A resident participates in a drawing game during a Double Ninth Festival celebration at the Jinchang senior apartment facility in Suzhou, Jiangsu Province.

---

 

Population aging is a real problem that will impact every market and industry, including housing, transportation, food industry, insurance, robotics, health, communication, internet, sports and leisure.

Governments and industry players are expected to present new policies and products in order to better serve the growing number of seniors. In particular, the demand for long-term care, including geriatric care and holistic eldercare, continues to mount in China as the average life expectancy rises and the typical family structure changes. Also, there is a shortage of services for chronic diseases, emergency treatment and hospice care.

Without disrupting the aforementioned services or cutting the connections between them, we need to reconstruct the medical service system by coordinating the development of healthcare and eldercare.

 

Differing needs
Long-term care for the elderly differs from health services for younger people who are injured or disabled. First, in the course of natural aging, the bodily functions of seniors weaken and at some point, they start to need assistance with the activities of daily life, but often there is little need for geriatric care. In most cases, the elderly rely on family members to provide eldercare until they pass away, and some might need hospice care from professional institutions to alleviate pain.

Second, seniors with disabilities need long-term geriatric care. This refers to long-term healthcare that is required for those who suffer illness or accidental injury. Though young people may need similar medical care, the elderly are more likely to seek long-term nursing. This type of assistance requires professional knowledge and skills, either from in-home care, community care or institutional care.

Third is long-term care for seniors with dementia. One of the illnesses associated with longevity is Alzheimer’s, which requires both long-term healthcare and eldercare.

The increasing demand for healthcare and eldercare brought by the aging population is now a serious social problem. The World Health Organization (WHO) has called upon countries to incorporate long-term care into the national social security system, but there are three issues that need to be discussed.

 

National social security
To begin with, there is a difference between long-term eldercare and long-term geriatric care. The former mainly concerns meeting seniors’ daily needs. Most seniors would choose in-home care and if economic conditions permit, they could purchase in-home services, such as bathing from private companies.

In contrast, the latter is built on healthcare and professional medical services. Some could purchase professional services at home such as massage, or others might choose to stay in a professional facility with rehabilitation and disability care services. The latter costs much more than the former.

In recent years, some real estate firms and insurance companies have collaborated and invested in the construction of retirement communities, where various kinds of entertainment, healthcare services and hospice care are available at different prices.

Next, though long-term care for the elderly can be integrated into the broad concept of medical treatment, it is essentially different from short-term emergency treatment, rehabilitation and chronic disease management.

Emergency treatment is an intervention to relieve illness or injury that usually occurs in a medical institution, and it is quantified as “average hospital days,” with a daily cost of about 3,000 yuan.
Rehabilitation is an important part of the treatment process. The nurse acts not only as the provider of medical services but also as the coordinator to ensure the patients’ smooth progression through the rehabilitation period. Long-term care for the elderly is thus a package of services required after the period of rehabilitation.

Management of senility and chronic diseases entails the administration of clinical medication and non-clinical health management under the guidance of a family doctor.

Finally, it comes down to whether long-term care for the elderly can be incorporated into the social security system. Obviously, the duration of long-term eldercare for the seniors who need assistance with daily activities is uncertain and the cost is relatively low, so it is difficult to gain eldercare insurance. Given the uncertainties about the causes and duration of disabilities caused by natural aging, long-term eldercare insurance could only be provided once a fee-management system is in place. In the meantime, it is feasible that the government could provide temporary subsidies to people who live in poverty.

On the other hand, the long-term geriatric care needs of seniors with disabilities are easier to predict and the costs are high, which makes it necessary to incorporate these services into social security insurance.

 

Integrated system
When reconstructing the medical service system, it is important to pay attention to the following aspects.

First, scientific classification is needed to improve professionalism and cost control. In the narrow sense, medical treatment refers to the diagnosis of disease and emergency treatment, which requires short-term therapy and has a strictly defined number of hospital days.

In the broad sense, medical services can extend to the prevention of disease, chronic disease management, long-term care, rehabilitation and hospice care. Therefore, to assess the impact of population aging, a distinction must be made between short-term and long-term medical care, with the former classified as high-cost medical services and the latter as low-cost social services.
In addition, there should be an integration of the medical system and better allocation of resources. An effective medical services system should have the following characteristics: First, a comprehensive cradle-to-grave health services system covering health management, disease prevention, diagnosis, treatment, rehabilitation and disability care must be in place to provide differentiated and interrelated services.

Second, a health management strategic zone could be formed comprising a cluster of family doctors as well as community, specialized and integrated services to provide accessible, safe and affordable diagnosis and treatment to patients in a given area.

Driven by people-oriented philosophy of development, medical services should transition from fragmentation to integration. In particular, to improve the health of the elderly, there should be a connection between the treatment-centered healthcare system and long-term eldercare system.
China may enter into a deep-level aging society by 2020, and it needs to complete the construction of the care service system by that time, in order to meet the huge needs of the elderly and promote the development of an eldercare industry, thus to realize the transformation of a “silver economy.”

 

Pilot cities
At the current stage, the interpretation of long-term care for the elderly is overgeneralized. China needs to draw on international experience to establish a set of indexes to determine the level of assistance that a senior needs in eldercare and healthcare. Afterward, based on the demand of services, the government should establish corresponding long-term care insurance.

Due to the lack of long-term care insurance for elderly with disabilities, some live in hospitals in various wards, such as the internal and respiratory wards, and are reimbursed from health insurance. Others live in a ward of the community medical center reserved for seniors, with some provinces providing healthcare bed subsidies.

In the long run, long-term care  insurance should be established for seniors with disabilities as a supplement to medical insurance instead of being included in general medical insurance.

On the whole, community hospitals and community daycare centers lack sufficient nursing staff and are not equipped with adequate facilities. A large number of seniors with disabilities must rely on family members, with little assistance from social services. There are also a lot of seniors with disabilities who end up in regular hospital beds due to lack of professional care institutions. Even worse, some become disabled because of the insufficient rehabilitation process. To change the status quo, we need to strengthen academic research and policy guidance.

In fact, an integration of healthcare and eldercare services could benefit multiple parties such as employment, industrial planning and social services. How to allocate resources and establish a long-term care service system consisted of public-private and private institutions remains a new issue in China.

Based on the current division of labor within the Chinese government, the health and family planning commission could take the lead in making standards for disability measurement and nursing services as well as industrial standards for professional rehabilitation and nursing institutions. The civil service department could help mobilize society and families to establish a long-term care system for aged and disabled seniors. The human resources and social security bureaus could establish a long-term care insurance scheme for the elderly while the China Insurance Regulatory Commission could encourage insurance companies to develop long-term care insurance products for the elderly.

At present, the National Health and Family Planning Commission and the Ministry of Civil Affairs are carrying out pilot city projects that combine healthcare and eldercare across the country, which should be taken as the opportunity to integrate the construction of the eldercare service system into the local government’s performance evaluation.

 

Yang Yansui is a professor from the Institute for Hospital Management of Tsinghua University. Chen Chengcheng is from the School of Public Policy and Management at Tsinghua University.