Options for Aged Care in China: Building an Efficient and Sustainable Aged Care System

by Elena Glinskaya, Zhanlian Feng

Overview

China is aging at an unprecedented rate. Improvements in life expectancy and the consequences of the decades-old family planning policy have led to a rapid increase in the elderly population. According to the United Nations World Population Prospects, the proportion of older people age 65 and over will increase by about one-fourth by 2030, and the elderly will account for about one quarter of the total population by 2050. Population aging will not only pose challenges for elder care but also have an impact on the economy and all aspects of society (World Bank, 2016a). The government is aware of the need to develop an efficient and sustainable approach to aged care. To this end, the General Office of the State Council issued the 12th Five-Year Plan for the Development of Aged Care Services in China and the Development Plan for a System of Social Services for the Aged (2011-2015). It is now in the process of formulating the 13th Five-Year National Plan on Aging, which will further elaborate and finalize the reform roadmap for 2016 to 2020. The Plan is expected to be finalized and launched by June 2016. The National Development and Reform Commission (NDRC) helped draft these plans and is now leading the development of policy measures for the provision of social services for the elderly. This volume has been prepared to support the translation of the broad ideas on aged care provision expressed in the 12th and 13th Five-Year Plans and other government plans into reality and to help the government tackle the challenges described above. It strives to identify a policy framework that fits the Chinese context and can be put in place gradually. Specifically, it aims to provide an up-to-date understanding of the evolving aged care landscape in China; review international experiences in long-term care provision, financing, and quality assurance and assess their relevance to China's current situation; discuss implications of current developments and trends for the future of aged care in China; and propose policy options based on available evidence and best practices.

Product Details

ISBN-13:	9781464810763
Publisher:	World Bank Publications
Publication date:	11/28/2018
Series:	Directions in Development - Human Development
Sold by:	INDEPENDENT PUB GROUP - EPUB - EBKS
Format:	eBook
Pages:	346
File size:	8 MB

About the Author

The World Bank came into formal existence in 1945 following the international ratification of the Bretton Woods agreements. It is a vital source of financial and technical assistance to developing countries around the world. The organization's activities are focused on education, health, agriculture and rural development, environmental protection, establishing and enforcing regulations, infrastructure development, governance and legal institutions development. The World Bank is made up of two unique development institutions owned by its 185 Member Countries. The International Bank for Reconstruction and Development (IBRD) focuses on middle income and creditworthy poor countries and the International Development Association (IDA), which focuses on the poorest countries in the world.

Table of Contents

Foreword ix

Acknowledgments xiii

List of Abbreviations xv

Glossary of Terms xvii

Overview Elena Glinskaya Zhanlian Feng 1

Introduction 1

Current Landscape and Challenges of Aged Care in China 6

Implications for the Future of Aged Care in China 38

Notes 71

References 73

Chapter 1 Population Aging and Long-Term Care Needs John Giles Elena Glinskaya Yaokui Zhao Xinxin Chen Yuqing Hu 79

Introduction 79

Demographic Trends 80

Elderly Patterns of Limited Functional Ability 81

Patterns of Informal Care Provision 87

Development and Demographic Change 90

Implications for Developing Aged Care Policies 95

Notes 96

References 97

Chapter 2 Policy Framework, Strategy, and Institutional Arrangements Dewen Wang 101

Introduction 101

Policy Framework and Institutional Arrangements 103

Challenges and Recommendations 118

Annex 2A Policies for Developing the Elderly Care System in the 12th Five-Year Plan Period 122

Annex 2B Acronyms of Chinese Government Agencies 124

Notes 125

References 126

Chapter 3 Building a Long-Term Care Delivery System with a Balanced Mix of Services Zhanlian Feng Qinghua Li Elena Glinskaya Nan Tracy Zheng Joshua M. Wiener 129

Introduction 129

International Experiences in Long-Term Care Provision 130

Current Long-Term Care Landscape in China 138

Looking Ahead: Issues for China's Development of an Aged Care Continuum 147

Notes 149

References 150

Chapter 4 The Role of the Private Sector in China's Senior Care Industry Yvonne Li Charlie Wang Heather Wong 155

Introduction 155

Community and In-home Senior Care Services 156

Institutional Care Industry 173

Conclusion 187

Notes 189

References 189

Chapter 5 Long-Term Care Financing: Issues, Options, and Implications for China Joshua M. Wiener Zhanlian Feng Nan Tracy Zheng Jin Song 191

Introduction 191

Background and Why Financing Is Important 192

Financing Design Choices 194

Current Long-Term Care Financing in China 203

Implications for China 207

References 209

Chapter 6 Commissioner-Provider Relations: International Experience and Implications for China's Policy Jan M. Bauer Lizzy Feller Elena Glinskaya 215

Introduction: Why Separate the Roles of Commissioner and Provider? 215

Developments in the Long-Term Care Sector 218

Key Elements of the Commissioner-Provider Relationship 220

Implications for China 234

Notes 239

References 239

Chapter 7 Strengthening Regulations, Standards, and Quality Assurance for Long-Term Care Nan Tracy Zheng Joshua M. Wiener Zhanlian Feng 243

Introduction 243

Long-Term Care Quality Assurance Systems: An International Overview 244

Ensuring Quality of Care and Quality of Life: International Experiences 245

Recent Developments in Quality Assurance in China 254

The Future of Quality Assurance in China: Prospects and Challenges 257

References 260

Chapter 8 Coordination of Services within Long-Term Care and between Medical Care and Long-Term Care Chang Liu 263

Care Coordination: The Characteristics of Integrated Care Systems 263

Care Coordination for an Aging Population 265

Care Integrative Processes and International Experiences 266

Care Coordination in Chinese Medical Care and Long-Term Care Systems 275

Implications for China's Future 280

References 281

Chapter 9 Long-Term Care Workforce Issues Jiahui Zhang Elena Glinskaya Gong Sen Shuo Zhang 285

Introduction 285

Current Long-Term Care Workforce Challenges in China 286

Health Care Labor Shortages and Challenges 288

Shortages of Qualified Social Workers 292

Challenges for Informal Caregivers 292

Recent Government Policies and Reforms 293

Recommendations 294

Notes 297

References 297

Chapter 10 Learning and Policy Formulation: International Experience and Implications for China's Policy Jan M. Bauer Du Peng 299

Introduction 299

The Chinese Government Network in Aging and Aging Policy Research Agencies 300

Policy Framework and International Experience 303

Policy Innovation and Methods of Modern Governance 314

Implications for China 317

Notes 321

References 322

Boxes

O.1 Action Plan of the Anhui Provincial Government to Boost Aged Care Services 15

O.2 Current Landscape of Aged Care Services in China 23

1.1 China Health and Retirement Longitudinal Study (CHARLS) 80

1.2 Measuring Limited Functional Ability 81

3.1 Examples of Institutional Care in China 141

4.1 Fuzhou Jin Tai Yang 161

4.2 On Lok Lifeways (PACE Program) in the United States 163

4.3 Community Sharing and Home Instead, Shenzhen 165

4.4 Pinetree in Beijing 170

4.5 Right at Home In-Home Care and Assistance, Beijing 172

4.6 Shuangjin Golden Heights in Beijing 180

4.7 Hong Tai Friendship House, Tianjin 182

4.8 Tianjin Wuqing District Second Nursing Home 183

8.1 Characteristics of an Integrated Care System 264

8.2 Six Categories of Care Integrative Processes 267

8.3 Characteristics of Successful Integrated Systems 274

10.1 The Base Case of the Personal Social Services Research Unit Macro Model 307

10.2 Possible Data Sources on LTC 318

Figures

O.1 Projected ADL and IADL Disabilities of the Population over Age 45, by Gender and Urban and Rural Location in China 7

O.2 Key Policy Papers on Aged Care in China 14

O.3 Institutional Setup for Aged Care at National and Local Levels 19

O.4 Lottery Sales Volume, 2010-15 20

O.5 China: Number of Residential Aged Care Facilities in China, 2010-04 26

O.6 China: Number of Beds in Residential Aged Care Facilities in China, 2010-14 26