Türkiye must immediately take out long-term care insurance

Türkiye’s population is aging rapidly, with the latest data from the Turkish Statistical Institute (TurkStat) pointing to a critical moment for the country.

In 2023, the share of the child population fell from 26.4% to 21.4%, while the share of people over 65 increased from 7.1% to 10.2%. The country’s average age reached 35 years in 2023, an all-time high. The fertility rate, which was 2.1 in 2017, has fallen to an all-time low of 1.97 in 2022. These figures underline Türkiye’s demographic challenges on the horizon, especially in addressing the needs of its aging population. Apparently, managing the aging population will pose significant policy challenges over the next decade as Turkey becomes an older populated country. Understanding the current situation and expectations of the older population is therefore crucial.

A crucial recent report on this issue is the Turkish Elderly Profile Survey. This groundbreaking study, conducted in the final months of 2023, included interviews with approximately 29,000 individuals aged 50 and over from 22,640 households across the country. The research, conducted in collaboration with the Ministry of Family and Social Services and TurkStat, provides valuable insights into the necessary policies to meet the needs of seniors, highlighting the urgent need to establish an insurance model for elderly care in the country is emphasized.

Healthcare and well-being of the elderly

Let’s first look at the health status of Turkish elderly people. According to the report, 78 in 100 people over the age of 65 have a chronic disease.

It’s no surprise that being healthy is the greatest source of happiness for people in this age group, similar to global examples.

According to the survey results, 78.7% of people over 65 have chronic diseases such as high blood pressure, diabetes, cardiovascular disease, cancer, kidney failure, stroke, hepatitis and asthma. Of the elderly with a disability report from the health council, 77.6% have a disability report due to chronic diseases, 48.7% have an orthopedic disability report and 23% have a disability report due to visual impairment.

As an important indicator, the percentage of those who claim that their chronic illness limits their daily activities is 32.3%. Moreover, only two in ten people over 65 indicate that they are in good health, while this proportion rises to three in ten among those over 50.

When older people with other health problems were examined, the percentage of people who had difficulty seeing was 10.1%, the percentage of people with hearing problems was 10.6% and the percentage of people who had difficulty speaking was 2.2%. . The percentage of those who had difficulty walking, climbing stairs or stairs was 27.1%, the percentage of those who had difficulty carrying or holding things was 29.7%, and the percentage of those who had difficulty learning, performing four simple actions, remembering or concentrating compared to their peers was 13.8%.

Looking at the general psychology of seniors in Türkiye, the survey shows that the percentage of people over 65 who stated that they were generally happy was 64.1%. An important feature is that the greatest source of happiness for 82% of people over 65 is being healthy. According to the survey, the percentage of people who stated they were unhappy was 8.0%. Moreover, the percentage of people aged 65 and over who look at their past with happiness was 71.1%.

Increased care needs

An important aspect of the research is the growing need for care in Türkiye. According to the research, more than half of elderly people over 50 indicate that they will receive home care in the future. More detailed: in the older age period, 54.6% prefer to stay at home by receiving home care/day care. About 24.2% of participants prefer to stay with their son/daughter, and only 5.9% indicate they prefer a nursing home.

Looking at the current situation, 16.4% of those over 65 were in need of home care support. This percentage was 10.5% for people aged 65-74 and 26.9% for people aged 75. However, the percentage of people aged 65 and over who received home care support in the past twelve months is only 2.5%.

On the other hand, the share of people needing care is expected to increase. According to the study, the percentage of people aged 50 who have fallen inside or outside their home in the past twelve months is 17.5%, while for 65 year olds this percentage is 24.0%. It appears that orthopedic problems in particular cause significant obstacles to maintaining daily life and participating in society.

When examining people’s ability to perform daily activities within the scope of the components included in the Lawton-Brody Instrumental Activity of Daily Living Scale, it is found that 85.7% of people aged 65 can use their telephone and 55.1% can use their telephone. own messages. It was found that 76.6% of them could prepare their own meals and clean the house, 72.8% of people could do laundry, 76.3% could travel, 85.5% could take their own medicines and 74.0% could arrange their financial affairs. .

When people’s ability to perform daily activities within the scope of the components of the Katz Activities of Daily Living (ADL) Scale is examined, it is found that 86.5% of people aged 65 years and older can independently bathing, 89.5% can dress independently and 92.1% can go to the toilet independently. It was found that 92.1% of people could move from bed to couch independently, 83.1% could meet their toilet needs and 95.2% could eat themselves. Figures show that the majority of Turkish seniors are in good condition in terms of living independently without being dependent for their daily activities, but there is also a growing need for care.

Home care as primary preference

The research also shows that a large proportion of Turkish elderly people prefer home care over institutionalized care. When examining the lifestyle preferences of 65 year olds, 51.9% prefer to stay at home by receiving home care/daycare, 29.6% prefer to stay with their son/daughter and 5, 1% seek institutionalized care in their later years.

Of men aged 65 and older, 55.7% preferred home care or childcare, 23.2% preferred to stay with their son or daughter and 6.4% preferred to go to a nursing home. For women, these percentages were 48.8%, 34.8% and 4.1% respectively.

Of those aged 50 and over who expressed a preference to stay in a nursing home in their later years, 41.3% said they did not want to burden their children, 26.5% mentioned better facilities in nursing homes and 10, 6% said they had no one to care for them.

Preference for nursing homes among the elderly is remarkably low, reflecting a cultural norm. In Turkish society, there is a long tradition of families receiving and caring for their elderly members, ensuring that they remain within their social circles. Furthermore, entrusting elderly parents to nursing homes is widely regarded as socially shameful.

But for reasons such as the breakdown of the traditional family structure, young people leaving their hometowns and migrating to big cities, increasing divorce rates and young people breaking away from traditional family values, more and more elderly people are finding themselves in trouble. in need of institutional care one way or another. The profound transformations that Turkish society is undergoing result in new demands in the field of the Turkish welfare state.

When the current situation is checked, the study shows that the percentage of people aged 65 living alone is 20.4%, while the percentage of people living with their partner is 35.8%, the percentage of people living with their son /daughter. law, daughter-in-law/son-in-law and grandchildren is 17.0%, and the percentage of people living with their spouse and children is 10%. These figures show that informal social care systems in Türkiye are still functioning. However, we see that 13.3% of older people whose opinions were consulted said there was no one they could ask for help in an emergency. This percentage is alarming and will increase significantly in the coming decades.

An urgent need: long-term care insurance

The data presented clearly indicate the acute increase in the number of elderly people requiring care in Turkish society. Moreover, the number of people living alone in Türkiye is increasing rapidly. More importantly, current informal care arrangements are expected to become chronically inadequate over the next decade.

The solution is clear: Türkiye needs premium insurance for elderly care immediately. The country has twenty years of opportunity. If care is not introduced, after the aging crisis hits, care will pose a major challenge that could collapse the current social security system. Moreover, the elderly care insurance system is also a requirement for Türkiye in terms of International Labor Organization (ILO) standards. Health insurance is one of the most important branches of social security offered by the ILO as a minimum standard, which is missing from family insurance in Türkiye.

Türkiye’s need for a pay-as-you-go model for elderly care insurance is not only a policy problem, but also a macroeconomic stability problem. The fund collected by the health insurance system would be a great fund to contribute to eliminating the country’s savings deficit. If started today, the first expenditure is expected to be incurred within ten years and the system will not require significant expenditure until twenty years later. Until then, the system will be a net fundraiser.

Because Türkiye still has a young population compared to its European peers, and because the young people will be net contributors, the system will continue to collect for almost twenty years, without significant costs. The system has the potential to create a fund larger than the successful Private Retirement Fund (BES) and the Unemployment Insurance Fund within ten years, by approximately $10 billion (TL 325.48 billion). This fund, if used wisely, would also help alleviate the burden on the current social security system.

In short, Türkiye is obliged to take immediate action for the long-term care insurance system, for a healthy welfare state and to avoid an unbearable burden on the shoulders of future generations.