亚开行-中国养老体系的发展与绩效（英）-2021.8-30页_254kb

Summary of the Development and Performance of the Elderly Care System in the People's Republic of China

Core Content

This paper examines the development and performance of the elderly care system in the People's Republic of China (PRC), highlighting the challenges and opportunities in the context of rapid aging and the need for a more integrated and sustainable approach to elderly care.

The PRC has developed a three-tiered elderly care system consisting of:

• Home-based care as the core support,
• Community-based care as necessary support, and
• Residential care as supplementary support.

The system has evolved over the past two decades, with increasing involvement of the private sector and government subsidies. However, the current system faces significant challenges in terms of underdeveloped home- and community-based care and low demand for residential care.

Main Policies and Development

II. Social Security Policies for the Elderly

The PRC's social security policies for the elderly include pensions and social assistance. These policies aim to ensure adequate retirement income and prevent poverty among the elderly.

A. International Practices in Pension

• Defined benefit and defined contribution pension systems are common globally.
• In Republic of Korea (ROK), the National Pension Scheme (NPS) covers the majority of the working population, with a special occupational pension for civil servants, soldiers, and teachers.
• Japan has the Employee's Pension Insurance (EPI) and National Pension Insurance (NPI), both contributing to a comprehensive pension system.

B. International Practices in Social Assistance

• Social assistance is typically means-tested and provides cash or in-kind benefits to low-income and vulnerable populations.
• Examples include South Africa's Older Person's Grant, which helps reduce elderly poverty and improves family living standards and human capital investment.

III. Development of the Elderly Care System

A. The Three-Tiered System

• Home-based care: Focuses on family support and is the mainstay of elderly care.
• Community-based care: Provides support through local organizations and is underdeveloped.
• Residential care: Offers institutional care and is less utilized due to low demand and high costs.

B. Residential Care

• Limited in demand due to family care availability and unaffordability of services.
• Supported by government subsidies and private sector involvement.

C. Home and Community-Based Care

• Generally underdeveloped, with limited care services and mainly recreational amenities.
• Needs to be expanded to meet the growing elderly population's demands.

D. Health and Care Integration

• Integration of health and care services is a key focus for improving the system's efficiency and accessibility.

E. Involvement of the Private Sector

• The private sector plays a significant role in providing elderly care services, often with government subsidies.

F. Financing

• The system is financed through a mix of public and private funding.
• The government is urged to increase its financial role to ensure equitable access to care services.

Performance of the Elderly Care System

IV. Performance Overview

• Residential care demand is low, primarily due to family support and cost barriers.
• Home- and community-based care is underdeveloped, with limited services and scope.
• The system lacks comprehensive integration and balanced development between the different tiers of care.

Key Policy Recommendations

V. Policy Suggestions

1. Improve the elderly care system for better integration of residential care and home- and community-based care.
2. Increase the government's role in financing to ensure access to care services for those in need.
3. Support community and nonprofit organizations in providing home- and community-based care.
4. Develop elderly care management tools to enhance service delivery and monitoring.
5. Strengthen the role of street office or township aging offices in coordinating care services and support.

Key Information

• The PRC became an aging society in 2001 with 90.62 million people over 65.

• By 2019, the population over 65 reached 176.03 million or 12.57% of the population.

• The PRC is projected to become an aged society by 2027 with 14% of the population aged 65 and older.

• The CNCA estimates that by 2035, the population over 65 will reach over 400 million, or 30% of the population.

• The basic pension system includes the Urban Employees' Basic Pension System (UEBPS) and the Residents Basic Pension System (RBPS).

• UEBPS covers 435 million participants and 123 million retirees in 2019.

• RBPS covers 533 million participants, with 160 million receiving benefits.

• The APSD and Dibao are the main social assistance programs for the elderly, targeting low-income and vulnerable groups.

• APSD provides cash and care services to those without family support.

• Dibao offers cash benefits to households below a certain income threshold.

• In 2019, Dibao covered 8.6 million urban and 34.6 million rural beneficiaries.

• The senior elderly allowance was introduced in several cities around the turn of the 21st century and became national in 2016.

• The three-tiered system is provincially unified, leading to significant regional disparities in pension benefits.

Conclusion

The elderly care system in the PRC is at an early stage of development, with home- and community-based care underdeveloped and residential care not widely utilized. The government needs to enhance financing, support community-based care, and promote integration between different care models to ensure a more equitable and effective elderly care system.