His key damning metric: Between 1981 and 2009, average Chinese life expectancy grew by only five years, while in nations that started the period with a similar statistic (68 years) and had slower economic growth (including South Korea and Malaysia), the average rose by 7-14 years.

[...]Huang notes that “of the more than 26 million Chinese who suffer from depression, just 10% receive any medical treatment.”  This may help to explain the recurrent incidents of bizarre antisocial violence including attacks on children, as well as a suicide rate that the author says is twice that of the U.S.

[...]Hospitals remain a weak link in China’s care strategy, Huang writes. In the mixed economy that is China today, the government continues to dominate the hospital sector and, though private operators keep trying to establish niches, theirs can be a frustrating initiative.

In an opinion piece from the NY Times recent series on healthcare in China, Huang attributes falling consumer spending to health related worries:

The share of China’s consumer spending in G.D.P. actually fell from 45 percent to 35 percent in the last decade. Domestic demand is suppressed in large part because of the absence of a well-developed safety net. When people have to worry about expensive medical bills and their children’s future tuition fees, they are less likely to spend money on other things. In 1998, when nearly 90 percent of rural residents were not covered by any health insurance, spending by farmers actually dropped, the first known such decline since 1978.

Even so, the government did not take any serious steps to address the issue until the global economic crisis made it imperative to stimulate domestic demand. From 2009 to 2011, the government pumped 173 billion renminbi, or about $27 billion, into the health care sector. While the revved-up government support has boosted the health coverage rate to more than 94 percent nationwide, it has not translated into real gains in domestic consumption.

The seemingly universal health coverage in China actually disguises the still extremely low level of benefit that most people receive. Out-of-pocket payment for health services remains higher than 50 percent in most regions of the country.

In another NY Times opinion piece, Harvard School of Public Health lecturer Liu Yuanli echoes Huang’s concerns. While acknowledging how far China’s health coverage has come in recent years, he explains that there is still cause for concern:

In 2009, China announced its ambitious plan to “deepen health care system reforms” and aimed to provide universal health care by 2020. With increased public spending totaling 127 billion renminbi over the 3-year period of 2009 to 2011 on insurance premium subsidies and health care infrastructures at the community levels, China managed to provide about 95 percent of its people some kind of basic insurance coverage.

[...]This is great progress. However, health insurance coverage in China is far from sufficient. To begin with, the benefit package is very limited, with average reimbursement rate of inpatient expenses being as low as 48 percent for urban residents and 44 percent for rural residents. Significant inter-regional inequalities also exist, as insurance plans are run by the local governments.

Moreover, given China’s health challenges — a growing aging population and a rise in more complicated and expensive chronic diseases — it needs to provide not just “nominal coverage,” but more “effective coverage” by increasing the reimbursement rate and covering more cost-effective services for all Chinese.

Another scholar argues that China’s socialist legacy keeps salaries low for Chinese healthcare professionals, resulting in a shortage of doctors:

Another challenge to health care — lack of physicians — has a socialist root. Unlike medical personnel in Western societies, Chinese doctors are not among the highest paid. And most hospitals are run by the government. To address the mounting pressure on health care and improve delivery of care to a larger spectrum of society, a rethinking of how to manage medicine and motivate the next generation of health care providers seems imperative.

For more information and opinion on healthcare in China, see the entire five part NY Times series Is China Facing a Health Care Crisis?

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Post tags: aging, doctors, healthcare
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Contemporary China is experiencing many of the same demographic and socioeconomic pressures as the United States, he recently reported in the Journal of the American Geriatrics Society. People are living much longer; family structures are changing; women have entered the workforce. With no national health insurance program like Medicare and with the one-child policy that places elder care responsibilities on fewer shoulders, Chinese families also face some challenges greater than ours.

There’s no safety net, Dr. Feng said, and “that has created an escalating need for care for a lot of aging people.” (A whole lot: roughly 112 million people over age 65 now, and a projected 329 million by 2040.)

Surveying seven Chinese cities, he found a proliferating number of elder care homes, the great majority privately built and operating with negligible government subsidies. The ancient capital of Nanjing, for example, had 27 homes in 1990 and 52 a decade later. By 2009, when Dr. Feng and his team began investigating, the city had 148. Beijing and Tianjin showed similar growth. Shanghai had 552 facilities.

The Economist’s recent Special Report on China visited one retirement home while describing the country’s looming demographic changes:

The clientele of the Le Amor retirement home in the Fragrant Hills of western Beijing are no ordinary folk. Staff boast that one of them taught President Hu Jintao when he was at university. Another is the descendant of a nutritionist who worked for the Empress Dowager Cixi, China’s last great imperial ruler. A third is a former senior official in the party’s top anti-corruption body. By the grim standards of such homes in China, it seems they are being treated well. If they wish, they can rent a suite of rooms, including one for a live-in servant. All rooms have an emergency button.

The home’s director is coy about how she secured such a desirable rural location for her $10m venture, away from the city’s downtown smog. Le Amor is one of only a handful of privately run retirement homes in the capital aimed at the well-to-do. Looking after the elderly is a business in its infancy in China, where that task usually falls to the offspring, if any. But Le Amor’s market has very attractive prospects.

EconomyWatch examines the same issue, asking Will China Grow Old Before It Gets Rich?

In 2040, the proportion of over-60s in the population will rise from the current 11 per cent to 28 per cent – and possibly even as high as 32 per cent, the year when communist leaders are confident that fast growth will have brought China close to challenging the economic power and strategic size of the United States.

“In Europe, the elder share of the population passed 10 percent in the 1930s and will not reach 30 per cent until the 2030s, a century later,” say Jackson and Howe in their paper for Washington’s Centre for Strategic and International Studies. “China will traverse the same distance in a single generation.”

… The issue puts a huge strain on families – and the next generation of Chinese youths who will be (culturally) expected to look after their elderly family members. Ordinary Chinese are coping with a 4-2-1 inverted pyramid, four grandparents to two parents, and all the responsibility of an only child.

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While many countries are struggling to cope with rapidly aging populations, in China there are forecasts that within three decades there could be nearly 400 million people over the age of 60 and, partly because of the one-child policy, a declining number of working-age people to care for them.

Recognizing the difficult road ahead, China is beginning to educate the public and the medical community about dementia, and big cities are making plans to build new facilities, like the Shanghai No. 3 Elderly Home.

The shift in attitudes is remarkable. A decade ago, many families were ashamed to admit that their elders had such a disease. And because of a lack of awareness about the disease, many dementia patients were confined to the psychiatric wards of hospitals, which placed steel bars over the windows.

But today, a growing number of families are desperate to place relatives in a nursing home. The problem, health experts say, is that there simply are not enough.

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It is a sign of the times that conservatives as well as liberals often underestimate the Middle Kingdom’s problems–in addition to America’s relative strengths.

Rarely mentioned in such analyses is China’s own aging problem. The population of the People’s Republic will be considerably older than the U.S.’ by 2050. It also has far more boys than girls–a rather insidious problem. Among the younger generation there are already an estimated 24 million more men of marrying age than women. This is not going to end well–except perhaps for investors in prostitution and pornography.

In the longer term demographic trends actually place the U.S. in a relatively strong position. By the end of the first half of the 21st century, the American population aged 15 to 64–essentially your economically active cohort–are projected to grow by 42%; China’s will shrink by 10%. Comparisons with other competitors are even larger, with the E.U. shrinking by 25%, Korea by 30% and Japan by a remarkable 44%.

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Family planning officials in Shanghai are making home visits and slipping leaflets under doorways to encourage certain residents to have a second child in a bid to balance the city’s expanding senior population.

A statement about the new campaign posted Thursday on the Web site of the Shanghai Population and Family Planning Commission was quick to emphasize that it didn’t signal any change in China’s one-child rule and was only an attempt to let people know about the policy’s many exceptions.

About 3 million, or 21 percent, of Shanghai’s nearly 13.7 million registered residents are now aged 60 or older, the statement said.

Xie Lingli, the commission’s director, was quoted as saying authorities will go door to door to try to encourage couples to have a second child if both grew up as only children.

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For three decades China’s one-child policy helped power this nation’s economic rise. With fewer mouths to feed, families saved. Poverty fell. Living standards improved.

But a social experiment that worked well in some respects is now threatening the country’s hard-won gains. China’s working-age population — the engine behind its prolific growth — will start shrinking within a few years.

Meanwhile, the ranks of elderly are projected to soar. By the middle of this century, fully a third of China’s population will be age 60 or older, compared with 26% in the United States. China’s projected 438 million senior citizens will outnumber the entire U.S. population.

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To promote services for pensioners, earlier this year the country set the goal of promoting care services for the elderly in all urban communities by 2010. In rural areas, 80 percent of townships will have at least one welfare center for retired persons… [Currently,] Special welfare care centers are still in short supply around the country. The number of beds they offer could accommodate only about 1.16 percent of current elderly population.

To help accommodate this growing population, local governments have built seniors’ housing, such as this one in Zhejiang Province.

China has been celebrating “Seniors Day” since 1989.  China has also created a monthly “Centarian Allowance” for seniors over 100 years old.

Read also CDT’s past posts, such as China Expects Communities to Take More Care of Elderly People

(Image courtesy of www.photoeverywhere.co.uk)

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“Population bonus,” the abundant supply of working-age population in a country, is contributing 27% to China’s per capital GDP growth, said Cai Fang, director of the population and labor economics institute with the Chinese Academy of Social Sciences. But with an aging population in China, the population bonus will be exhausted by 2013.

Chinese policy makers are increasingly aware that China not only needs to worry about the overgrowth of population, but also about a changing demographic, especially when China’s baby boomers enter retirement age. Now, these people born in the 1960s and 1970s were or have been at the stage in their lives of getting married and buying homes late last century and early this one. But since 1990, China’s birth rate has been decreasing. According to the 2000 census, there were 69 million of those aged 0-4 years old, half the number for the range aged 10-14.

Many worry that while the baby boomers have pushed up the housing market over the last decade, China will soon be dealing with dwindling demand from the new generation coming of age but with a dramatically small population scale. And this will mean a slipping real estate market and dipping house prices.

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Wu Yi retired at the mandatory age of 55. Bored at home, she saw hip-hop dancing on TV and thought it would be fun to try.

She is 70 and says she is active. “Those in their 70s just eat a little and watch TV, sit in front of it, say, ‘What is this?’ They are withering, and walk like this. But you can see I am different. I dance everyday. Life is about exercise. It makes me not only healthy, but gives me a flexible body and I do not suffer from sickness,” she said.

See also a VOA Video: Retired Women Lead New Dance Craze in China

Chinese audiences have responded with enthusiasm and, according to Independent Television News, the world may be next, as the “grannies” bring their energy to the Olympic stage this summer:

More about The Hip-Hop Grannies, from Reuters.

More about aging and retirement in China, from CDT.

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The country faces unprecedented challenges in economic and social spheres as a result of a fast expanding aging population, top officials warned Monday.

With two working people for every retiree between 2030 and 2050, the country is expected to see the end of a decades-long advantage it enjoyed with a low-cost labor market.

Currently, the ratio is 6:1, according to figures from the China National Committee on Aging (CNCA).

“We might encounter the heaviest burden especially after 2030, when the demographic dividend is set to end,” said Yan Qingchun, deputy director of the office of the CNCA. [Full Text]

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