China Faces Significant Policy Challenges as Population Ages

RESEARCH TRIANGLE PARK, N.C. – The United States isn’t the only country struggling to meet the needs of its aging population. China faces immense growth in its aging population and must tackle significant policy challenges to shape a viable long-term care system, according to a new paper by researchers at RTI International and colleagues.

The paper, published in the December issue of Health Affairs, analyzes China’s evolving long-term care landscape and traces major government policies and private-sector initiatives shaping it, as well as offers insights that are applicable to China and other rapidly aging and developing countries.

By 2050, the median age of Chinese will approach 50 and one out of every four Chinese will be 65 or older. The ratio of older people to the working-age population is projected to soar from 13 elders per 100 working-age people in 2010 to 45 elders per 100 working-age people by 2050.

At the same time rapid demographic shifts and socioeconomic changes in China, exacerbated by the one-child family policy, are eroding traditional family care for older adults.

“These developments are revolutionary in a society that for millennia has been deeply rooted in family care for seniors,” said Zhanlian Feng, Ph.D., a senior research public health analyst at RTI and the paper’s lead author. “Chinese policy makers face mounting challenges overseeing the rapidly growing residential care sector, given the tension arising from policy inducement to further institutional growth, a weak regulatory framework and the lack of enforcement capacity.”

Among the challenges facing Chinese policy makers noted in the paper is that although home and community-based serves are preferred by most elderly Chinese and promoted by the government, such services remain spotty across most cities and towns in China and are virtually nonexistent in rural areas. However, institutional elder care is expanding rapidly across urban areas in China, with little regulatory oversight, and current policies and resource allocations are tilted toward institutional care.

The authors recommend providing a mix of services that elderly people want and building a balanced system of services that reflects older people’s preferences as much as possible.

According to the paper, there is also little regulatory oversight for the kinds of services and the quality of care provided in Chinese long-term care facilities. The authors suggest that Chinese policy makers institute a formalized regulatory structure soon, perhaps similar to the United States where all publicly certified nursing homes must report both facility- and resident-level data electronically.

Additionally, “The lack of a qualified and professional workforce in long-term care is an urgent issue in China,” Feng said. “Chinese policy makers need to prioritize education and training initiatives to grow a professionalized long-term care workforce.”