趨 老齡化的人口、更長的壽命以及對生活質量越來越高的期望正在給亞洲各地的公共醫療衛生系統帶來壓力。這種情況乍聽起來跟西方國家決策者面臨的挑戰相似，但 其中存在一個重大差別。美國和歐洲的領導人正在艱難地對現行效率低下的醫療系統進行調整，使之適應變化的形勢，而許多亞洲國家政府則有機會從頭開始打造醫 療系統。而在構建這個系統的時候，他們應當留心私營部門能夠在哪些方面提供幫助。
在 這方面，新加坡於2002年開始的樂齡健保計劃(ElderShield Plan)提供了一個可以效仿的良好范例。政府與保險行業磋商制定了該計劃，並讓民眾從一系列得到認可的計劃中選擇保險類別。在那之後，政府一直與私營合 作伙伴一起通過額外的公共咨詢和用戶調查不斷審查和改進這項服務，從而打造出適應性強、最具成本效益的保險類別。
此 外，需要讓收入較低的消費者了解他們可以有哪些選擇，最好是通過政府和私營保險公司協調進行的溝通措施來實現。在馬來西亞，從2003年開始、由保險行業 提供支持的保險信息項目(Insurance Info Programme)提供了易於理解的材料、網絡資源以及在校金融教育，以提高金融包容性。這類方案必須利用多種渠道，最大限度地讓人們了解。
How Asia Can Get Health Care Right
Aging populations, longer life spans and ever-higher expectations of quality of life are placing burdens on public health-care systems across Asia. At first this sounds similar to the challenges facing policy makers in Western countries, but there is a critical difference. While leaders in the U.S. and Europe struggle to adapt existing but inefficient health-care systems to changing circumstances, many Asian governments have the opportunity to build from scratch. As they do so, they should be alert to ways the private sector can help.
According to the United Nations, the number of Asians older than age 65 will soar to 857 million in 2050 from 207 million in 2000. As a result, the dependency ratio is projected to rise sharply, to 27.8 young or elderly dependents per 100 people in 2050 from 9.1 dependents per 100 people in 2000. An ever-greater proportion of resources will shift toward health care. While the U.S. economy devotes roughly 18% of its annual output on health care, in China that number is only 5% and in Indonesia 3%.
Policy makers must tread carefully, however. Higher spending alone could skew incentives and permanently cripple government balance sheets. The focus must be not only on expanding access to care, but building a sustainable financing model from the start.
A first step should be to recognize that the private sector, including foreign companies, can offer valuable expertise. Through the aggregate decisions of millions of customers, commercial entities are acutely aware of consumer needs and demands. Furthermore, the global reach of international players offers a broader perspective of how different solutions can apply to various policy goals.
Such collaboration already is bearing fruit. The Hong Kong government, in its consultation on healthcare reform in 2008, solicited input from the private sector in such areas as enhancing primary care and reform of health-care financing. The insight, expertise and data private insurers and others were able to provide proved valuable for policy makers.
Private insurers, both domestic and foreign, also can play a useful role in implementing solutions. Over the last 10 years China has made great strides in its health-care provision, enrolling 900 million people in various public schemes to ensure coverage of more than 95% of Chinese citizens. However, current coverage is patchy, leading to a lack of confidence among consumers and fears of high costs.
Beijing says it will rely on private insurers to fill the gap beyond basic coverage. Already local governments in Fujian province and Chongqing allow private insurers to manage public schemes. The industry has grown 27% annually over the past 10 years.
In this regard, Singapore's ElderShield Plan, started in 2002, provides a particularly good example for others to follow. The government developed the scheme in consultation with the insurance industry, and works by allowing citizens to select coverage from a slate of approved plans. Since then, the government has worked with its private partners to review and improve the service through additional public consultation and surveys from users, resulting in adaptable, more cost effective coverage.
However, the mechanics of designing a new health program are only part of the challenge. Policy makers must also be alert to several other necessary components of health-care sustainability. Education is the most important.
First, educated consumers are likely to make wiser choices. Singaporeans are encouraged, through public health education programs, to adopt healthy lifestyles and be responsible for their own health. Evidence-based health screening has been introduced for the early detection of common ailments, such as cancer, heart disease, hypertension and diabetes mellitus.
Alongside this is the importance of policy education building an understanding within government of the long-term needs of the public. Laying the foundations for consensus in this regard is important for lasting change. Singapore initiated its reforms based on the findings of two foundational reports from the Ministry of Health. These helped explore the issues at play and recommended the involvement of private insurers, building support for the solution within government.
Finally, policy makers need to ensure that financing solutions are as inclusive as possible right from the beginning. Studies show that shifting responsibility for financing onto the private sector does tend to favor the middle class and wealthy who can afford more care. Any program must provide satisfactory minimum levels of coverage not least to maintain political support for such systems.
Furthermore, lower-income consumers need to be made aware of the options available to them, ideally through coordinated outreach efforts by governments and private insurers. In Malaysia, the industry-backed Insurance Info Programme since 2003 has provided easy-to-understand materials, online resources and financial education in schools to promote financial inclusion. Such schemes must use multiple channels to engage the broadest possible audience.
Sustained by its high growth rates, Asia has time yet before the cost of health and aged care becomes an overwhelming force and threatens a Eurozone-style crisis. Governments across Asia should use this grace period to devise health-care public-private partnerships that actually work for their citizens. With the unrelenting demographic forces at play, time may be shorter than they think.
(Mr. Bishop is chief executive of AXA Asia.)