By Feng Wenmeng & Ge Yanfeng

Research Report Vol.21 No.6, 2019

I. Health Care for Senior Citizens are facing Increasingly Prominent Challenges

1. A rapidly aging population creates heavy burdens of health care for the elderly

Residents over 60 years old find it significantly more challenging to remain healthy. Findings of our survey show that 40% of the population could not stay healthy after turning 60. The figure rises to 60% when people turn 70 (Figure 1).

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Chronic diseases are a major health risk for older people. Surveys show that more than 60% of the elderly suffer from chronic diseases that require long-term medication. Among them, hypertension, cardio-cerebrovascular disease, and osteoarthropathy are the most prevalent, suffered by 28.9%, 19.2%, and 14.5% of the total population respectively (Figure 2).

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Despite the high prevalence, it is also common for the old people to have more than one chronic disease at the same time. The survey finds out that 19.0% of the respondents have two or more chronic diseases. Surveys of some medical institutions also show that on average inpatients over 80 years of age have more than 9 chronic diseases.

The declining health, the prevalence of chronic diseases, and the coexistence of more than one disease have become the three prominent health issues faced by the elderly in China, which requires high attention from the society. An effective health care system should assume a central place in our present and future efforts to better serve our senior citizens.

2. New demand emerges for innovative medical service models

At present, at-home medical services and emergency rescue services are urgently needed as society continues to improve its services for the elderly. When asked about the most needed services for the elderly, half of the respondents chose at-home medical care and one quarter chose health monitoring and emergency rescue, far more than those choosing other options. There are also significant differences between rural and urban respondents (Figure 3).

In recent years, significant progress has been made in the infrastructures of primary medical and health institutions in China. The survey shows that residents of more than 80% of urban communities and rural villages can reach the nearest medical institution within a 15-minute walk, signaling the increasing accessibility of medical services. As far as the elderly are concerned, however, the current local hospital-based service model is far from meeting their actual needs. As many senior citizens cannot move freely, there is a greater demand for at-home medical services. Subject to various restrictions, such services are not available in many places.

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Aging also creates an increasing number of empty nesters and a larger elderly population living on their own in China, which requires high attention from the society. Findings of the 2014 China Family Development Tracking Survey showed that 40.6% of the urban elderly population lived with their spouse and 8.8% lived alone. In rural areas, the figures were 45.5% and 9.3% respectively (Figure 4). In some parts of the countryside with a large outgoing population, the percentage of elderly people living in empty nests or alone was even higher.

As the number of elderly people living in empty nests or alone continues to increase, there is a growing number of cases where the elderly fail to obtain timely rescue in emergencies. In fact, it has become a serious social problem. Our survey finds that 10.5% of the elderly live alone and 44.3% live with their spouse. It is urgent to set up a daily health monitoring system to provide timely rescue to thesick and elderly who live alone or in empty nests in case of emergencies. However, the current medical care and health system is unable to provide the required services for the health and safety of our senior citizens.

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3. The outdated service model further increases the economic pressure on the elderly Despite significant progress in China’s medical security system in recent years (less than 3% of the respondents are not covered by any medical insurance policy), individuals still have to bear a quite large portion of the medical expenditure as the financing model requires^①, and many seniors feel keenly the pressure onmedical spending. According to our survey findings, more than 40% of the elderly believe that medical spending takes up the largest share in their current household spending (Figure 5).

We should note that besides the low imbursement ratio and excessive treatment in some cases, the current big hospital-centered passive service model also contributes to the high economic pressure faced by the elderly. Under the current model where major treatments are only accessible to inpatients, the seniors have to bear not only direct medical treatment costs but also indirect costs such as transportation and accommodation for accompanying family members, which can be quite high. At the same time, the disabled and semi-disabled elders also find it extremely difficult to move from their home to the hospital.

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The prevalence of illnesses and the high economic pressure have made medical care the biggest concern for the elderly. The survey shows that medical care is the biggest concern in life for 23.6% of the respondents, the highest of all. The elderly are more concerned with medical care than the non-elderly people. Up to one third of the elderly population worry about medical services far more than other issues in life (Figure 6). It should be pointed out that even the non-elderly people are quite anxious about medical care, which ranks third on their worry list after income and children education.

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