LTC Model Development in China

A quick post from the plane on the way home from a week talking about LTC policy in China, and visiting a variety of LTC/elderly service delivery institutions in and around Shenyang, which is in the North East of China. I was there via a World Bank project in conjunction with the Development Research Council (DRC) which is a Chinese governmental research and analysis unit that is a part of the State Council of China that does work supporting health and social care delivery.

  • There seems to be great interest in testing and evaluating new and divergent models in LTC delivery. I found the week to be an intellectually invigorating exercise of thinking through what I know about the U.S. LTC system and trying to learn more about China’s system, and trying to figure out what that might mean for China going forward (and for China as a model for other nations).
  • A key theme of the week was the Government’s goal of increasing private delivery (as opposed to, for example, a government run nursing home) of LTC. We visited several NGOs that have repurposed existing facilities into LTC delivery/adult day care type centers. It was especially interesting to meet two young people (30s is young for me now) who had advanced degrees from the U.S. but who returned to their country to do new things in LTC.
  • There are also very interesting moves toward Government directly paying for services that are delivered by private entities, be they NGOs that would be like non profits in the U.S. context, or for profit entities. They are in the process of getting the relevant laws and regulations lined up with goals in this area.
  • One visit really stands out. We saw a very large, modern set of facilities that are like a continuing care retirement community (CCRC; independent apartments, assisted living and a nursing home facility all in one place) that the Chinese Government had built, and that a private company was running.
  • There is a great stock of empty Nursing Home beds in and around Shenyang, especially in the more rural areas, while in certain (city center) neighborhoods there are waiting lists.
  • A key demographic reality is that China is now nearly as old as the U.S. is (in terms of percent of the population age 65 and older), but it has aged far more rapidly than did the U.S. This means that LTC is a more pressing issue even as China is just beginning to move toward broad major medical insurance coverage (the 2009 reforms now have around 1.4 Billion persons covered by health insurance, though there is a huge maldistribution of care delivery infrastructure. The point is that the U.S. has gone decades since the passage of Medicare and Medicaid without directly addressing LTC. China has a chance to build an insurance system that better integrates LTC into the overall system.

I will have more to say on this, but a great trip. And on the tourist angle, if you get the chance to visit the Chinese museum that is adjacent to Tian’anmen Square, it is very well done and I highly recommend it in addition to the sights in the square itself.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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