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Old-Age Disability in China Implications for Long-Term Care Policies in the Coming Decades

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CHILDREN AND FAMILIES The RAND Corporation is a nonprofit institution that helps improve policy and EDUCATION AND THE ARTS decisionmaking through research and analysis. ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE This electronic document was made available from www.rand.org as a public service INFRASTRUCTURE AND of the RAND Corporation. TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS Skip all front matter: Jump to Page 16 NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY Support RAND SCIENCE AND TECHNOLOGY Browse Reports & Bookstore TERRORISM AND Make a charitable contribution HOMELAND SECURITY For More Information Visit RAND at www.rand.org Explore the Pardee RAND Graduate School View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non- commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. This product is part of the Pardee RAND Graduate School (PRGS) dissertation series. PRGS dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world’s leading producer of Ph.D.’s in policy analysis. The dissertation has been supervised, reviewed, and approved by the graduate fellow’s faculty committee. Old-Age Disability in China Implications for Long-Term Care Policies in the Coming Decades Jianhui Hu This document was submitted as a dissertation in March 2012 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Megan Beckett (Chair), Lisa Shugarman, and Paul Heaton. PARDEE RAND GRADUATE SCHOOL The Pardee RAND Graduate School dissertation series reproduces dissertations that have been approved by the student’s dissertation committee. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from RAND. Published 2012 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 RAND URL: http://www.rand.org To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] ABSTRACT China’s population is aging rapidly. The increase in the elderly population, along with the rising prevalence of major chronic diseases and greater longevity among those afflicted with many of these diseases, will lead to a growing number of functionally disabled elders who may need long- term care (LTC). Elders in China have traditionally relied on their families as the main source of LTC. This situation is changing as fewer family members are available to provide care, due to shrinking family size caused by continuously low fertility, combined with increased female workforce participation. Without a well designed LTC system to address the growing care need, it is increasingly obvious that the current LTC situation in China will not be sustainable in the coming decades. Old-age disability and LTC have not yet been well studied in China. Using logistic regressions and a prevalence ratio projection model, and considering international practices, this dissertation addresses three research questions: 1) What are the key risk factors for old-age disability in China? 2) What are the projected numbers of older adults with disabilities in China in future decades through 2050? 3) How can China develop a feasible and sustainable LTC delivery and financing system to address projected growth in LTC needs of this population over the next four decades? Findings indicate that old age, being female, single, and in poor health (e.g., presence of a chronic condition and poor self-rated health) are the key risk factors associated with functional disability among older adults in China. Although urban older adults are more likely to be severely disabled, the overall disability risk is higher among rural older adults. No matter whether disability rates remain constant, increase or decline in the future, the sheer number of disabled older adults and the ratio of disabled elders to potential caregivers (however defined) will increase rapidly, especially in rural areas. I describe how my findings, combined with an understanding of common features of existing LTC systems and international guidelines can inform strategies policymakers can use to develop a feasible and sustainable LTC system to prepare for its growing care needs in the future. iii CONTENTS Abstract ..........................................................................................................................iii Figures............................................................................................................................vi Tables ............................................................................................................................vii Acknowledgements ........................................................................................................ix Glossary ..........................................................................................................................x CHAPTER ONE Understanding Old-Age Disability and Long-Term Care (LTC) in China 1.1 Introduction: What are Old-Age Disability and Long-Term Care (LTC) ............. 1 1.1.1 Old-age disability ........................................................................................... 1 1.1.2 Long-term care (LTC) .................................................................................... 2 1.2 Background: LTC is an Urgent Policy Issue in Many Countries ......................... 3 1.3 Policy Issue: China Lacks a National LTC Delivery and Financing System to Provide Care to Meet Its Growing Needs ........................................................................................ 5 1.3.1 Demographic change: accelerating population aging .................................... 8 1.3.2 Epidemiological transition: rising prevalence of chronic diseases .............. 12 1.3.3 Old-age disability: more older adults are living with disability .................. 13 1.3.4 Current LTC situation in China: unsustainable care delivery and financing 15 1.4 Challenges and Opportunities ............................................................................ 21 1.5 Descriptions of the Dissertation ......................................................................... 22 1.5.1 Purpose and research questions ................................................................... 22 1.5.2 Methodologies.............................................................................................. 23 1.5.3 Roadmap ...................................................................................................... 24 CHAPTER TWO Risk Factors for Old-Age Disability among Chinese ......................... 2.1 Key Risk Factors Indentified in Previous Studies .............................................. 27 2.2 Methodological Approach .................................................................................. 36 2.2.1 Data .............................................................................................................. 36 2.2.2 Measures ...................................................................................................... 37 2.2.3 Statistical approaches ................................................................................... 41 2.3 Results ................................................................................................................ 41 2.3.1 Descriptive statistics .................................................................................... 41 2.3.2 Bivariate analysis ......................................................................................... 44 2.3.3 Multivariate analysis .................................................................................... 47 2.4 Conclusions and Discussions ............................................................................. 52 CHAPTER THREE Projections for the Disabled Elderly Population in China: 2015 – 2050 iv 3.1 Purpose of Projections ........................................................................................ 57 3.2 Existing Projection Approaches ......................................................................... 58 3.3 Methods .............................................................................................................. 59 3.3.1 Prevalence ratio method ............................................................................... 59 3.3.2 Projection outcomes and data .....................................................................
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