The Health System Role of
Traditional Medicine
India
has experienced a major demographic transition in the past few decades
resulting in a substantial increase in the aged population. Consequently there
is increasing burden on the health system. Neither the current healthcare
infrastructure nor the professional capacity is equipped to handle this
situation. This is further challenged by the fact that there is no social
security system in the country and over 80 percent of the health care is
accessed through out of pocket expenditure. Changing social support systems,
rapid urbanization, deteriorating environment further complicate the situation.
In
this context, the article explores the relevance of traditional systems of
medicine in the country for improving healthcare for the elderly population.
The article briefly highlights certain unique principles and features of
traditional systems of medicine in geriatric care by focusing on Ayurveda, the
most popular traditional medical system in the country. The article takes two
fold approaches to address the challenges i.e. from the point of view of
individual care what measures are desired and from a health system focus what
policy directions are needed to integrate these systems into geriatric care.
Indian
life expectancy has increased by 25 years in the last 5 decades. This has
resulted in tripling of elderly population in the country. India is going to become the second
largest country in the number of elderly in the world. It is expected
that by 2026, 12.4 percent of the population will be in the above 65 age
category (Patwardhan 2012, Dey et al. 2012). Extrapolated figures indicate that
elderly population (60+ age group) will be 100 million in 2013 and will raise
to 198 million by 2030 (Government of India 2011). Two thirds of the elderly
population live in rural areas and around half of them have poor socio economic
status thus making health service a major challenge (Dey
et al. 2012).
Due to the diverse stages of social, political and economic development there
is considerable disparity among Indian states in the demographic transition and
their consequences. It is anticipated that the South India will face a faster
transition as compared to the North owing to this. Another critical fact
to take note of is that around half of the elderly population is dependent and
70 percent of elderly are women (Dey et al. 2012). It is estimated that 51% of
Indian elderly will be women by 2016 and compared to males, women have poorer
health status (Government
of India 2011).
Health Systems Challenges
in an Aging Society
International instruments such as the United Nations Human Rights
Commission, Millennium Development Goals (MDGs) and the World Health Organization
(WHO) have increasingly acknowledged access to appropriate healthcare as a human
right. At the same time the
situation of the aging population in the country is challenged by the fact that
the health system is not adequately equipped to take care of these emerging
needs. There is a huge out of pocket expenditure of almost 83% for outpatient
care which is not covered by any insurance at all (Duggal 2007; 2009).
Availability, accessibility and affordability of health services continue to be
major issues. Declining social support systems,
reduction in disposable income post-retirement, family nuclearization, lack of appropriate
social security policies, increasing chronic disease morbidity, high
diversity and heterogeneity in different regions in the country, reduction in post
retirement earning, gender, caste and religious based inequities are some of
the key contributing factors. Elderly health is also dependant on several other
factors such as marital status, education, economic freedom, sanitation and so
on (Dey et al. 2012). According to the
2004-2005 National Family Health Survey, only 10% of the households had atleast
someone in a family covered under any type of health insurance. Only the
privileged groups of the society avail insurance coverage and most needy are
left out. Often elderly are excluded from insurance coverage due to certain age
limits or based on their previous health status (Dey et al. 2012). Due to reduction in income postretirement
most are unlikely to be able to pay the insurance premium regularly.
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