世界银行+白银机会：围绕初级卫生保健为老年人建立综合服务.pdf
Building Integrated Services for Older Adultsaround Primary Health CareXiaohui HouJigyasa SharmaFeng ZhaoEdited byBuilding Integrated Services for Older Adults around Primary Health CareEdited by Xiaohui Hou,Jigyasa Sharma,and Feng Zhao 2023 International Bank for Reconstruction and Development/The World Bank1818 H Street NW,Washington,DC 20433Telephone:202-473-1000;Internet:www.worldbank.orgSome rights reserved1 2 3 4 26 25 24 23This work is a product of the staff of The World Bank with external contributions.The findings,interpretations,and conclusions expressed in this work do not necessarily reflect the views of The World Bank,its Board of Executive Directors,or the governments they represent.The World Bank does not guarantee the accuracy,completeness,or currency of the data included in this work and does not assume responsibility for any errors,omissions,or discrepancies in the information,or liability with respect to the use of or failure to use the information,methods,processes,or conclusions set forth.The boundaries,colors,denominations,and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of the privileges and immunities of The World Bank,all of which are specifically reserved.Rights and PermissionsThis work is available under the Creative Commons Attribution 3.0 IGO license(CC BY 3.0 IGO)http:/creativecommons.org/licenses/by/3.0/igo.Under the Creative Commons Attribution license,you are free to copy,distribute,transmit,and adapt this work,including for commercial purposes,under the following conditions:AttributionPlease cite the work as follows:Hou,Xiaohui,Jigyasa Sharma,and Feng Zhao,eds.2023.Silver Opportunity:Building Integrated Services for Older Adults around Primary Health Care.Washington,DC:World Bank.doi:10.1596/978-1-4648-1958-2.License:Creative Commons Attribution CC BY 3.0 IGOTranslationsIf you create a translation of this work,please add the following disclaimer along with the attribution:This translation was not created by The World Bank and should not be considered an official World Bank translation.The World Bank shall not be liable for any content or error in this translation.AdaptationsIf you create an adaptation of this work,please add the following disclaimer along with the attribution:This is an adaptation of an original work by The World Bank.Views and opinions expressed in the adaptation are the sole responsibility of the author or authors of the adaptation and are not endorsed by The World Bank.Third-party contentThe World Bank does not necessarily own each component of the content contained within the work.The World Bank therefore does not warrant that the use of any third-party-owned individual component or part contained in the work will not infringe on the rights of those third parties.The risk of claims resulting from such infringement rests solely with you.If you wish to re-use a component of the work,it is your responsibility to determine whether permission is needed for that re-use and to obtain permission from the copyright owner.Examples of components can include,but are not limited to,tables,figures,or images.All queries on rights and licenses should be addressed to World Bank Publications,The World Bank Group,1818 H Street NW,Washington,DC 20433,USA;e-mail:pubrightsworldbank.org.ISBN(paper):978-1-4648-1958-2ISBN(electronic):978-1-4648-1965-0DOI:10.1596/978-1-4648-1958-2Cover illustration:Tetiana Garkusha/iStock.Used with the permission of Tetiana Garkusha/iStock.Further permission required for reuse.Cover design:Chris Phillips,Circle Graphics,Inc.Library of Congress Control Number:2023931889ContentsForeword xiAcknowledgments xiiiAbout the Editors and Authors xvAbbreviations xviiOverview and Framework for Action 1Xiaohui Hou,Jigyasa Sharma,Feng Zhao,and Alexander IrwinIntroduction 1A Challenge That Will Not Wait 2Diverse Populations with Complex Needs 3Aging in the Time of COVID-19 3What This Book Contributes 4Investing in Healthy Aging:Toward a“Triple Dividend”for Health Systems andSocieties 5Fulfilling the UHC Promise:PHC-Centered,Integrated Care for AgingPopulations 5Todays Reality:Shortfalls in Age-Responsive Care Worldwide 6Tackling PHC Gaps for Healthier Aging 6Closing Care Gaps:Where Do Countries Start?7Understanding the Care Needs and Preferences of Diverse Older Populations 7PHC-Centered Integrated Care for Aging Populations:AFrameworkforAction 9Levers for Age-Responsive Health System Change:Presenting theFIREFramework 9Informing Action through the FIRE Framework 11Methods and Limitations 15Structure of the Volume 16Notes 18References 19vSILVER OPPORTUNITYviChapter 1.High-Quality Health Systems for an Aging Population:Primary Care Models with Users at the Center 23Todd P.Lewis,Margaret E.Kruk,Jigyasa Sharma,and XiaohuiHou Key Messages 23The Health and Service Needs of an Aging Population 23Context Matters:Health Services at Home and in InstitutionalSettings 28Primary Care for Older Adults:Frameworks and Functions 30Toward a Fit-for-Purpose Primary Care Model with Older Users attheCenter 38Conclusions 41Note 41References 41Chapter 2.Financing Primary Health Care forOlder Adults:Framework and Applications 47Victoria Y.Fan,Jigyasa Sharma,and Xiaohui HouKey Messages 47Introduction 47Conceptual Background 48Financing Framework for PHC of Older Adults 52A Review of Selected Country Cases 57Policy Recommendations 65Notes 67References 67Chapter 3.Innovations in Models of Care for an Aging Population 75Xiaohui Hou,Zhanlian Feng,Sana Haider,and Guadalupe SuarezKey Messages 75Introduction 75The Current Landscape of LTC Services in LMICs:An Overview 77Innovations in LTC in HICs 81Innovations in LTC in LMICs 88Discussion and Policy Considerations 90Conclusion 92Notes 93References 93Chapter 4.How Digital Health Technology IsTransforming Health Care for Older Adults 97Gabriel Catan Burlac and Xiaohui HouKey Messages 97ContEntsviiDelivering Health to Older Adults in a Digital World 97Transforming Service Delivery for Older Populations 100Challenges and Barriers to Implementation 102Conclusion 108Notes 109References 110Chapter 5.Designing Integrated Care for an Aging Population:Regulationand Governance for Healthy Aging 113Naoki Kondo,Koryu Sato,and Yuiko NagamineKey Messages 113Core Values in Regulating Primary Health Care for OlderPeople 113Stakeholders and Their Roles 116Managing Good Governance Mechanisms(RegulatoryDevices)120Country Example#1:Japan 123Country Example#2:Thailand 128References 132Chapter 6.Evaluating Care of Older Adults in Low-and Middle-Income Countries 133Zhanlian Feng,Guadalupe Suarez,and Elena E.Glinskaya Key Messages 133Introduction 133Demand-Side Evaluation 135Supply-Side Evaluation 140Discussion and Policy Considerations 148Concluding Remarks 151Annex 6A Measures for Long-Term Care Outcomes 152Note 152References 153Chapter 7.Community-Based Integrated Carein Japan 159Japan International Cooperation Agency(JICA),summarizedby Risa Nakayama and Xiaohui HouKey Messages 159Historical and Institutional Background of Japans Community-Based IntegratedCare System 160The Philosophy of Long-Term Care 163Practicing Community-Based Integrated Care in Japan:Three Cases 167Key Lessons from the Three Cases 173Lessons Learned and Recommendations 176Notes 178References 178SILVER OPPORTUNITYviiiChapter 8.Conclusions and Policy Takeaways 179Xiaohui Hou,Jigyasa Sharma,Feng Zhao,and Alexander IrwinIntroduction 179Financing:Managing Resources for PHC-Led System Change 180Innovation:New Tools for the Aging Challenge 182Integrated Care Delivery 183Digital Health for Older Adults 184Regulation:Leveraging Older Adult Care to Advance Health SystemStewardship 185Evaluation:Better Measurement Fuels Efficiency 187Summary of Policy Recommendations 189An Ongoing Learning Agenda 189The Way Forward:Systems Integration for the Silver Age 190Notes 192References 192Box4.1 Examples of Digital Health Technology Use 101FiguresO.1 Estimated and Projected Global Population,by Age Group,19502100 2O.2 PHC-Centered Integrated Care for an Aging Population:The FIRE Framework 101.1 Global Disability-Adjusted Life Years Burden,by Cause,for Adults Age 60 and Older,2019 251.2 Percentage of Adults with Hypertension Who Were Undiagnosed,Reported a Diagnosis,Who Used Treatment,and Whose Blood Pressure Was Effectively Controlled,by Region and Age Group,2019 271.3 Percentage of Adults Age 65 and Older Receiving Long-Term Care in Institutions,2005 and 2019(or Nearest Year)281.4 Percentage of Adults Age 60 and Older Living in a Solo Household,201018 291.5 Conceptual Framework for a High-Quality Health System for Older Adults 331.6 Percentage of Adults Age 65 and Older in 11 Countries Who Had Problems Accessing Health Care Services Because of Their Cost,2014 361.7 Percentage of Adults Age 65 and Older in 11 Countries Who Experienced Problems with the Coordination of Their Care,201314 362.1 Financing Framework for Population Eligibility,Benefits Package,and Means of Financing 522.2 Out-of-Pocket Spending as a Percentage of Current Health Expenditure and Population Age 65 and Older as a Percentage of Total Population,2019 54ContEntsix2.3 Selected Country Case Studies:Out-of-Pocket Spending as a Percentage of Current Health Expenditure and Population Age 65 Years and Older as a Percentage of the Total Population,2019 585.1 Dedicated Multisectoral Coordinating Body for the Continuum of Long-Term Care 1165.2 Key Stakeholders of a Community-Based PHC System for Older People and TheirRoles 1175.3 A Model of Key Driving Factors for Sustainable Actions for UHC for Older Adults inJapan 1205.4 The Framework of Accountability Relationships 1215.5 Conceptual Framework of the Community-Based Integrated Care System in Japan 1265.6 Community-Based Integrated Care Visualizing System 1275.7 Long-Term Care Policy Development in Thailand,19862018 1296.1 The Donabedian Framework to Evaluate the Quality of Care 1407.1 Trends in Population Composition and Aging Rate,Japan,19502019 1607.2 Trends in Hospitalization Rates,by Age Group,Japan,19652020 1617.3 Trends in Outpatient Consultation Rates,by Age Group,Japan,19652020 1627.4 Timeline of Health Care Development in Japan,19612017 1647.5 Long-Term Care Insurance Operating Mechanism in Japan 1657.6 Community Targets in Community-Based Integrated Care 175Maps1.1 Life Expectancy at Age 60 for Men and Women,2019 247.1 Secondary Medical Area(Kamiina District),Japan 1687.2 Fujisawa Citys 13 Districts(Areas),Japan 1707.3 Higashiomi City and Eigenji District,Japan 172Tables1.1 Elements of Differentiated Primary Care with Older Users at the Center 402.1 Summary of Countries Selected for Review 592.2 Eligibility Criteria,Premium,and Cost Sharing,and Market Structure in Selected Countries 602.3 Role of Primary Care for Coordination,Gatekeeping,and Referrals to Long-Term Care 606.1 ADL-and IADL-Based Measures of Disability among Older Adults in Select LMICs 1376A.1 Candidate Measures for Long-Term Care Outcomes of Well-Being,Quality of Life,and Personhood 1527.1 Outline of Long-Term Care Insurance in Japan 1658.1 Policy and Implementation Takeaways in the FIRE Domains 190 xiForewordLike many diseases,COVID-19(coronavirus disease 2019)has had a sharply disproportionate impact on older people.During the first year of the pan-demic,people age 65 years and older in high-income countries accounted for 89 percent of official and excess COVID-19 deaths,and in low-and middle-income countries,they accounted for nearly half.The strain on health systems worldwide from the burden of both infec-tious and chronic diseases is growing by the day,in part because populations are rapidly aging.In 2018,for the first time in history,people age 65 years and older outnumbered children under five worldwide.By 2050,the number of older people is projected to more than double from 2019.Why does this matter?A failure by countries to improve the capacity of their health systems to care for their aging populations will have a devastating ripple effect on older people and their families,communities,and economies.When medical care does not meet older peoples needs,population aging can cause health and social care costs to balloon,government deficits to rise,and economic growth to declineand,of course,can have deleterious effects on older people themselves.Moreover,in communities where formal long-term care infrastructure is weak,the burden of care for older adults often falls on family members,who may have to forgo employment to care for their relatives,with consequences for their own health and well-being and for human capital accumulation in their countries.It does not have to be this way.As our report title suggests,governments have a“silver opportunity”to improve health by reimagining primary health care(PHC)and integrating it with other forms of person-centered care,including long-term care,to better address the health needs of older populations.Longevity gains reflect hard-won progress in human development.Now we need to redesign health care systems and link PHC to broader forms of social care and supportincluding community care,secondary and tertiary care,and long-term care facilitiesto maintain and accelerate this progress.SILVER OPPORTUNITYxiiHowever,PHC delivery systems in most countries have yet to fulfill their promise,and most systems do not regularly provide the range of quality ser-vices that meet the needs of older populations.Addressing the high burden of disease among seniors,especially epidem-ics of chronic disease,will require reforming PHC systems to make them more agile and responsive to the needs of this growing population.This book presents an original framework to show how core policy levershealth financing,innovation in service delivery and digital technology,regula-tion,and evaluation,which we call the FIRE frameworkcan help countries make their PHC systems more responsive to the needs of older people,coor-dinate care across different types of medical and social support,and uplift older peoples health.The ultimate result will be more integrated care systems that link different facets of peoples health and well-being across their lifespans.If governments can improve the supply-side levers outlined in the FIRE framework to meet the needs of their surging populations of older adults swiftly and at scale,they can usher in a silver age of healthier people and societies.Doing so will pay other dividends.Providing integrated care centered in PHC systems not only will have a positive impact on individual health and allow people to thrive in old age but also will speed progress toward achieving two critical goalsuniversal health coverage and health equity.This book weaves together a collection of studies and thought leadership contributed by research groups from d
