In the dusk of their life, an alarming number of India's ninety one million sixty-plus population is suffering from loneliness, neglect, depression, physical and mental abuse and a plethora of diseases without proper medical care. Often enough, the senior citizens' help lines are the only support the old people have in teeming metropolises like Hyderabad, Bangalore, Mumbai, Kolkatta, Delhi etc.Property disputes and financial concerns are the main causes of abuse of the elderly, with the youth often perceiving them as a burden. The help lines promise the senior citizens seeking help absolute confidentiality and carry out social intervention to solve the problem, Many of the elderly have lost their spouses. Their friends and relatives circles also narrow down as disease and death take their toll. There has been a spurt in suicides by the elderly as increased loneliness, depression, disease and lack of care induces a sense of helplessness amongst them.

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Old age healthcare security-An Urgent need for the
ageing Urban Population.
By Dr.Mahboob ali khan MHA,Phd
That is no country for old men. The young In one another's arms, birds in the
trees —Those dying generations—at their song, The salmon-falls, the mackerel-
crowded seas, Fish, flesh, or fowl, commend all summer long Whatever is
begotten, born, and dies. Caught in that sensual music all neglect Monuments of
unageing intellect. An aged man is but a paltry thing, A tattered coat upon a stick,
unless Soul clap its hands and sing, and louder sing For every tatter in its mortal
dress, Nor is there singing school but studying Monuments of its own
magnificence; And therefore I have sailed the seas and come To the holy city of
Byzantium. Sailing to Byzantium - W B Yeats
In the dusk of their life, an alarming number of India's ninety one million sixty-
plus population is suffering from loneliness, neglect, depression, physical and
mental abuse and a plethora of diseases without proper medical care. Often
enough, the senior citizens' help lines are the only support the old people have in
teeming metropolises like Hyderabad, Bangalore, Mumbai, Kolkatta, Delhi
etc.Property disputes and financial concerns are the main causes of abuse of the
elderly, with the youth often perceiving them as a burden. The help lines promise
the senior citizens seeking help absolute confidentiality and carry out social
intervention to solve the problem, Many of the elderly have lost their spouses.
Their friends and relatives circles also narrow down as disease and death take their
toll. There has been a spurt in suicides by the elderly as increased loneliness,
depression, disease and lack of care induces a sense of helplessness amongst them.

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With increasing life expectancy and decreasing fertility the population pyramid is
slowly inverting leading to a narrower base and a heavier burden. Add to this a
change in disease pattern and a change in the social fabric - leading to the break
down of the joint family system, and the problem of how to take care of our elderly
looms large over us. In this changing environment, Old Age Security will no
longer be ensured by only providing monetary support, there are physical,
emotional and social factors that will need to be considered. Apart from taking care
of the health care requirements, there is a need to provide the elderly with physical
security in terms of a fully furnished and serviced accommodation and concierge
services to support. Besides this, provision of emotional and social security, by
creating an environment where they may build and sustain social networks is
crucial. They are also in need of legal advice and estate planning services to be
able to manage their funds better. While, we work towards creating a robust
framework for elderly care, we also need to ensure the young know of their choices
and start planning early. Initiatives such as a single view of retirement funds,
which will help them understand their current corpus and plan for the future, and a
retirement planning helpline that would guide them in their choices would go a
long way in ensuring overall success of the program. However, this solution cannot
be worked upon in isolation by any one entity, there is a need for different
stakeholders like Government, Insurers, Financiers, NGOs, and Health Care
Providers to come together and work in collaboration to achieve a total security
solution. There will be structural changes in policies and a central agency required
to ensure implementation of the various schemes. This report is a first step in
defining the challenge and a possible solution, we hope for this to be the starting
point to stir a larger debate and discussion, culminating in the development of a
new framework for Old Age Security.
Social security is a basic human right. The object of social security is to provide
livelihood to those who cannot earn their livelihood by work for chronic or
temporary reasons. The older persons need social security as they cannot work and
earn due to age factor. The eligibility criteria of the National Old Age Pension
Scheme need to be liberalized, the quantum of benefits under the scheme needs to
be enhanced.

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The subsidized insurance schemes need to be enlarged to cover all sections of the
unorganized sector linked to welfare funds and rationalized in so far as the subsidy
element is concerned. Thus the system of social security in India would consist of a
multi-tiered structure. Indeed, there is already such a structure though in a
rudimentary form in the first tier there is the National Social Assistance
Programme and other social assistance programmes. In second tier there are the
social insurance schemes namely the ESI Scheme, the schemes framed under the
EPF Act, the Employers' Liability Schemes and such others.
Old age is a relatively recent phenomenon and until the second half of the 20th
century the few that survived beyond 60 were typically cared for by family
members. Ageing of population is affected with downward trends in fertility. With
improvement in nutrition and healthcare, average life expectancy had increased to
over 60 years in developed regions, reaching 75 years by 20001 . The life
expectancy continues to increase and the gap between the developed and
developing countries is gradually reducing.
Though longevity is a positive measure of healthcare development in the
developing countries, it brings with it a whole lot of social, economic and
healthcare challenges for the elderly and puts pressures on the society. Not many
countries, including India, have woken up to the fact that this stratum requires
inclusive policies which can potentially reduce stress on governments in terms of
pensions and healthcare expenditures as the younger generation may not be willing
or may be unable to provide for senior people in the future. Golden age or second
innings is becoming a major concern for the policymakers all over the world.
Prominent Trends Increasing life span With the rapid advancement in medical
science and technology it has now become easier to control various dreaded
diseases which were the cause of high mortality earlier. This has resulted in a
steady increase in life expectancy. United Nations predict that by 2050, average
life expectancy will be almost 80 years in developed regions and more than 70
years in less developed parts of the world.2 Globally, the number of persons aged
60 year or above is expected to more than triple by 2100, increasing from 841

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million in 2013 and close to 3 billion in 21003 . In the developed regions,
population above 60 years will be increasing at 1.0 per cent annually before 2050
and 0.11 per cent annually from 2050 to 2100. In the less developed regions,
population above 60 years will increase at a faster pace—it is projected to increase
by 2.9 per cent annually before 2050 and 0.9 per cent annually from 2050 to 2100.
Supply and demand gap in healthcare With the increasing number of senior people
who are prone to chronic illnesses, the demand for long-term care will increase in
the coming years but long working hours and low wages in the field of geriatrics
prevents talented people to enter this field. Also, most of the skilled people find
better job opportunities outside India. Around one-fifth of doctors practicing in
Organisation for Economic corporation and Development (OECD) countries are
immigrants or contractors from abroad. India is a major source of doctors for
Australia, Canada, New Zealand, the UK and the US while the Philippines is the
single largest supplier of nurses. Further, the problem is aggravated by the
infrastructure gaps which continue to remain substantial in India. The hospital bed
density in India is currently 9 beds (2005-2012) per 10,000 population which is
significantly lower than the WHO global number of 30 beds per 10,000 population.
Increasing health expenditure Ageing society puts a burden on healthcare
expenditure by the government. For most of the countries, healthcare expenditure
as a per cent of GDP is minuscule when compared with the growing population.
Amongst the BRICS nations, the public and private spending on healthcare in India
is the lowest—3.9 per cent of GDP on healthcare as compared to Brazil and South
Africa which spend in the range of 8.5-9 per cent.
The current government expenditure on healthcare is only 1.2 per cent of the GDP
and it is planned to increase it to 2.5 per cent by 2017 and 3 per cent by 202211. To
provide for better coverage/ care to the citizens insurance could be an alternative.
OECD nations such as the US, Mexico, Spain and Austria offer preferential
incentives such as tax deductions, tax credits and allowances to encourage citizens

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to buy insurance policies to ease strain on public expenditure. Some of these
benefits are available in India too but the Indian insurance market still remains
under-penetrated as compared to some of the other international markets. Senior
people face chronic illnesses and most of the people below poverty-line do not
even consider insurance as an option. Insurance companies have an entry age limit
and senior people may not have their life and medical expenses covered when they
need it the most.
Currently, a vast population of India does not have any health insurance or any
other medical cover. The Government of India has been discussing policies
towards universal coverage. The Planning Commission, in its 12th five year plan
for India, visualises a comprehensive health reform for the aged. Positioning the
health of the elderly in a broader framework of universal access and affordability
of universal health coverage has potential to transform the structural conditions
that hamper the well-being of the aged. Considering the fact that the insurance
penetration and density in India is extremely low at the moment, and
Governments’ policies for healthcare expenditure is not sufficient, out-ofpocket
healthcare expenses for individuals is the only way out. The graph below gives out
details about out-of-pocket. Healthcare expenditure by individuals. USA and South
Africa has the minimum out-of -pocket expenses for individuals due to the
insurance cover and strong Government policies for senior population.
In 2012, India was ranked third in the World Health Organization's latest list of
"countries with highest out- of-pocket expenditure on health" in the south-east Asia
region. Even amongst the developing countries, India has the highest out-of-pocket
expenditure only next to Mexico and Russia. As in July 2012, the healthcare
inflation in India was 15 per cent. Due to the increase in medical inflation, cost for
various treatments for senior people has been increasing. The cost of treatment like
Angiography, Cholecystectomy (Gall Bladder removal), TURP among others has
increased by almost 50 -60 per cent in 2007 – 2012. While the technology has
reduced the time taken for certain medical procedures, the expertise to use such
technology is limited. The cost of super specialty and robotics is also passed to
patients.

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In India, the concept of disease management is in its nascent stage. The concept of
wellness and overall physical well being is not very common with a lot of people
associating wellness services with beauty services and spas rather than fitness
centers. However, awareness about fitness and preventive care is gradually picking
up. There have been a few entrants in the disease management space, though they
have a very small footprint currently. A few large corporate such as Apollo
Hospitals and other health insurance companies are also introducing concepts
related to wellness and preventive care.
Perception about Elderly Most of the younger generation feels that elder generation
should retire after 60 years as they cannot cope with the stress and work but if the
elder generation is healthy and willing to work, the perception needs to change.
Everyone has a right to a dignified life and with some help in honing the elderly
genrations' skills and making them technology-savvy, the younger generation
could benefit from their experience. Though the Constitution of India mandates the
well-being of elderly generation under Article 41 but if the elder generation does
not get adequate help from the extended family, society, and take charge of their
own life, the pension schemes run by the Government would not be adequate to
sustain this generation.
During the last two decades, aging population has become a cause of worry for the
policy makers all over the world — both developed and developing countries alike.
The proportion of elderly (above 60 years of age) is expected to increase from 8.3
per cent in 2013 to 18.3 per cent by 2050 and to 30.2 per cent by 2100). Therefore,
the formulation and successful implementation of welfare policies for senior
citizens pose a challenge to the Central and the State Government. This section
highlights significant policies initiated and implemented by various governments
(center/state) in the post-independence era.
Maintenance and Welfare of Parents and Senior Citizen Act 2007 Maintenance and
Welfare of Parents and Senior Citizen Act 2007 is considered to be a landmark
development for senior citizens. It aimed to ensure need based maintenance for
parents and senior citizens, protection of the rights and welfare from their children.
It contains penal provisions for the abandonment of senior citizens, provides for
the establishment of old age homes for indigent senior citizens, and envisages
protection of the life and property of senior citizens.