China, People's Republic of : Support for Development of a Coordination Mechanism for Community and Home-Based Elderly Care and Health Care Services in Xiangyang

Health / Health sector development and reform - Health system development

Public sector management / Social protection initiatives

The PRC's population is aging rapidly, with 166.6 million people aged 65 and over in 2018, and an aging rate (the proportion of people aged 65 or older to the total population) of 11.9%. The increase in the ratio of the population aged 80 or older is expected to accelerate from about 1.8% in 2020 to more than 7.5% in 2050. The demand for elderly care is highly age-dependent and rises with longevity. The expected change in the demographic structure indicates that demand for care will continue to accelerate in the PRC. Rapidly aging populations are accompanied by increases in aging-associated diseases. Elderly people typically have chronic diseases and experience multiple morbidities. The primary cause of elderly people's care dependence is the loss of physical function resulting from chronic disease and impairments associated with aging. In addition, many elderly people have complex cases of multiple chronic diseases and physical and/or cognitive disabilities. Those elderly people would require both elderly care and health care services to sustain their daily living.

Elderly people account for an increasing percentage of hospitalization, and those discharged are often functionally frail. In transition from hospitals, elderly care institutions, and homes, elderly people are vulnerable and at risk of experiencing fragmented care. Frail elderly people are often unprepared to face the challenges associated with continued care needs after hospitalization. After being discharged from hospitals, elderly people with multiple chronic conditions still require post-acute care and rehabilitation to stabilize their functions, along with continued care to retain and maintain their daily living. A coordination system that effectively links acute phase care, post-acute care, rehabilitation, and elderly care (covering institutional care as well as community and home-based care) is key to ensuring continuity across elderly care and health care services and attaining better health outcomes for elderly people.

The Government of the PRC has recognized the importance of addressing the division between elderly care and health care services. A key policy, jointly issued by 10 ministries in 2015, provides guidance on the integration of elderly care and health care services; another policy was issued by 12 ministries and committees in 2019. Following guidance from the central government, Xiangyang Municipal Government issued a policy on elderly care and health care integration in 2017.

However, proper integration of elderly care and health care services has not progressed in Xiangyang due to several constraints. A key issue is that the policy primarily focuses on the institutional level, while greater attention is needed to respond to the needs and services at the community and home levels. The financial resources are limited for community and home-based care services. Furthermore, the policy appears to focus more on physical integration by expanding elderly care institutions' scope to include health care services, whereas limited attention is provided to establish a coordination mechanism between health care and elderly care.

Institutional coordination has also been ineffective, which limits the timely referral between elderly care and health care. The role of the municipal government in the provision of coordinated care services is unclear, and institutional arrangements across those sectors have not been established. Furthermore, elderly care and health care providers do not have financial incentives to coordinate their services. Because of unclear lines of responsibility in the municipal government, coordination among bureaus is not clearly defined, which critically limits the capacity of the municipal government to effectively manage the coordination of care services at the community and home levels.

Xiangyang Municipality needs to develop a coordination mechanism for elderly care and health care services, particularly at the community and home levels. An ongoing ADB TA project is supporting the development of an elderly care policy framework at the central government level. ADB has also been supporting local governments to strengthen their capacity to provide and manage care services. Building on that support with attention on institutional care, this TA will continue and complement ADB's support by focusing on coordination of community and home-based elderly care and health care services. It is aligned with the pillar on inclusive growth of ADB's country partnership strategy for the PRC, 2016-2020; and the Operational Plan for Health, 2015-2020 which has elderly care as a focus area. It is also in line with ADB's Strategy 2030 as it supports operational priority 6 (strengthening governance and institutional capacity) through strengthening service delivery. Coordination at the community and home levels is a key issue not only for Xiangyang but also for many other cities in the PRC. Further, it is a critical issue for many aging societies. The TA will have a knowledge transfer impact not only in other cities in the PRC but also in other developing member countries facing population aging challenges through TA seminars and dissemination of knowledge products.

Accessibility to coordinated care services in Xiangyang Municipality improved

Coordination between elderly care and health care services focusing on the community and home levels in Xiangyang improved

Status of coordination among care services for elderly people examined

Model for coordination between elderly care and health care services produced

Knowledge and management capacity in coordinating elderly care and health care services strengthened