Options for Aged Care in China Care Aged Options for Public Disclosure Authorized Public Disclosure Authorized DIRECTIONS IN DEVELOPMENT Human Development Glinskaya and Feng Options for Aged Care in China Public Disclosure Authorized Building an Efficient and Sustainable Aged Care System Elena Glinskaya and Zhanlian Feng, Editors Public Disclosure Authorized Options for Aged Care in China DIRECTIONS IN DEVELOPMENT Human Development Options for Aged Care in China Building an Efficient and Sustainable Aged Care System Elena Glinskaya and Zhanlian Feng, Editors © 2018 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 21 20 19 18 This work is a product of the staff of The World Bank with external contributions. 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ISBN (paper): 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 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. Options for Aged Care in China • http://dx.doi.org/10.1596/978-1-4648-1075-6 Contents Foreword xi Acknowledgments 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 79 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 References 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 Options for Aged Care in China • http://dx.doi.org/10.1596/978-1-4648-1075-6 v vi Contents 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 Zheng, 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 China’s Development of an Aged Care Continuum 147 Notes 149 References 150 Chapter 4 The Role of the Private Sector in China’s Senior 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. Wiener, 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 Implications for China’s 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 Options for Aged Care in China • http://dx.doi.org/10.1596/978-1-4648-1075-6 Contents vii Key Elements 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 Systems: 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 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 Care Systems 275 Implications for China’s 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 Qualified Social Workers 292 Challenges for Informal Caregivers 292 Recent Government Policies and Reforms 293 Recommendations 294 Notes 297 References 297 Options for Aged Care in China • http://dx.doi.org/10.1596/978-1-4648-1075-6 viii Contents Chapter 10 Learning and Policy Formulation: International Experience and Implications for China’s 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 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 Institutional 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 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 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