China, People's Republic of : Demonstration of Guangxi Elderly Care and Health Care Integration and Public-Private Partnership Project

Health / Health sector development and reform - Health system development

The PRC is facing a serious change in its demographic structure. In 2017, 158 million people-11.4% of the population-were aged 65 years and above. The aging rate is expected to reach 14% in 2025 and 21% in 2035. The aging population increases incidence of age-related diseases. Elderly people typically have chronic diseases and experience multiple morbidities. The primary cause of their care dependence is the loss of physical function resulting from chronic diseases and age-associated impairments. Further, many elderly people have complex cases of multiple chronic diseases and physical and/or cognitive disabilities which require a continuity of services for both elderly care and health care. Coordination of care between health sector and elderly care sector is necessary to provide seamless care services for elderly people in need and to reduce avoidable hospitalization.

In an aging society, elderly people tend to be readmitted to hospital because of lack of appropriate elderly care institutions that allow them to transition back to their homes. However, it would be difficult for families to provide adequate care for elderly people who are discharged from hospitals and still require medical and elderly care services. Inadequate care at home can cause further health problems, which may require readmission to hospital. Frequent transitions between hospitals and homes or long stays in hospitals further reduce the functional abilities of the elderly.

In the PRC, more than 100 million elderly people had at least one chronic disease in 2013. The burden of chronic disease is expected to increase by 40% by 2030 from the status of 2013. The number of elderly people with multiple chronic conditions is also increasing significantly in the PRC. Those elderly people would require post-acute care and rehabilitation to restore or stabilize their functionality after discharge from hospital as well as elderly care (long-term care) to maintain their daily living. A coordination system, linking the acute phase care, post-acute phase care, rehabilitation, and elderly care in an effective and efficient way, is at the core of integrated health and elderly care. Such a system needs to ensure smooth linkage of care services across the elderly care and health care sectors.

To create a coordination system, a functional hospital discharge management system needs to be established. The discharge management system will (i) clarify care needs after hospitalization, including needs for medical care, medication, rehabilitation, and elderly care; and (ii) identify where and how an elderly person can access his or her needed care. Such individualized care plans should be prepared based on discussions with the elderly people, their families, medical experts, therapists, social workers, and elderly care experts. Further, it is necessary to strengthen the elderly care service capacity to meet a range of care needs. The integration of health and elderly care will provide seamless care services across the two sectors based on needs, and avoid using medical resources for the elderly care service provision.

Enhanced private sector involvement is vital to fill the gap in supplying coordinated elderly care and health care services. Quantity of private providers varies greatly across localities, and no scheme has been established to ensure their quality. Considering substantial increase in care needs due to rapid aging of the population, it would be unrealistic for the public sector to be the main provider of care services. Meanwhile, the public sector needs to take responsibility for establishing standardized care needs assessment and service quality monitoring systems. The private sector could bring its knowledge and experience to better design facilities, engage skilled staff, and provide efficient services under the guidelines and regulations set by the public sector. Such alignment of responsibilities is not yet clearly established in the PRC elderly care sector.

The Government of the PRC has recognized the importance of integrated elderly care and health care services to respond to its rapidly aging population, and issued a related policy in 2015. In line with the central policy, the Government of GZAR (GGZAR) in 2016 issued policies on the implementation of elderly care and health care integration, and for enhancing the involvement of the private sector in care service provision for elderly people. While the GGZAR issued those policies, it has limited experience and capacity in promoting the integration of elderly care and health care, and private sector involvement in the coordinated care service provision.

In order to build the institutional capacity and system, the municipalities of Nanning and Hezhou were selected as pilot cities for elderly care and health care integration in 2017. In the same year, people aged 65 years and above were 0.8 million and 0.2 million in Nanning and Hezhou municipalities which account for 11.4% and 10.1 % of the population, respectively. More than 85% of those elderly people have at least one chronic disease and about 60% have multimorbidity. The integration of elderly care and health care is necessary to provide needed care services for those elderly people. However, most elderly patients directly return home after discharge from tertiary level hospitals. A functional coordination system is not established between hospitals and elderly care facilities in those municipalities. The inter-sectoral coordination among bureaus, such as the civil affairs bureaus and the health commission, needs to be established.

Integrated elderly care and health care services in Guangxi Zhuang Autonomous Region established

Utilization of coordinated health care and elderly care services in Guangxi Zhuang Autonomous Region increased

Coordinated care services and facilities improved

Public-private partnership project for integrated elderly care and health care services provision developed

Management and policy development capacities in promoting integrated elderly care and health care services developed

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