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Projecting future demand for informal care among older people in China: the road towards a sustainable long-term care system

Published online by Cambridge University Press:  19 June 2018

Bo Hu
Bo Hu*
Affiliation:
PSSRU, Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
*
*Correspondence to: Dr. Bo Hu, PSSRU, Department of Health Policy, London School of Economics and Political Science, 4.06 Cowdray House, Portugal Street, London WC2A 2AE, UK. Email: b.hu@lse.ac.uk
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Abstract

The long-term care system in China relies heavily on informal care provided by family members. This study makes projections on the demand for informal care among Chinese older people between 2015 and 2035 and quantifies the level of long-term care resources needed to meet their needs. The data come from longitudinal information in a nationally representative sample, China Health and Retirement Longitudinal Survey 2011 and 2013. The macrosimulation approach (PSSRU model) and the Markov approach are integrated into one Bayesian modelling framework. The Monte Carlo simulation technique is used to capture parameter uncertainty. We project that the demand for informal care will increase from 41.3 million people (95% CI: 39.9–42.7) in 2015 to 82.6 million people (95% CI: 78.3–86.9) in 2035. The long-term care system faces unbalanced pressure of demand for informal care from different groups of older people. The projected demand is sensitive to changes in older people’s disability trajectory and the availability of formal care provided by the government, but less sensitive to an increase in singleton households in the future. We discuss possible policy measures to alleviate the mounting pressure on the demand for informal care.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Issue 1 , January 2019 , pp. 61 - 81
Copyright
© Cambridge University Press 2018 

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References

Anderson, R. and Newman, J. F. (2005), ‘Societal and individual determinants of Medican care utilisation in the United States’, The Milbank Quarterly, 83(4): 1–28.Google Scholar
Beijing Municipal Government (2013), Advice on the Implementation of Home-Based Care Services in Beijing (guanche luoshi beijingshi shimin jujia yanlao fuwu banfa de yijian), Beijing: Beijing Municipal Government. http://zhengwu.beijing.gov.cn/gzdt/gggs/t1098110.htm [5 January 2017].Google Scholar
Briggs, A., Claxton, K. and Sculpher, M. (2006), Decision Modelling for Health Economics Evaluation, New York: Oxford University Press.Google Scholar
Bruce, D. G., Paley, G. A., Nichols, P., Roberts, D., Underwood, P. J. and Schaper, F. (2005), ‘Physical disability contributes to caregiver stress in dementia caregivers’, Journal of Gerontology: Medical Sciences, 60A(3): 345–349.Google Scholar
Cai, F. and Wang, M. (2009), ‘China’s Process of Ageing Before Getting Rich’, in F. Cai and Y. Du (eds) The China Population and Labour Yearbook, Volume 1 Beijing: Social Sciences Academic Press.Google Scholar
Cheung, C.-K. and Kwan, A. Y.-H. (2009), ‘The erosion of Filial piety by modernisation in Chinese cities’, Ageing and Society, 29(2): 179–198.Google Scholar
Du, Y. and Yang, C. (2014), ‘Demographic transition and labour market changes: implications for economic development in China’, Journal of Economic Surveys, 28(4): 617–635.Google Scholar
Feng, Z., Zhan, H. J., Feng, X., Liu, C., Sun, M. and Mor, V. (2011), ‘An industry in the making: the emergence of instituitonal elder care in urban China’, International Health Affairs, 59(4): 738–744.Google Scholar
Fries, J. F. (1980), ‘Aging, natural death and the comparession of morbidity’, The New England Journal of Medicine, 303: 130–135.Google Scholar
Fries, J. F. (1983), ‘The compression of morbidity’, The Milbank Memorial Fund Quarterly. Health and Society, 61(3): 397–419.Google Scholar
Gill, J. (2017), Bayesian Methods: A Social and Behavioural Sciences Approach, Boca Raton: CRC Press.Google Scholar
Glaser, K., Stuchbury, R., Tomassini, C. and Askham, J. (2008), ‘The long-term consequences of partnership dissolution for support in later life in the United Kingdom’, Ageing and Society, 28(3): 329–351.Google Scholar
Greenberg, E. (2013), Introduction to Bayesian Econometrics, New York: Cambridge University Press.Google Scholar
Gruenberg, E. M. (1977), ‘The failures of success’, The Milbank Memorial Fund Quarterly. Health and Society, 55(1): 3–24.Google Scholar
Grujiters, R. J. (2017), ‘Family care-giving and living arrangements of functionally impaired elders in rural China’, Ageing and Society, 37(3): 633–655.Google Scholar
Houtven, C. H. V., Coe, N. B. and Skira, M. M. (2013), ‘The effect of informal care on work and wages’, Journal of Health Economics, 32(1): 240–252.Google Scholar
Hu, B. and Ma, S. (2016), ‘Receipt of informal care in the Chinese older population’, Ageing and Society, 38(4): 766–793.Google Scholar
Jacobs, M. T., Groenou, M. I. B. v., Aartsen, M. J. and Deeg, D. J. H. (2016), ‘Diversity in older adults’ care networks: the added value of individual beliefs and social network proximity’, The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 73(2): 326–336.Google Scholar
Kenny, P., King, M. T. and Hall, J. (2014), ‘The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort’, Health and Social Care in the Community, 22(6): 646–659.Google Scholar
Kramer, M. (1980), ‘The rising pandemic of mental disorders and associated chronic disease and disabilities’, Acta Psychatrica Scandinavica, 62: 282–297.Google Scholar
Kruschke, J. K. (2015), Doing Bayesian Data Analysis: A Tutorial with R, JAGS, and STAN, London: Elsevier.Google Scholar
Larsson, K. and Silverstein, M. (2004), ‘The effects of marital and parental status on informal support and service utilisation: a study of older Swedes living alone’, Journal of Aging Studies, 18(2): 231–244.Google Scholar
Lei, P., Feng, Z. and Wu, Z. (2016), ‘The availability and affordability of long-term care for disabled older people in China: the issues related to inequalities in social securities benefits’, Archives of Gerontology and Geriatrics, 67(November–December): 21–27.Google Scholar
Li, M., Zhang, Y., Zhang, Z., Zhang, Y., Zhou, L. and Chen, K. (2013), ‘Rural-urban differences in the long-term care of the disabled elderly in China’, PLoS ONE, 8(11): e7955.Google Scholar
Lou, V. W. Q. and Ci, Q. (2014), ‘Ageing under the one-child policy: long-term care needs and policy choices in urban China’, International Journal of Public Policy, 10(4–5): 231–242.Google Scholar
Lu, B., Liu, X. and Piggott, J. (2015), ‘Informal long term care in China and population ageing: evidence and policy implications’, Population Review, 54(2): 28–41.Google Scholar
Manton, K. G. (1982), ‘Changing concepts of morbidity and mortality in the elderly population’, The Milbank Memorial Fund Quarterly. Health and Society, 60(2): 183–244.Google Scholar
McDaid, D. (2001), ‘Estimating costs of informal care for people with Alzheimer’s disease: methodological and practical challenges’, International Journal of Geriartric Psychiatry, 16(4): 400–405.Google Scholar
Murphy, C. M., Whelan, B. J. and Normand, C. (2014), ‘Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)’, Health and Social Care in the Community, 23(4): 408–418.Google Scholar
National Bureau of Statistics of China (2014), China Population and Employment Statistics Yearbook 2014, Beijing: China Statistics Press.Google Scholar
National Survey Research Centre (2014), China Longitudinal Ageing Social Survey Report, Beijing: Renmin University. http://class.ruc.edu.cn/index.php?r=Index/index [29 December 2016].Google Scholar
Office for National Statistics UK (2013), What Does the 2011 Census Tell Us about Older People, London: Office for National Statistics. http://webarchive.nationalarchives.gov.uk/20160105160709/http://www.ons.gov.uk/ons/dcp171776_325486.pdf [03 March 2017].Google Scholar
Pickard, L., Wittenberg, R., Comas-Herrera, A., Davies, B. and Darton, R. (2000), ‘Relying on informal care in the new century? Informal care for elderly in England to 2031’, Ageing and Society, 20(6): 745–772.Google Scholar
Prince, M., Knapp, M., Guerchet, M., Mccrone, P., Prina, M., Herrera, A. C., Wittenberg, R., Adelaja, B., Hu, B., King, D., Reholl, A. and Salimkumar, D. (2014), Dementia UK: Update, London: Alzheimer’s Society.Google Scholar
Shanghai Municipal Government (2011), The 12th Development Plans of Shanghai Economy and Society (shanghaishi guomin jingji he shehui fazhan di shier ge wunian guihua gangyao), Shanghai: Shanghai Municipal Government. http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw22396/nw22401/u21aw144564.html. [5 January 2017].Google Scholar
Silverstein, M., Cong, Z. and Li, S. (2006), ‘Intergenerational transfers and living arrangements of older people in rural China: consequences for psychological well-being’, The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 61(5): S256–S266.Google Scholar
State Council (2013), The Twelfth Five-Year Outline of Development in National Economy and Social Development (Guomin jingji he shehui fazhan shierwu guihua gangyao), Beijing: State Council of People’s Republic of China. http://www.gov.cn/2011lh/content_1825838_2.htm [19 July 2017].Google Scholar
Suanet, B., Van Groenou, M. B. and Van Tilburg, T. (2012), ‘Informal and formal home-care use among older adults in Europe: can cross-national differences be explained by societal context and composition?’, Ageing and Society, 32(3): 491–515.Google Scholar
United Nations (2016), World Population Prospects, the 2015 Revision, New York: United Nations. https://esa.un.org/unpd/wpp/ [29 December 2016].Google Scholar
US Department of Health and Human Services (2014), A Profile of Older Americans, Washington: Administration for Community Living. https://aoa.acl.gov/aging_statistics/profile/2014/docs/2014-profile.pdf [3 March 2017].Google Scholar
Vlachantoni, A., Shaw, R. J., Evandrou, M. and Falkingham, J. (2015), ‘The determinants of receiving social care in later life in England’, Ageing and Society, 35(2): 321–345.Google Scholar
Wang, Y. (2014), ‘An analysis of changes in the Chinese family structure between urban and rural areas: on the basis of the 2010 national census data’, Social Sciences in China, 35(4): 100–116.Google Scholar
Wimo, A., Jonsson, L., Bond, J., Prince, M. and Winblad, B. (2010), ‘The worldwide economic impact of dementia 2010’, Alzheimer’s & Dementia, 9(1): 1–11.Google Scholar
Wittenberg, R. and Hu, B. (2015), Projections of Demand for and Costs of Social Care for Older People and Younger Adults in England, 2015-2035, London: London School of Economics.Google Scholar
Wittenberg, R., Pickard, L., Comas-Herrera, A., Davies, B. and Darton, R. (1998), Demand for Long-Term Care: Projections of Long-Term Care Finance for Elderly People, Kent: Personal Social Services Research Unit.Google Scholar
Wolf, D. A. (2014), ‘Getting help from others: the effects of demand and supply’, Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 69(7): S59–S64.Google Scholar
Wong, Y. C. and Leung, J. (2012), ‘Long-term care in China: issues and prospects’, Journal of Gerontological Social Work, 55(7): 570–586.Google Scholar
Zeng, Y. (2008), ‘Introduction to the Chinese Longitudinal Healthy Longevity Survey (CLHLS)’, in Y. Zeng, D. L. Poston, D. A. Vlosky and D. Gu (eds), Healthy Longevity in China: Demographic, Socioeconomic and Psychological Dimensions. Dordrecht: Springer.Google Scholar
Zeng, Y., Chen, H., Wang, Z. and Land, K. C. (2015), ‘Implications of changes in households and living arrangements for future home-based care needs and costs for disabled elders in China’, Journal of Aging and Health, 27(3): 519–550.Google Scholar
Zhan, H. J. and Montgomery, R. J. V. (2003), ‘Gender and elder care in China: the influence of Filial piety and structural constraints’, Gender and Society, 17(2): 209–229.Google Scholar
Zhao, Y., Strauss, J., Yang, G., Giles, J., Hu, P. P., Hu, Y., Lei, X., Liu, M., Park, A., Smith, J. P. and Wang, Y. (2013), China Health and Retirement Longitudinal Study – 2011-2012 National Baseline Users’ Guide, Beijing: Peking University. http://charls.ccer.edu.cn/uploads/document/2011-charls-wave/application/CHARLS_nationalbaseline_users_guide.pdf [8 January 2017].Google Scholar
Zhou, J. and Walker, A. (2016), ‘The need for community care among older people in China’, Ageing and Society, 36(6): 1312–1332.Google Scholar
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