Studying Senior Care in China
Last month, I left for Beijing, China for the Price International Lab with eighteen of my fellow Price students. Together, we represented five of Price’s graduate degree programs, the Los Angeles and Sacramento campuses, and local and international students. This diverse group set out to put our learning into practice by providing consulting services to Taikang Life, one of the largest insurance companies in China.
Earlier this month, on the outskirts of Beijing, Taikang opened one of the first Continuing Care Retirement Communities (CCRC) in China, a type of senior care facility that provides a continuum of care from independent living up through skilled nursing. The theory behind CCRCs is that residents can enter as independent living residents and age in place by having access to all levels of care.
Senior care is an area of growing need in China due to recent demographic and socioeconomic changes. About 12 percent of China’s 1.3 billion people are over the age of 60, making it the largest elderly population in the world. The elder share of the population is expected to reach one third by 2042. In addition, as a result of China’s one child policy, the “4:2:1” paradigm now exists where today’s young adults bear the burden of supporting two parents and four grandparents.
For our consulting project, Taikang asked us to present a comparison of the American and Chinese health systems as they pertain to senior care, with recommendations for how Taikang can emulate CCRCs in the United States and expand this model across China. With only two weeks to deliver on this ambitious goal, we set off to learn as much as we could about health policy and senior care in China and how it compares to the United States.
We spent the first several days visiting health facilities in China, including hospitals, rehabilitation centers, independent living homes, nursing homes, and more. Many of the places we visited were new, having been built in the last five to ten years to try to meet the demands of China’s rapidly growing and rapidly aging population.
While the population demand for senior care facilities certainly exists, the culture of living in residential care, rather than with family, has been slow to change. It was fascinating to see the juxtaposition between these new facilities, most of which have been modeled after U.S. systems and designed for the latest technology and the practice of Western medicine, with China’s elderly population. This generation was born in a time that predates China’s Cultural Revolution and period of rapid economic development (and for some, predates World War II.) This generation, much like the Depression-era generation in the United States, is one for which frugality is an instinct and a modest and traditional lifestyle is largely preferred. In terms of health, this generation is also one that is often more familiar with Traditional Chinese Medicine than Western practices. Witnessing this contrast, all the while keeping in mind our mission to help Taikang expand the American-born CCRC model across China, presented us with some interesting cultural and policy-related challenges.
Throughout our two weeks, we also learned first-hand about the many challenges that China’s health care industry if facing not just in serving elders but in serving the entire population. China’s health care system delivers care predominately through public hospitals, and very few primary care services exist. As a result, many people only seek medical services when they are quite sick, and they all go to the same hospitals.
At the same time, government-mandated caps on physician salaries and reimbursement rates by the nation’s social insurance program have contributed to a demand for medical services that far exceeds the supply that hospitals are able to provide. We visited one of Beijing’s largest and most well-respected hospitals and it resembled a train station more than a university hospital we’d expect to find in the United States. People were waiting anywhere they could find a seat, and reported to us that when they did see a doctor the visit would likely only last a matter of minutes, with a harried and perfunctory physician.
We often complain in the United States about how complicated it is to choose and pay for insurance and find doctors who accept our plans.However, I now have a deeper appreciation for the fact that once you’ve found a doctor and made an appointment you can predict with some certainty that you’ll see a doctor relatively quickly, that the doctor has a genuine interest in your health and in offering the best care, and that insurance will cover most basic services. Of course, the American health system is not devoid of its own problems or challenges, but I appreciate the emphasis the U. S. health system places on preventative health and primary care, and on encouraging physicians to have a caring bedside manner.
In the end, my understanding of health policy- both in the United States and in China- grew immensely, and my appreciation for the importance of planning for a future when many post-industrial countries have aging societies, have grown immensely. Developing a plan for addressing this policy and governance challenge will be vital to both China and the United States, and I take pride that -in our small way- our Price class has made a valuable contribution to this effort.
And of course, we had some fun too!