8.D. Workshop: Population ageing: societal triumph or end of the welfare state?

Abstract   Longer, healthier lives are a triumph in human history, but their implications for health systems, economies, and societies are still up for debate. Many observers and policymakers, in fact, view societal ageing as a problem. For them, an ageing population entails higher health care costs, slower economic growth, and fewer tax revenues, all of which is compounded if people age in poor health. Taken together, many policymakers may conclude that the only solution is to clamp down on the welfare state. This belief in the inevitability of an age-related fiscal crisis often coincides with and contributes to intergenerational conflict, as generations struggle over public spending priorities. But are the adverse consequences of population ageing really inevitable, or is there scope for policy intervention? The purpose of this workshop is to present new evidence on the implications of population ageing for health and health systems and to consider policy options. Research indicates that the extent that population ageing creates difficulties for economies, public finances, and health systems is complex and, importantly, conditional on a host of modifiable factors. Indeed, while some consequences of ageing are unlikely to be very bad even without policy interventions, some genuine causes for concern can be better managed with effective interventions. Furthermore, a focus on intergenerational conflict distracts us from other, important, inequalities within generations, which is a much more urgent policy challenge to address. This workshop is based on findings from the European Observatory's “Economics of Healthy and Active Ageing” series which brings together research on why population ageing is often (erroneously) viewed negatively from a health financing perspective, and reviews relevant policies that may improve health system financial sustainability. The workshop will have 4 presentations followed by a brief debate on how to better use this type of evidence for policymaking. Presentation #1 sets out the main challenges and presents a new simulator tool for assessing the health financing sustainability gap attributable to population ageing. Presentation #2 explores in detail the role of proximity to death as a driver of health expenditures and considers policy options to improve and rationalize end-of-life care. Presentation #3 will use time use survey data to consider what it means to age in good health by reviewing the daily lives of older people and comparing those in good health to those in poor health. Lastly, Presentation #4 will consider what drives ageing-related policymaking and what is needed to get more lifecourse policies in place. A debate including audience members will be facilitated by an expert associated with the Observatory. Key messages The way societies address the challenges of ageing is a policy choice – there are a multitude of interventions to ensure that people age in good health without damaging fiscal sustainability. Beyond the intrinsic value of good health, there are a wide range of benefits of supporting healthy ageing over the life course.