Analysis of the practice of integration of healthcare and senior care services in Guangdong province

This essay aims to critically analyze the practice of the integration of healthcare and senior care services in Guangdong Province, China. It will be introduced in aspects respectively including background information, objective, main target, contents and details, and comments. The traditional private elderly service sector’s business is now taking shape to become home-based, community-dependent, and institution-supported. The health needs of seniors not only rely on hospitals but also begin to expand the needs of enjoying quality medical services in nursing house or even at home.

Background:

China’s population is aging at a rapid rate. In 2017, the number of people aged over 60 in China reached 188 million, and it is expected to exceed 350 million by 2030. In addition, elder people who aged over 65 take up 10% of the total population in 2017, and the proportion is forecast to double twenty years later, according to the Population Division of the United Nations. The percent of China’s aging population has already grown beyond the world’s average. It is one of the consequences of the 36-year one-child policy, which leads to a shift of family structure to the 4-2-1 family, referring that one couple support four seniors and one child. Data from the sixth demographic census of the People’s Republic of China (PRC) shown that among the 32.22 million families in Guangdong province, 4-2-1 family occupies almost 60% of the total. Therefore, the traditional family-support senior care mode is no longer suitable for meeting needs.

The population projection for China in 2020. Source: https://chinapower.csis.org/aging-problem/

Objective:

In order to respond to the changes in the need of social systems, shaping a modern, affordable, and quality medical system for elder people is of great essentiality. Hence, in 2016, the government approved a blueprint entitled “Healthy China 2030” with the goal of building a more salubrious PRC by establishing an integrated healthcare and senior care system, meanwhile encouraging private investment in the healthcare and senior care sector. The ultimate objective of the integration is to deal with “the last mile” problem of the elderly care services.

Main target:

The brand-new proposition is expected to better serve the elder people with modern medical services, especially for those seniors who need assisted living or stay ambulatory, suffering from disability and semi-disability. Due to that aging is usually along with health problems such as hypertension, heart disease, stroke, diabetes, osteoporosis and dementia, seniors no matter lives in the nursing home or at-home require highly attention, special care, and abundant accompany. With the traditional mode of the senior nursing system, once the olds have health problems, they have to go between home, nursing house, and the hospital. It not only wastes plenty of time but also creates great inconvenience for both the olds and their family members.

Contents and details:

In 2016, the National Health Commission of the people’s republic of China first proposed the integration of medical and aged care services, addressing a new trial of combing medical and elderly care services together to maximize resource optimization. Last year, a conference promoting combined healthcare and senior care services was held in Beijing, to further advance the integration of medical care and elder care services. Moreover, Li Keqiang, the current Premier of the State Council of the People's Republic of China, stressed the importance of reforming the social system by encouraging the development of new service models and cross-sectoral integration, combined medical and elderly care services and so forth in the 2017 major areas of work report. There are several trail spots in Guangdong province, including Jinagmen, Dongguan, and Guangzhou.

The new trail consists of two major sectors, the healthcare sector and the senior care sector. The healthcare sector, which is made of four parts, to prevent, to diagnose, to cure, and to recovery, is considered the foundation, while the senior care sector is core. Compared to the traditional mode of the senior nursing house, the new combination provides professional medical care on the foundation of basic elderly care. In addition, segments are classified by different health stages of the older people, for example, seniors who can take care of themselves, need assisted living, being incapacitated, and need palliative care. These segmentations are necessary because seniors of different health conditions need diverse but sustainable level of cares.

There are four modes in practicing the integration of healthcare and senior care service so far. The first mode is to combine the resources in community hospital and community elderly nursing house by doctor’s patrol system and signing agreements to obtain the maximum of the utilization; The second mode, which is the most popular model, is to distribute a professional medical team to long stayed in the elderly nursing house, establishing medical institutions such as rehabilitation hospitals and medical rooms in the institutions for the aged with professional medical teams to operate; The third mode is the investment of nursing house on employing expert medical team; The fourth mode is to allow hospital and professional care center to host the nursing house for elder people, providing rich advanced medical equipment. However, it has a low effect because medical institutions have no motive to provide elderly care services, together with potential risks resulted from abundant demands of beds.

Comments on the integration of healthcare and senior care services:

The integration of healthcare and senior care services is beneficial for the society, not only for the olds but also for their families. To some extent, it fosters the social environment in which senior citizens are respected, recognized, and cared for. It is a clear development priority for the elderly care sector in China.

The integration of healthcare and senior care services enables hospitals and elder nursing houses to have more flexibility and feasibility. It refers to the organic combination of medical and elderly care resources that draw tighter daily care and rehabilitation.

On the one hand, for those seniors who cannot take care of themselves, time is saved by shortening the distance between hospitals, nursing house, and family. It also provides flexibility for the main responsible party. In the new trial, the major responsible party could be public or private hospital, professional healthcare center, senior center or community center. On the other hand, for the distributions of doctors and nurses, both the time and workplace flexibility increase. The intellectual resources of doctors and nurses can be taken full advantage of. The cross-industry entry and cooperation help achieve the final goal, to maximize the resources utilization in the society. The central government will encourage the private sector to operate services that integrate healthcare and aged care, and allow areas with sufficient medical resources to convert some public hospitals into rehabilitation and aged care centers.

Furthermore, a more sufficient elderly care service can reduce the mortality rate as the seniors are being better cared. It also can avoid circumstances of mortality due to delayed salvage. Therefore, accidents are able to avoid, as seniors who need emergency aids can be treated within the institutions, along with professional medical equipment and people. In addition, chronic disease can be also treated in time.

Albeit that the new trail of integration of healthcare and senior care services is good for various groups of people with different interests, there are a lot of limitations and challenges during the practice. Currently, Chinese integrated medical and elderly care sector is still in its early stage and requires more explorations.

So far, most of the institutions that practicing care integration do not cover health insurance. Even though some of them do, there are only a few types of diseases cover health insurance. Without medicare, citizens need to pay more on their medications and diagnostic fees, which in some way becomes an obstacle for the elderly’s willingness to choose institutions with integrated cares. What is more, it is costly to establish medical institutions for senior care institutions, because of the requirement of more time, manpower, and sufficient capital costs.

Besides, it is out of balance in China's elderly care personnel, especially with talent shortage in caregivers and nursing staff. The professional of the field is not enough to meet the need of the rapid increasing demands. The 2017 Report on Training of Elderly Care Service Staff in China released by China Philanthropy Research Institute of Beijing Normal University shows that there are less than 500,000 service staff in various elderly care service facilities and organizations, and less than 20,000 personnel with qualification certificates of old-age care. Thus, training is inevitable to provide care for the elderly. Yet, it is understandable that these institutions that provide integrated cares have difficulties in making profits, as the elderly care products are less profitable in services and most of the earnings are targeting at a few individuals instead of the general ordinary elders.

To facilitate the future development of integrated healthcare and senior care services, Guangdong can refer to the experience and lesson of other provinces such as Chongqing and Beijing, or foreign models such as Japan and the U.S., and combine with the actual situation and cultural traditions of Guangdong to establish a well-developed system and to ensure the aged living with dignity by improving the medical service capabilities.

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