towards aging in place
TRANSCRIPT
Towards aging-in-place: collaborative governance in senior health and care system
National Interdisciplinary Institute on Aging (NIIA) ,Southwest Jiaotong University, China
Ⅰ The problem
Unhealthy aging and mismatch between supply and demand
The demand side
20002002
20042006
20082010
20122014
0
20
40
60
80
100
120
140
160
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
Population aged over 65 in China (2000-2014)
population aged over 65 (million)percentage (%)
2015 2020 2025 2030 2035 2040 2045 20500
50
100
150
200
250
300
350
400
450
500
152
193226
269
334
382400
430
Population aged over 65 in China (2015-2050)
population aged over 65 (million)
*Data from China's National Bureau of Statistics *Data from United Nations Population Division
Life expectancy at birth in China (years)
Year 1990-1995 2005-2010 2010-2015 2015-2020 2025-2030 2045-2050
Life expectancy 69.4 74.4 75.4 76.5 78.6 82.5
Data from United Nations Population Division
2012 2013 2014E 2015E34
35
36
37
38
39
40
41
36
37
39
40
The number of disabled/semi-disabled elderly in China
The number of disabled/semi-disabled elderly(million)
*Data from China Research Center on Aging
2015 2020 2025 2030 2035 2040 2045 20500
5
10
15
20
25
30
35
14.04
16.38
19.15
23.12
26.32 27.228.15
29.86
4.89 5.716.68
8.069.18 9.48 9.81 10.41
1.63 1.9 2.23 2.69 3.06 3.16 3.27 3.47
The number of beds and paramedics required for fully disabled elderly (2015-2050)
Number of fully disabled elderly(million) Number of beds required(million)Number of paramedics required(million)
*Data from China Research Center on Aging
0-4 5-14 15-24
25-34
35-44
45-54
55-64
over 65
0
10
20
30
40
50
60
0 0 1.443.83
11.5
23.54
38.9
53.99
The prevalence of chronic diseases in survey areas in 2013
prevalence rate of chronic diseases(%)
*Data from China health statistics yearbook (2015)
Chronic diseases Prevalence(%)
Hypertension 19.72
Cerebrovascular 3.85
Diabetes 3.68
Chronic obstructive pulmonary disease
3.42
Arthritis deformans 3.07
Ischemic heart disease 3.05
Gastroenteritis 1.95
Intervertebral disc disease
1.94
Gallstones and cholecystitis
1.09
Cataract 0.86
Top 10 chronic diseases of the elderly
*Data from China Report of the Development on Siliver Industry (2014)
The supply side
Germany
Australia
France
United Kingdom
United St
ates
CanadaKorea
ChinaIndia
0
0.5
1
1.5
2
2.5
3
3.5
4
4.54.05
3.39 3.33
2.772.56 2.55
2.17
1.65
0.73
The number of physicians per thousand people in selected
countries in 2013
The number of physicians per thousand people
JapanKorea
Germany
France
Switz
erland
China
United Kingdom
Sweden
India0
2
4
6
8
10
12
14 13.32
10.96
8.28
6.29
4.68
3.32.76 2.59
0.5
The number of beds per thousand people in selected
countries in 2013
The number of beds per thousand people
*Data from OECD
34%
48%
17%
1%
The downsizing family
one-generation householdstwo-generation householdsthree-generation householdsfour-generation households
1953 1964 1982 1987 1990 1995 2000 2005 2010 20150
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
4.33 4.43 4.44.2
3.963.7
3.44
3.13 3.1 3.02
Average number of residents per household
Average Number of Residents per Household ( person)
*Data from China's National Bureau of Statistics
50-54 55-59 60-64 65+0
5
10
15
20
25
30
35
40
45
50
44.1
39.537.6
36.2
The rate of empty nest elders
The rate of empty nest elders(%)
*Data from China family development report (2015)
1953 1964 1982 1987 1990 1995 2000 2005 20100
2
4
6
8
10
12
14
7.4
6.5
8 8.3 8.3
9.29.9
10.7
11.9
The elderly dependency ratio in China (1953-2010)
The elderly dependency ratio (%)
*Data from China Statistical Yearbook (2011)
Rapid growth of the elderly population
Institutional care• Not enough supply
Family care• Weakening
Tremendous demand on health care
Insufficient supply
Transmission
The extension of life expectancy
Higher prevalence rate of chronic diseases
Ⅱ Challenges
Insufficiency, mismatching and misallocation of medical resources;Difficulty in integrating both medical and nursing service
1993 1998 2003 2008 20130
5
10
15
20
25
3.6 3.5 3.6
6.8
9
6.1
8 8.4
15.3
19.9
Hospitalization rate in survey areas (1993-2013)
Hospitalization Rate (%)
Hospitalization Rate of 65 and over(%)
2005 2006 2007 2008 2009 2010 2011 2012 2013 20140
1
2
3
4
5
6
The number of beds per thou-sand people have in all kinds of medical and health institutions
in China(2005-2014)
The number of beds per thousand people
The number hasn’t changed much in recent 10 years.
*Data from China health statistics yearbook
2009 2010 2011 2012 2013 20140
1
2
3
4
5
6
7
2.66
3.153.53
4.17
4.94
5.78
The number of beds in all kinds of care institutions in China
(2009-2014)
The number of beds in all kinds of pension institutions(million)
*Data from Statistical bulletin of the development of social services
2009 2010 2011 2012 2013 20140
10
20
30
40
50
60
70
80
9079 77
7470
6255
Actual occupancy rate of pen-sion institutions in China(2009-
2014)
Actual occupancy rate of pension institutions(%)
The actual occupancy rate of care institutions has been decreasing.
Total
Total a
ssets
Health te
chnicia
ns
Building a
rea
Equipmen
t over
¥10,000Bed
s0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
2.6%
80.9%
62.5% 59.6%
84.7%
75.2%
3.5% 2.6% 5.5% 4.6% 1.8% 3.0%
Hospitals Community health centers
Allocation of resources between hospitals and community health centers
*Data from China health statistics yearbook 2015
*Data from China health statistics yearbook 2015
Hospitals (2.6%)
Community health centers (3.5%)
total assets 80.9% 2.6%
health technicians 62.5% 5.5%
building area 59.6% 4.6%
equipment over ¥10,000 84.7% 1.8%
beds 75.2% 3.0%
bed usage rate 88.0% 55.0%
average days of hospitalization 9.6 9.6
annual visits 39.1% 9.0%
check-up 41.2% 14.4%
visits per physician receives daily 7.5 15.7
Input
output
More high-quality
resources
Attracting more patients
More income and grant
Hospitals
Lack of resources
Lack of high-level personnelLess patients
Less income
Community health centers
• Medical insurance can only be reimbursed in designated medical institutions (hospitals).
• The reimbursement ratio can be much higher if patients choose to be hospitalized; And within specified scope, the higher hospitalization expenses, the higher the reimbursement ratio is
High-level medical service
High-level care facilities
hospital-based health care
general care facilities
Community health service
Community-based nursing homes
Self-supportFamily support
Community support
Actual structure
shrinking
gatekeeper in healthcare, accessible but too weak
Need to be rebuilt
professional but too crowded
Three lacks of current system
Accessibility fairness
efficiency
Ⅲ The Aim
From “9073” towards Aging-in-place
90%
7%
3%
90% live at existing home with assistance of service and care
3% live in nursing homes or care facilities
7% get community care service, such as community based nursing homes
PREVIOUS Aim: the “9073” system
97% of the senior will realize “ageing in place”
High-level medical service
High-level care facilities
hospital-based health care
general care facilities
Community health service
Community support
Community-based nursing homes
Self-support Family support
AGING IN PLACE with services
Medical-nursing combined care
• Medical institutions were not approved to establish pension institutions, and vice versa.
(The State Council issued a circular on April 9th this year approving the above-mentioned activities)
Remaining problems: Finance, price, reimbursement……
geriatrics
rehabilitation nursing medical service
rehabilitation nursing
Ⅳ The Path
collaborate to build a senior health and care system response to “aging in place”
High-level medical service
High-level care facilities
hospital-based health care
general care facilities
Community health service
Community support
Community-based nursing homes
Self-support Family support
The elderly
Market
Social organizations
Community
Family
Health sector(government)
Incentives of the government
• To respond to the reform of downsizing and decentralization • Unable to meet the elderly’s increasingly diverse and complex
need all by itself; lack of professionality in service delivery
Incentives of social organizations
• As social forces grow, civil society wants to be involved in public affairs
• To get support from the government• To enhance its strength by the inflow of resources
Government
governor
implement medical reformcoordinate the market, community and social organizations and pool resources introduce preferential policies
supervision and evaluation
buyer improve the mechanism of service outsourcing
Social organization,market
provide formal health care service
Family provide informal care、 purchase formal careThe elderly self-help, mutual aid, offer feedback
Different roles of subjects involved in collaborative governance
Market
Government
Social organizations
Community
Family
guidancestaff
fundsguidance
purchasepolicies
purchase
High-level medical service
High-level care facilities
hospital-based health care
general care facilities
Community health service
Community support
Community-based nursing homes
Self-support Family support
The elderly
Market Government
Social organizations
Community
Family
purchaseguidance
staff
fundsguidance
purchase
policies
Health sector
Policy implications
• Implement the word of “aging-in-place” to replace “family/community”.• Socialization means that more social and market-driven resources to be
introduced, which should be ehanced.• Collaborative governance is the most possible way for China to solve the
problem of increasing need of health and care for elderly. • Care-giver-support system is needed!
Thank you