Abstract

As there is very little information available in English, this case study on China provides a rare insight into the emergence of LTC services and regulatory structures in this strongly developing economy.

The presentation begins with some brief background on the various forces driving the escalating needs for LTC and posing unprecedented challenges to families and society to meet those needs. These include rapid aging of China’s population; increased longevity; fertility decline and shrinking family size; increased population mobility; further industrialisation and urbanisation. This is augmented with some information on the traditional practice of elder care in China, based on the Confucian ideal of filial piety, and how traditions have both continued and adapted in the face of rapid socio-economic change. The next section goes on to outline how formal care provided in the home and community-based settings has been developing in a few major urban centres, but that it is institutional elder care services that have emerged with greater visibility and expanded more rapidly across Chinese cities. The growth is mostly in the private sector and largely an urban phenomenon. As examples, the authors report on their research in Nanjing and Tianjin, on growth, ownership, staffing, resident case-mix and crude measures of quality.

The paper then goes on to look at the government’s role in building LTC services for the aged and its emphasis of a three-tiered system: family or home-based care as the basis (first pillar); community-based services as support (second pillar); and institutional care as supplement (third pillar). The Chinese government is actively promulgating the first pillar (with families urged to continue to shoulder the major responsibility of elder care), beginning to talk about and invest in the second pillar (still pretty much invisible in most localities), and encouraging development of the third pillar in the private sector through preferential policy treatments and some financial inducements for bed construction (which is expanding rapidly, with little regulatory oversight).

Turning to the topic of regulatory oversight, the authors then review the current regulatory structure which, while far from fully developed, is shared between the central government (setting national policy guidelines, priorities, and standards) and local-level authorities (provincial, city and county), which are responsible for operationalising and implementing specific policy measures, which vary substantially from place to place depending on local conditions. Importantly, local government authorities are responsible for inspecting and licensing LTC providers.

The presentation ends by looking at the challenges and initiatives in building an information infrastructure as part of the regulatory framework of LTC.

Slides