China, People's Republic of: Development of a Comprehensive Elderly Care System

Health / Health sector development and reform - Health system development

Public sector management / Social protection initiatives

Family support traditionally plays a key role in providing care for elderly people in the PRC. Formal support has been mainly limited to social assistance, which provides in-kind support only for targeted people based on social assistance criteria, or provides income support for those whose incomes are below a threshold level. Therefore, the quality and type of care services have been limited since social assistance only provides a minimum level of care to the targeted elderly people.

Rapid demographic changes in the PRC have required changes in the concept of care for elderly people. The traditional family support is currently unable to meet the needs for elderly care, while social assistance services cannot meet the needs of regular elderly people who are not eligible for social assistance services. Care for people with physical and/or cognitive disabilities caused by aging is needed not only by people covered by social assistance. The elderly population, 65 years old and above, was 158 million in the PRC in 2017, accounting for 11.4% of the total population. Elderly people need to be integrated into, rather than segregated from, society. The PRC needs to develop a comprehensive elderly care system that is able to provide the scale and type of care to meet the growing needs of the elderly. Considering the sustainability of the elderly care system, it is important to focus on elderly people with actual care needs but not elderly people who are healthy.

The Government of the PRC has begun to respond to the needs of its aging society. The Twelfth Five-Year Plan, 20112015 and the Thirteenth Five-Year Plan, 20162020 stated the need to develop and support elderly care services. The government issued policy directions to support (i) development of the elderly care system for the PRC's aging population and private sector involvement in 2017, and (ii) further development of elderly care services in 2019. However, current responses to the growing needs of elderly people and their families are still limited. Various demand for care services have not been clearly identified yet. Quantity and quality of care are still limited, and the number and scope of service providers are also limited. To develop a comprehensive elderly care system in the PRC, the keys are to identify a local-level development strategy as well as possible mechanisms to make needed care accessible for rural elderly people.

It is necessary to understand the variation in the demographic, social, and elderly's conditions across provinces and localities in the PRC. Local governments play a key role in identifying various care needs and the status of care service supply in their respective localities. Based on the understanding of the local status, a practical plan for the development of the elderly care system needs to be established at the local level. The plan should be able to clarify the scale and type of care services; and determine existing and potential care service providers, possible financial resources needed for the provision of services, and needed human resources. Care service providers are expected to include public institutions, nonprofit organizations, and for-profit companies. Hence, it is necessary to set up a scheme and rules to ensure that care services provided by these various providers meet the appropriate quality level, and that these services are properly provided to elderly people who need the care. Based on the relevant guidelines set by the central government, local governments need to set up such a scheme and rules for service provision and management. Generally, at the local level, a provincial government provides overall guidance on the scheme and rules to be developed in the province, and a municipal government prepares practical standards and implementation plans. Further, clear responsibility and risk alignment between the public and private sectors is a key factor to enhance the private sector's involvement in elderly care.

The other critical issue in developing a comprehensive elderly care system is providing care for rural elderly people. While family and community support has been particularly important for the rural elderly, demographic change has impacted the rural population. The traditional family support is unable to meet rural elderly care needs because of rapid urbanization and internal migration of rural workers; additionally, rural migrant workers have been also rapidly aging. Elderly people are more dispersed in rural areas than urban areas, making efficient care delivery difficult and limiting access to needed care. Further, socioeconomic conditions of care for rural elderly people are diversified across regions of the PRC, but the diversified conditions have not been clarified yet. Possible financial options on the basis of different costs in delivering care services need to be examined for rural elderly care. The PRC needs to identify a model of care services provision that is applicable to the rural population.

Development of a comprehensive elderly care system is important for the PRC to respond to its aging population and deliver inclusive development. An ongoing Asian Development Bank (ADB) TA project is helping prepare an elderly care policy framework at the central level of the PRC, and ADB is also providing loan projects to help strengthen the capacity of elderly care service provision. The knowledge and support TA will continue and complement support provided by ADB. It will help prepare plans for elderly care system development by focusing on two critical issues: (i) elderly care strategy at the local level, and (ii) care for rural elderly people. It is aligned with the pillar on inclusive growth of ADB's country partnership strategy for the PRC, 20162020; and the Operational Plan for Health, 20152020, which has elderly care as a focus area. The TA will help the PRC adapt to its aging population and is in line with two operational priorities of ADB's Strategy 2030: operational priority 1 (addressing remaining poverty and reducing inequalities through increasing social inclusion and ensuring social protection for those in need); and operational priority 6 (strengthening governance and institutional capacity through strengthening service delivery).

Accessibility to proper elderly care services improved

Strategic plans of elderly care sector developed

Status of elderly care examined

Model of elderly care system plan developed

Capacity of central and local governments to manage elderly care provision strengthened

TA consultants have been engaged, a virtual inception was held in May 2020 and a review mission was held in May 2022. A minor change to reflect changes in consulting service requirements was approved in August 2020. Under component 1, the TA has initiated development of the strategic plan for elderly care services in GZAR, and human resource development needs. Under component 2, the consulting firm has almost completed data collection in Shaanxi, Zheijang, and Henan provinces and will provide preliminary analysis of the collected data. The consultant team is currently using the data to provide detailed reports on human resource needs, the rural elderly care system needs and requirements, and international practices on elderly care systems in rural areas. Data from the China Rural and Urban Elderly Living Conditions Sample Survey (made in 20152019 by National Research Center on Aging) has also been analyzed.

Due to the ongoing data collection and COVID-19 challenges and restrictions, the executing agency requested a TA extension of 1 year until December 2023, which ADB approved in August 2022. Additional work during the extension will include further data collection, more focus group discussions, and data analysis. Under component 1, ADB has engaged national resource persons to draft standards and schemes for elderly care facilities in GZAR. The consultants will conduct financial analyses, a human resource assessment, and develop draft operational procedures for elderly care facilities to ensure proper standard operating procedures within the facilities and tertiary hospital care.