The world economy has experienced profound changes in the past few decades and is expected to undergo uneven globalization trends. The increasing influence of the large emerging economies on the global economy has become an important issue that calls for more rigorous research and policy attention [11]. This growth is expected to be primarily driven by the emerging markets and developing nations, with the EM7 economies growing at an annual average rate of almost 3.5% during the next 34 years. In contrast, an annual average growth rate of 1.6% is predicted for the G7 countries [12]. It further elucidates that the EM7 could account for nearly 50% of the globe’s GDP by 2050, while the G7’s share of global GDP might decline to just over 20%. It is due to the population aging [13] and lack of natural resources [14]. It clearly indicates that the EM7 is expanding, while the G7 is shrinking [15].
However, it takes more time to implement universal health care (UHC) in the EM7 because there is still no policy and program priority for health [16]. Except for the United States, the G7 countries have already achieved UHC. Coverage of universal health insurance should be in high priority for the EM7 countries [16]. Ordinary citizens’ capacity concerning the acquisition spread efficiently, but not fast to enough follow-up disproportionate rapid growth of out-of-pocket spending [17]. In the XXI century, the G7 countries invest in health more than 10 percent of current health expenditure [18], along with energy and infrastructure [19]. In contrast, the EM7 countries have invested in health less than five percent of current health expenditure [20] and set priority to infrastructure and the economic growth.
Lastly, the results of the regression analysis related to the composition of indicators affected by the real GDP growth as well as the predicted direction of effect can be attributed to the differences in budget planning priorities and GDP per capita in the compared groups.
A set of economic inefficiencies among emerging markets are also attributable to the double economic burden of the unliquidated pool of infectious diseases associated with non-communicable affections [21]. Contribution of population aging to the growing demand for long-term medical care and pharmaceuticals is probably the most vivid when comparing Japan with China. These two are most typical representatives of both groups. In demographic terms, Japan remains in the most advanced stage of population aging. Yet, even with the recent abolishment of one-child policies, China has exhibited only a sudden, but temporary upward shift in fertility rates during the early 2010s, returning back to the ratio of 1.1 child per woman. This is far below simple population replacement threshold of 2.1, and China is most likely to become the fastest aging nation by 2050.
In addition to the accumulation of incidence of autoimmune, cancer, and dementia morbidity among the elderly citizens, here we face another important phenomenon. It is the so-called “the last year of life”. Its costs of intensive, palliative, and home-based medical care requiring nursing staff due to gradual disappearance of family caregiving across Asia, generates costs which are on average equal to the entire life-time medical consumption of that individual citizen.
Thus, the economic implications for the health system workload and financial burden for the social support systems in the societies with ever-larger populations of elderly citizens are clear in both the G7 and the EM7. Yet, the latter group of countries finds itself confronted with a much more serious challenge. Namely, population aging as the third demographic transition does not only become global phenomenon (with 17–18 outlier African nations and Afghanistan), but it is accelerating across the globe. Unlike the Western hemisphere, in the EM7, such changes were driven by spreading of globalization and sexual revolution during and after the XX century, leading to the absorption of women into the labor markets worldwide. Ultimate outcome of this equation was creation of financial incentives by the contemporary societies, Eastern and Western alike to attract women into the workforce, which in turn had a negative effect of fertility ratios. Here we come up to the important disadvantage of the emerging nations in this struggle. Aging itself in Western European societies had its roots in the XIX century. Thus, if one observes the time that was necessary to double the population of senior citizens from 7–14%, in France it took 115 years, while in Brazil 21 year only. It is clear that the G7 nations, experiencing these changes historically in a much earlier momentum had far more time to evolve gradually their social support and health insurance coverage systems to meet the challenge [22]. However, in the emerging, rapidly developing nations, which with the notable exception of the former Soviet Union [23], were largely non-industrialised countries, it happened much faster.
Indonesia, Mexico, and Turkey face similar problems related to the double burden of infectious illnesses, non-communicable diseases, and lack of social capital and medical staff capacities to cover these needs. These same matters were already elaborated in academic literature on BRICS with Russia having historically the earliest developed capacities in preventive medicine and screening procedures. Even today in a leading Chinese nation with abundant national welfare, cancer-screening procedures leading to serious long-term savings, are only being systematically pursued in coastal and some urban areas.
The approaching health policy reforms in the EM7 is likely to enforce these priorities even despite the reluctance of their governments to push for higher health care investments. Actually, among the BRICS, as the core subgroup of the EM7, all states except India, have managed to increase their GDP share of national health spending from one to two percentage points on average since 1990 [24]. This positive trend needs more financial resources and development to be a par with the G7 countries.
This is how we try to explain the core finding of this research. How could it be possible that the EM7, despite their better performance in terms of real GDP growth throughout the crisis, did not channel more welfare into the population health? The answer lies in the fact that the XIX century European-style health systems were entirely built upon in the era of sustainable demographic growth [25]. Working citizens contributed to various social and health insurance models through mandatory taxes to support the devaluating and insufficiently large pensions and retirement funds for the elderly. Long decades of the post-WWII European social evolution resulted in the creation of the welfare state. In France, an average citizen could enjoy up to 24 years of state-sponsored pension with full pension and release from any mandatory work after his or her retirement [26]. Given the current stage of fertility falls and increased longevity post-war generations of baby boomers have long forgone. We face nowadays ever-shrinking cohorts of work-capable citizens in their best age. At the same time cohorts of elderly become annually more and more massive leading to severe distortion of healthy demographic pyramids. The only partial exemption from this case, driven by Latin American immigration are the USA [27]. All other Western nations follow the very same pattern with Germany and Italy being among the worst ones in the most advanced stage of the third demographic transition [28]. Here we easily observe that the base of taxpayers is getting smaller and base of tax consumers is getting larger and heavier. Currently foreseen strategies, some of them imposed by the European Commission, refer to extending life work age [29] and thresholds for retirements including re-integration of cancer-survivors [30] and other people with decreased working ability back to the labour markets. These measures, including immigration of foreign-born work force, so far imply the limited outreach [31]. Therefore, the health expenditures among the G7 are likely to continue growing at least twice faster that overall economy size (with notable exception of Japan) in the upcoming decades [32]. Obviously, mature economies of the G7 and rapidly evolving economies of the EM7 each following its own distinctive historical pathway, are likely to conform similar challenges, but from entirely different perspectives [33]. Likewise, their strategies to cope with the burden of medical care spending, and citizen out-of-pocket spending in particular are likely to be profoundly different and tailored at their own needs.