How MDB Partnerships Expand Health and Long-Term Care for Older People

The population aged 60 and above in Asia and the Pacific is projected to triple between 2010 and 2050, reaching nearly 1.3 billion and posing challenges for economic growth. In the People's Republic of China (PRC), people aged 60 and above are expected to account for 33% of the total population by 2050.

Combined with gaps in social protection and health care financing, this demographic shift is already placing financial pressure on health-care facilities and services across the region, particularly long-term care.

As the share of older people rises relative to the working-age population, governments may face increasing fiscal pressures as demand for age-related health and care services grows. These pressures highlight the need to strengthen public systems while mobilizing complementary sources of financing to meet this growing demand. 

At the same time, ageing is occurring alongside broader challenges, including climate change, potential pandemics, and other crises that can have long-term societal impacts and extend beyond national borders. These challenges can disproportionately affect vulnerable populations, including older people, adding to pressures on health and long-term care systems.

Growing demand for health and long-term care is creating opportunities to mobilize private investment. Potential investment areas include health monitoring systems, disease management innovations, and remote care technologies. As the need for age-related goods and services grows, commercial banks are showing more interest in the expanding “silver economy.”

MDBs have expanded the use of nonsovereign financing to support private sector investments in health and long-term care for older people. These investments can help mobilize commercial cofinancing, share project risk, and complement public resources.

These approaches can help advance the Sustainable Development Goals while supporting the health, well-being, and economic participation of older people.

Commercial banks can play a role in mobilizing private finance for health and long-term care. One example is the Bank of Tianjin (BOT) in PRC. Tianjin is a major industrial and commercial hub. At the end of 2023, more than one-quarter of its population was aged 60 or above. A $50 million loan agreement between BOT and the Asian Development Bank (ADB) will finance investments in facilities, equipment, information technology systems, and related services for health and long-term care providers. It is ADB’s first private sector loan to a commercial bank dedicated to such financing.

The project will also support BOT in strengthening its digital systems and platforms to improve access to financial services. This includes digital services that can facilitate appointments, payments, and medical insurance claims without requiring physical visits.

Drawing on its presence in the Beijing–Tianjin–Hebei region, BOT can work with government agencies, regulators, academic institutions, businesses, and communities to support the development of health and long-term care services. This network can also provide experience that may inform similar approaches elsewhere.

Insurers can also serve as financing partners. ADB has made its first direct equity investment in the insurance sector through an investment in Fosun United Health Insurance Company Limited (FUHI), a private sector partner in PRC. The investment aims to expand commercial health-insurance coverage and strengthen long-term care services, including care for older people.

The BOT and FUHI initiatives demonstrate complementary approaches to mobilizing private finance for health and long-term care. One channels financing through a commercial bank, while the other does so through an insurance provider.

Experience from these initiatives can help inform similar approaches in other developing member countries and contribute to regional knowledge sharing on financing models for ageing societies. This may include countries participating in the Central Asia Regional Economic Cooperation (CAREC) Program and the Greater Mekong Subregion (GMS) Program.

ADB also has a social sector team focused on structuring bankable projects and evaluating investments in health and education while supporting portfolio-level financial sustainability. This would help broaden the use of nonsovereign financing approaches in the social sectors.

Asian Development Bank (ADB). Private Sector Operations: Unlocking Private Capital for Impact in Asia and the Pacific.

ADB–PRC Regional Knowledge Sharing Initiative (RKSI). 2026. ADB, Bank of Tianjin Sign Loan to Support Health Care and Elderly Care Development in the PRC. 28 May.