1、Options for Aged Care in China Building an Efficient and Sustainable Aged Care System Elena Glinskaya and Zhanlian Feng, Editors DIRECTIONS IN DEVELOPMENT Human Development Options for Aged Care in China Options for Aged Care in China Building an Efficient and Sustainable Aged Care System Elena Glin
2、skaya and Zhanlian Feng, Editors DIRECTIONS IN DEVELOPMENT Human Development Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 2018 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet:
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7、ease cite the work as follows: Glinskaya, Elena and Zhanlian Feng, Editors. 2018. Options for Aged Care in China: Building an Efficient and Sustainable Aged Care System. Directions in Development. Washington, DC: World Bank. doi:10.1596/978-1-4648-1075-6. License: Creative Commons Attribution CC BY
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13、): 978-1-4648-1075-6 ISBN (electronic): 978-1-4648-1076-3 DOI: 10.1596/978-1-4648-1075-6 Cover photo: Li Wenyong. Used with permission. Further permission required for re-use. Cover design: Debra Naylor, Naylor Design, Inc. Library of Congress Cataloging-in-Publication Data has been applied for The
14、term “country,” used interchangeably with “economy,” does not imply political independence but refers to any territory for which authorities report separate social or economic statistics. v Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 Contents Foreword xi Acknowledgments
15、 xiii List of Abbreviations xv Glossary of Terms xvii Overview 1 Elena Glinskaya and Zhanlian Feng Introduction 1 Current Landscape and Challenges of Aged Care in China 6 Implications for the Future of Aged Care in China 38 Notes 71 References 73 Chapter 1 Population Aging and Long-Term Care Needs 7
16、9 John Giles, Elena Glinskaya, Yaohui Zhao, Xinxin Chen, and Yuqing Hu Introduction 79 Demographic Trends 80 Elderly Patterns of Limited Functional Ability 81 Patterns of Informal Care Provision 87 Development and Demographic Change 90 Implications for Developing Aged Care Policies 95 Notes 96 Refer
17、ences 97 Chapter 2 Policy Framework, Strategy, and Institutional Arrangements 101 Dewen Wang Introduction 101 Policy Framework and Institutional Arrangements 103 Challenges and Recommendations 118 Annex 2A Policies for Developing the Elderly Care System in the 12th Five-Year Plan Period 122 vi Conte
18、nts Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 Annex 2B Acronyms of Chinese Government Agencies 124 Notes 125 References 126 Chapter 3 Building a Long-Term Care Delivery System with a Balanced Mix of Services 129 Zhanlian Feng, Qinghua Li, Elena Glinskaya, Nan Tracy Zh
19、eng, and Joshua M. Wiener Introduction 129 International Experiences in Long-Term Care Provision 130 Current Long-Term Care Landscape in China 138 Looking Ahead: Issues for Chinas Development of an Aged Care Continuum 147 Notes 149 References 150 Chapter 4 The Role of the Private Sector in Chinas Se
20、nior Care Industry 155 Yvonne Li, Charlie Wang, and Heather Wong Introduction 155 Community and In-home Senior Care Services 156 Institutional Care Industry 173 Conclusion 187 Notes 189 References 189 Chapter 5 Long-Term Care Financing: Issues, Options, and Implications for China 191 Joshua M. Wiene
21、r, Zhanlian Feng, Nan Tracy Zheng, and Jin Song Introduction 191 Background and Why Financing Is Important 192 Financing Design Choices 194 Current Long-Term Care Financing in China 203 Implications for China 207 References 209 Chapter 6 Commissioner-Provider Relations: International Experience and
22、Implications for Chinas Policy 215 Jan M. Bauer, Lizzy Feller, and Elena Glinskaya Introduction: Why Separate the Roles of Commissioner and Provider? 215 Developments in the Long-Term Care Sector 218 Contents vii Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 Key Elements
23、of the Commissioner-Provider Relationship 220 Implications for China 234 Notes 239 References 239 Chapter 7 Strengthening Regulations, Standards, and Quality Assurance for Long-Term Care 243 Nan Tracy Zheng, Joshua M. Wiener, and Zhanlian Feng Introduction 243 Long-Term Care Quality Assurance System
24、s: An International Overview 244 Ensuring Quality of Care and Quality of Life: International Experiences 245 Recent Developments in Quality Assurance in China 254 The Future of Quality Assurance in China: Prospects and Challenges 257 References 260 Chapter 8 Coordination of Services within Long-Term
25、 Care and between Medical Care and Long-Term Care 263 Chang Liu Care Coordination: The Characteristics of Integrated Care Systems 263 Care Coordination for an Aging Population 265 Care Integrative Processes and International Experiences 266 Care Coordination in Chinese Medical Care and Long-Term Car
26、e Systems 275 Implications for Chinas Future 280 References 281 Chapter 9 Long-Term Care Workforce Issues 285 Jiahui Zhang, Elena Glinskaya, Gong Sen, and Shuo Zhang Introduction 285 Current Long-Term Care Workforce Challenges in China 286 Health Care Labor Shortages and Challenges 288 Shortages of
27、Qualified Social Workers 292 Challenges for Informal Caregivers 292 Recent Government Policies and Reforms 293 Recommendations 294 Notes 297 References 297 viii Contents Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 Chapter 10 Learning and Policy Formulation: Internationa
28、l Experience and Implications for Chinas Policy 299 Jan M. Bauer and Du Peng Introduction 299 The Chinese Government Network in Aging and Aging Policy Research Agencies 300 Policy Framework and International Experience 303 Policy Innovation and Methods of Modern Governance 314 Implications for China
29、 317 Notes 321 References 322 Boxes O.1 Action Plan of the Anhui Provincial Government to Boost Aged Care Services 15 O.2 Current Landscape of Aged Care Services in China 23 1.1 China Health and Retirement Longitudinal Study (CHARLS) 80 1.2 Measuring Limited Functional Ability 81 3.1 Examples of Ins
30、titutional Care in China 141 4.1 Fuzhou Jin Tai Yang 161 4.2 On Lok Lifeways (PACE Program) in the United States 163 4.3 Community Sharing and Home Instead, Shenzhen 165 4.4 Pinetree in Beijing 170 4.5 Right at Home In-Home Care and Assistance, Beijing 172 4.6 Shuangjin Golden Heights in Beijing 180
31、 4.7 Hong Tai Friendship House, Tianjin 182 4.8 Tianjin Wuqing District Second Nursing Home 183 8.1 Characteristics of an Integrated Care System 264 8.2 Six Categories of Care Integrative Processes 267 8.3 Characteristics of Successful Integrated Systems 274 10.1 The Base Case of the Personal Social
32、 Services Research Unit Macro Model 307 10.2 Possible Data Sources on LTC 318 Figures O.1 Projected ADL and IADL Disabilities of the Population over Age 45, by Gender and Urban and Rural Location in China 7 O.2 Key Policy Papers on Aged Care in China 14 O.3 Institutional Setup for Aged Care at Natio
33、nal and Local Levels 19 O.4 Lottery Sales Volume, 201015 20 O.5 China: Number of Residential Aged Care Facilities in China, 201004 26 O.6 China: Number of Beds in Residential Aged Care Facilities in China, 201014 26 Contents ix Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-
34、6 O.7 A Conceptual Framework for Aged Care Governance and Delivery Systems 39 O.8 Service Provision Triangle in Aged Care: a “Quasi-Market” 54 O.9 Stages of a Governmental Commissioning Strategy 56 1.1 ADL and IADL Disabilities, by Age Group and Gender in China 82 1.2 Share of CHARLS Respondents wit
35、h an Increase in ADL and IADL Disabilities from 2011 to 2013 84 1.3 Projected ADL and IADL Disabilities of the Over-45 Population, by Gender 85 1.4 Projected ADL and IADL Disabilities of the Population over Age 45, by Gender and Urban and Rural Location in China 86 1.5 Share of Population with ADL D
36、isabilities Receiving Help in 2013 89 1.6 Share of the Population with IADL Disabilities Receiving Help in 2013 90 2.1 Stakeholders in Policy Design and Implementation at the Subnational Level 117 2.2 Trends of Total Beds and Care Services Received by the Elderly 119 2.3 Utilization Rate of Beds for
37、 the Elderly between 2009 and 2013 121 3.1 Proportion of Long-Term Care Recipients Aged 65 Years and Older Receiving Care at Home in Selected OECD Countries, 200013 134 3.2 Proportion of Total Medicaid Long-Term Care Expenditures for Institutional Care versus Home- and Community-Based Services in th
38、e United States, 19952012 135 4.1 Types of Institutional Care in China 174 5.1 Lottery Sales Volume, 201015 204 6.1 Commissioning Structure, Based on Gash et al. 2013 235 8.1 Interplay among the Six Integrative Processes 268 9.1 Health Professionals per 1,000 Population in Rural and Urban China, 200
39、313 289 9.2 Number of Health Care Professionals per 1,000 Population in China, 200313 290 9.3 Ratio of Nurses to Physicians, 2009 (or Nearest Year) 291 10.1 China National Committee on Aging Office and Its Members 301 10.2 Sources of Information for Quality Assessment Based on CQC 2015a 312 Tables O
40、.1 Incidence and Time Spent Caring for Elderly Parents and Parents-in-Law 9 O.2 Number of Beds for Elderly Care in China, 200913 (10,000 Beds) 26 x Contents Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 O.3 Types of Public-Private Partnerships in Institutional Care 31 O.4
41、 Elements for Designing a Model of Financing for Aged Care 45 O.5 Advantages and Disadvantages of Financing Approaches to Aged Care 47 1.1 Incidence and Time Spent Caring for Elderly Parents and Parents-in-Law 88 2.1 Policy Evolution of Chinas Elderly Care System in the Reform Era 103 2.2 Trends in
42、Total Beds and Their Composition, 200913 119 3.1 Residential Aged Care Facilities and Beds in China 139 4.1 Types of Senior Care Organizations in the Private Sector 156 4.2 Types of Community Care Services Procured by the Government 159 4.3 Assessment and Scope of In-home Care in Selected Economies
43、168 4.4 Sources of Funding for Elderly Care Facilities, 2009 174 4.5 Institutional Care: China versus Selected Economies 176 4.6 Cooperation between Foreign and Domestic Companies in Institutional Senior Care Projects 178 4.7 Chinas Three-Pillar Pension System 184 4.8 Differences between Public-Run
44、Facilities and For-Profit Private Senior Care Facilities 185 4.9 Types of Public-Private Partnerships in Institutional Care 187 8.1 “Integration” Interventions for Medicare and Medicaid (United States) 269 8.2 Veterans Health Administration (United States) 270 8.3 Torbay Care Trust (United Kingdom)
45、271 8.4 Individual Care Plan (Norway) 271 8.5 Chains of Care (Sweden) 272 8.6 Home Market (Finland) 272 8.7 Regional Health Care System and Agency for Integrated Care (Singapore) 273 10.1 Overview of Indicator Categories for Residential Care for Older People 310 10.2 Examples of Indicators 311 10.3
46、Domains and Definitions of the Adjusted ASCOT 313 10.4 Example of Assessment Results for Long-Term-Care Hospitals in Korea 314 xi Options for Aged Care in China http:/dx.doi.org/10.1596/978-1-4648-1075-6 Older people make up a growing proportion of the populations in many middle- and high-income cou
47、ntries, which presents new challenges for growth and development. Whereas the degree and pace vary by country, falling fertility rates and longer life expectancies mean there is a declining proportion of young people and an increasing proportion of the elderly. Such population aging has major econom
48、ic implications and raises concerns about increased health care costs, the sustainability of pension systems, and the availability of care services for the elderly. China is experiencing one of the most rapid transitions to an aging society ever witnessed. It will move from being an aging to an aged
49、 society by 2027; in just 25 years, 14 percent of Chinas population will be 65 and older, up from 7 percent in 2002. This transition took 115 years for France, 45 years for England, and 69 years for the United States. The aging process in China is pro- jected to accelerate further in the coming decades, with growth of the elderly population being especially pronounced between 2015 and 2040. By 2050, 26 percent of Chinas population is expected to be 65 or older, and about 8 percent will be 80 years or older. Such rapid aging is putting pressure on Chinas
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