24 May 2022, by Azusa Sato, Helen Dempster, Dorothy Leab, Hang Nguyen, and Linh Hoang
Migration for long-term care (LTC) in Asia has increasingly gained attention due to rapidly aging populations and the ensuant increase in demand for care1. COVID-19 has had a unique impact on these dynamics. Migration patterns have shifted, as some countries initially suspended out-migration, including deployment of nurses and other medical workers, to ensure enough personnel remained at home. Our research explores the impact of aging and COVID-19 on current and future health and care worker migration for LTC in Asia. We largely focus on describing and analyzing migration from primary countries of origin (Indonesia, Malaysia, the Philippines, Sri Lanka, Thailand, and Vietnam) to countries of destination (China, Japan, Singapore, South Korea, and Taiwan).
- Fueled by increasing life expectancy and falling total fertility rates, the number of people in Asia aged 60 or over will triple to 1.3 billion by 2050
- Meeting this demand requires millions of new long-term care (LTC) workers, many of whom will need to be migrants
- Most migration for LTC occurs from poorer Southeast Asian countries to richer East Asian ones, though primary countries of origin are shifting as those countries age and develop
- COVID-19 has exposed many countries’ reliance on migrant workers, and promoted a ‘global scramble’ to expand immigration pathways
- Asian countries of destination should expand immigration pathways for LTC, but in ways that are both ethical and sustainable.
This note has been prepared by GaneshAID, in collaboration with the Center for Global Development (CGD). It is a summary of a longer paper, COVID-19, Long-Term Care, and Migration in Asia, released by CGD in late April 2022. For more details please see the report and get in touch (Helen Dempster, Policy Fellow, CGD: email@example.com).
The Demand for LTC
Our countries of destination are experiencing rapidly aging populations. Over the past seven decades, total fertility rates (TFR) have fallen steeply and life expectancy has jumped dramatically. Thanks to better healthcare and basic standards of living and sanitation, both men and women in these countries can now expect to live well into their 80s, if not 90s. These trends have led to a higher old-age dependency ratio (Figure 1), which puts more pressure on younger people to care and provide for older people.
Data shows large gaps in the provision of, and access to, LTC services in many low- and middle-income countries3. There are many reasons as to why someone may not be able to access LTC, including problems with affordability, acceptability, accessibility, and availability.
In 2012, a survey found that, on average, 50 percent of people in Asia experienced an ‘unmet need’ for care. Such gaps were greater for those living in rural areas. (especially in Indonesia, the Philippines, Thailand, and Vietnam) and for women (especially in Singapore, Japan, and South Korea). Those living in poverty are more likely to experience a significant unmet need for care, especially in our countries of origin (Indonesia, Malaysia, the Philippines, and Vietnam). Meeting this need will require more LTC workers in the years to come.
Figure 1. Old-age dependency ratio growth in China, Indonesia, Japan, malaysia, the Philippines, Singapore, South Korea, Sri Lanka, Taïwan, Thailand, and Vietnam, 1950-250.