will depend on the health status of people as populations of OECD countries. they reach these ages, population ageing will likely lead to On average across OECD countries, the share of the greater demand for elderly care and contribute to increases population aged over 65 years increased from less than in health spending. Nevertheless, most studies have found 9% in 1960 to 17% in 2015, and is expected to continue new technologies and rising incomes to be more significant to increase, reaching 28% in 2050 (Figure 11.1, left panel). drivers of health spending growth than population ageing In more than two-thirds of OECD countries, at least one- (OECD, 2015). quarter of the population will be over 65 years of age by As populations age, the potential supply of labour in the 2050. This proportion is expected to be especially large in economy is expected to decline. On average across OECD Japan, Spain, Portugal, Greece and Korea, where nearly countries, there were slightly more than four people of 40% of the population will be aged over 65 years by 2050. working age (15-64 years) for every person 65 years and Population ageing will also occur rapidly in China, where older in 2012. This rate is projected to halve from 4.2 in 2012 the share of the population over 65 is expected to nearly to 2.1 on average across OECD countries over the next 40 triple between 2015 and 2050, to reach a level just below years (OECD, 2013). Moreover, ageing may lead to shortfalls the OECD average. Conversely, Israel, the United States and in certain revenue-raising mechanisms, particularly payroll Mexico will see a more gradual increase in the share of the taxes, making it more difficult for countries to maintain or elderly population due to significant inflows of migrants or increase government spending on health. higher fertility rates. The growth in the share of the population aged 80 years and over will be even more dramatic (Figure 11.1, right Definition and comparability panel). On average across OECD countries, nearly 5% of the population was 80 years old and over in 2015. By 2050, the Data on the population structure have been extracted percentage will increase to more than 10%. In Italy, Spain, from the OECD historical population data and Portugal, and Germany, the proportion of the population projections (1950-2050). The projections are based aged over 80 is expected to more than double between 2015 on the most recent “medium-variant” population and 2050. The rise will be even faster in Korea, where the projections from the United Nations, World Population share of the population aged over 80 years will grow from Prospects – 2017 Revision. 3% to 14% over the next four decades. Population ageing is a phenomenon affecting most countries around the world, but the speed of the process References varies (Figure 11.2). The speed of population ageing has been particularly fast in Japan, where the share of the Muir, T. (2017), “Measuring Social Protection for Long- population aged 80 years and over increased from 2% in term Care”, OECD Health Working Papers, No. 93, OECD 1990 to nearly 8% in 2015, and is expected to rise to 15% by Publishing, Paris, http://dx.doi.org/10.1787/a411500a-en. 2050. The population in Korea remains relatively young, but OECD (2015), Fiscal Sustainability of Health Systems: Bridging is expected to age rapidly in the coming decades, so that by Health and Finance Perspectives, OECD Publishing, Paris, 2050 the share of the population over 80 will be nearly the http://dx.doi.org/10.1787/9789264233386-en. same as in Japan. The pace of population ageing has been slower in non-OECD countries, although it is expected to OECD (2013), Pensions at a Glance 2013: OECD and G20 Indicators, accelerate. In large partner countries including Brazil and OECD Publishing, Paris, http://dx.doi.org/10.1787/pension_ China, less than 2% of the population was 80 years and over glance-2013-en. in 2015, though this share is expected to reach close to 7% United Nations (2017), 2017 Revision of World Population in Brazil and more than 8% in China by 2050. Prospects, United Nations, https://esa.un.org/unpd/wpp/.

198 Health at a Glance 2017 © OECD 2017 11. AGEING AND LONG-TERM CARE

Demographic trends

11.1. Share of the population aged over 65 and 80 years, 2015 and 2050

2015 2050 Population aged 65 years and over Population aged 80 years and over Japan 27 Japan 8 Spain 19 Italy 7 Portugal 20 Korea 3 Greece 21 Spain 6 Korea 13 Portugal 6 Italy 22 Germany 6 Slovenia 18 Greece 6 Poland 15 Austria 5 Germany 21 Slovenia 5 Austria 18 Switzerland 5 Czech Republic 18 Netherlands 4 Estonia 19 France 6 Switzerland 18 Canada 4 Slovak Republic 14 Belgium 5 Hungary 18 Finland 5 Netherlands 18 OECD35 4 Latvia 20 United Kingdom 5 OECD35 17 Estonia 5 France 18 Poland 4 Belgium 18 Denmark 4 China 10 Sweden 5 Finland 20 Lithuania 5 Canada 16 New Zealand 4 Lithuania 19 Iceland 4 Ireland 13 Latvia 5 United Kingdom 18 Czech Republic 4 Iceland 14 Norway 4 Sweden 20 United States 4 Denmark 19 Luxembourg 4 Chile 10 Chile 2 Norway 16 Australia 4 New Zealand 15 Ireland 3 Costa Rica 7 Costa Rica 2 Luxembourg 14 China 2 Brazil 8 Slovak Republic 3 Australia 15 Hungary 4 United States 15 Brazil 2 Russian Federation 14 Russian Federation 3 Colombia 8 Israel 3 Turkey 8 Turkey 2 Mexico 7 Mexico 2 Israel 11 Colombia 1 Indonesia 5 India 1 India 6 Indonesia 1 South Africa 5 South Africa 1 010203040 0510 15 20 % %

Source: OECD Health Statistics 2017, OECD Historical Population Data and Projections Database, 2017. 12 http://dx.doi.org/10.1787/888933605654

11.2. Trends in the share of the population aged over 80 years, 1990-2050

Korea Japan Partner countries¹ World % OECD 16

14

12

10

8

6

4

2

0 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

1. Partner countries include Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, the Russian Federation and South Africa. Source: OECD Historical Population Data and Projections Database, 2017. 12 http://dx.doi.org/10.1787/888933605673

Health at a Glance 2017 © OECD 2017 199 From: Health at a Glance 2017 OECD Indicators

Access the complete publication at: https://doi.org/10.1787/health_glance-2017-en

Please cite this chapter as:

OECD (2017), “Demographic trends”, in Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris.

DOI: https://doi.org/10.1787/health_glance-2017-73-en

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