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15 - Long-term care in China: reining in market forces through regulatory oversight

Published online by Cambridge University Press:  05 February 2014

Zhanlian Feng
Affiliation:
Nanjing University
Xinping Guan
Affiliation:
Nankai University
Xiaotian Feng
Affiliation:
Nanjing University
Chang Liu
Affiliation:
Duke–NUS Graduate Medical School, Singapore
Heying Jenny Zhan
Affiliation:
Georgia State University
Vincent Mor
Affiliation:
Brown University
Vincent Mor
Affiliation:
Brown University, Rhode Island
Tiziana Leone
Affiliation:
London School of Economics and Political Science
Anna Maresso
Affiliation:
London School of Economics and Political Science
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Summary

Introduction

Traditionally, elder care in China has been confined to the familial sphere, long enshrined by the Confucian norm of filial piety. However, in recent years demographic shifts and rapid socioeconomic changes have escalated concerns about whether Chinese families will still be able to take care of a rapidly growing elderly population. These concerns are compounded by China’s one-child policy, which has been in effect for more than thirty years, further straining the capacities of family caregivers. Against this backdrop, formal long-term care services have emerged and expanded rapidly in China, a process catalysed both by government policies and private-sector initiatives.

In this chapter, we begin with an outline of the unprecedented challenges for Chinese elder care in the context of population ageing and profound socioeconomic transformations, followed by an overview of the evolving long-term care landscape in China. Next, we document the rise of formal long-term care services for the elderly, and summarize major policy efforts mounted by the Chinese government in spurring the growth of these services over the last decade. This is followed by a description of the current regulatory structure and process from the perspectives of both central and local government authorities. We conclude by highlighting the need for strengthening regulatory oversight through the building of an information infrastructure in this rapidly growing long-term care service sector.

Type
Chapter
Information
Regulating Long-Term Care Quality
An International Comparison
, pp. 409 - 444
Publisher: Cambridge University Press
Print publication year: 2014

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References

Banister, J. (1987). China’s Changing Population. Stanford University Press.Google Scholar
Chen, S. (1996). Social Policy of the Economic State and Community Care in Chinese Culture: Aging, Family, Urban Change, and the Socialist Welfare Pluralism. Brookfield, VT: Avebury.Google Scholar
China National Committee on Ageing (2006). Opinions on Accelerating the Development of Social Services for the Aged (in Chinese). Beijing.Google Scholar
Chow, N. (1999). Diminishing filial piety and the changing role and status of the elders in Hong Kong. Hallym International Journal of Aging, 1(1): 67–77.CrossRefGoogle Scholar
Chu, L. W. and Chi, I. (2008). Nursing homes in China. Journal of American Medical Directors Association, 9(4): 237–43.CrossRefGoogle Scholar
Croll, E. J. (1999). Social welfare reform: trends and tensions. The China Quarterly, 159: 684–99.CrossRefGoogle Scholar
Davis, D. S. (1993). Financial security of urban retirees. Journal of Cross-Cultural Gerontology, 8: 179–96.CrossRefGoogle ScholarPubMed
Fan, C. C. (2008). China on the Move: Migration, the State, and the Household. London and New York: Routledge.Google Scholar
Fan, M. (2006). In China, aging in the care of strangers: one-child policy changes tradition. Washington Post, p. A01.Google Scholar
Feng, Z. (2011). Charting an inevitable course: building institutional long-term care for a rapidly aging population in China. China Health Review, 2(2): 2–5.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 institutional elder care in urban China. Journal of American Geriatrics Society, 59(4): 738–44.CrossRefGoogle ScholarPubMed
Feng, Z., Zhan, H. J., Guan, X., Feng, X., Liu, C. and Mor, V. (2012). The rise of long-term care facilities in urban China: emerging issues of access disparities (in Chinese). Population and Development 18(6): 16–23.Google Scholar
Flaherty, J. H., Liu, M. L., Ding, L., Dong, B., Ding, Q., Li, X. and Xiao, S. (2007). China: the aging giant. Journal of American Geriatrics Society, 55(8): 1,295–300.CrossRefGoogle ScholarPubMed
Gu, D., Dupre, M. E. and Liu, G. (2007). Characteristics of the institutionalized and community-residing oldest-old in China. Social Science & Medicine, 64(4): 871–83.CrossRefGoogle Scholar
Gu, S. and Liang, J. (2000). China: population aging and old age support. In Bengtson, V. L., Kim, K., Myers, G. C. and Eun, K. (eds.), Aging in East and West: Families, States, and the Elderly. New York: Springer, pp. 59–93.Google Scholar
Guan, X., Zhan, H. J. and Liu, G. (2007). Institutional and individual autonomy: investigating predictors of attitudes toward institutional care in China. International Journal of Aging and Human Development, 64(1): 83–107.CrossRefGoogle Scholar
Harwood, R. H., Sayer, A. A. and Hirschfeld, M. (2004). Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios. Bulletin of the World Health Organization, 82(4): 251–8.Google ScholarPubMed
Haub, C. (2011). China Releases First 2010 Census Results. Washington, DC: Population Reference Bureau.Google Scholar
Ikels, C. (1989). Becoming a human being in theory and practice: Chinese views of human development. In Kertzer, D. I. and Schaie, K. W. (eds.), Age Structuring in Comparative Perspective. Hillsdale, NJ: L. Erlbaum Associates, pp. 109–34.Google Scholar
Ikels, C. (1993). Chinese kinship and the state: shaping of policy for the elderly. In Maddox, G. and Lawton, M. P. (eds.), Annual Review of Gerontology and Geriatrics. New York: Springer, pp. 123–46.Google Scholar
Jiang, L. (1995). Changing kinship structure and its implications for old-age support in urban and rural China. Population Studies, 49(1): 127–45.CrossRefGoogle Scholar
Jiangsu News (2010). Subsidies of 80 yuan per resident per month to non-government owned elder care homes (in Chinese). Available at: . Accessed 18 September 2010.
Kinsella, K. and He, W. (2009). An Aging World: 2008. International Population Reports (P95/09–1). Washington, DC: US Census Bureau.Google Scholar
Lam, T. P., Chi, I., Piterman, L., Lam, C. and Lauder, I. (1998). Community attitudes toward living arrangements between the elderly and their adult children in Hong Kong. Journal of Cross Cultural Gerontology, 13(3): 215–28.CrossRefGoogle ScholarPubMed
Lee, C. K. (1995). Engendering the worlds of labor: women workers, labor markets, and production politics in the south China economic miracle. American Sociological Review, 60(3): 378–97.CrossRefGoogle Scholar
Levin, D. (2008). A tradition under stress: who will care for the nation’s elders? AARP Bulletin. Available at: . Accessed 2 September 2013.
Liang, Z. (2001). The age of migration in China. Population and Development Review, 27(3): 499–524.CrossRefGoogle Scholar
Logan, J. R., Bian, F. and Bian, Y. (1998). Tradition and change in the urban Chinese family: the case of living arrangements. Social Forces, 76(3): 851–82.CrossRefGoogle Scholar
Ministry of Civil Affairs (1999). Provisional Measures for the Management of Social Welfare Institutions (in Chinese). Beijing: Ministry of Civil Affairs.Google Scholar
Ministry of Civil Affairs (2001). Basic Standards for Social Welfare Institutions for the Elderly (MZ008-2001) (in Chinese). Beijing: Ministry of Civil Affairs.Google Scholar
Ministry of Civil Affairs (2000a). Opinions on Accelerating Socialized Welfare Services (in Chinese). 13 February. Beijing: Ministry of Civil Affairs.Google Scholar
Ministry of Civil Affairs (2000b). Opinions on Promoting Urban Community Construction Nationwide (in Chinese). 3 November. Beijing: Ministry of Civil Affairs.Google Scholar
Ministry of Civil Affairs (2005). Opinions on Supporting Non-government Entities in the Development of Social Welfare Institutions (in Chinese). 16 November. Beijing: Ministry of Civil Affairs.Google Scholar
Ministry of Civil Affairs (2010). Circular on conducting inspections on the implementation of ‘Two guī fàn, One biāo zhǔ n’ in aged care institutions (issued: 10 September 2009). In Ministry of Civil Affairs and China National Committee on Ageing (eds.), Policy Documents on the Standardization of Aged Care Services Nationwide: A Collection (in Chinese). Beijing: China Society Publishing House.Google Scholar
Ministry of Civil Affairs and China National Committee on Ageing (2010a). Basic Situation of Aged Care Services Nationwide: A Collection (in Chinese). Beijing: China Society Publishing House.Google Scholar
Ministry of Civil Affairs and China National Committee on Ageing (2010b). Policy Documents on Aged Care Services Nationwide: A Collection (in Chinese). Beijing: China Society Publishing House.Google Scholar
Ministry of Civil Affairs and China National Committee on Ageing (2010c). Policy Documents on the Standardization of Aged Care Services Nationwide: A Collection (in Chinese). Beijing: China Society Publishing House.Google Scholar
Ministry of Construction and Ministry of Civil Affairs (1999). The Code for Design of Buildings for Elderly Persons (JGJ 122–99) (in Chinese). 1 October. Beijing.Google Scholar
Ministry of Labour and Social Security (2002). National Occupational Standards for Old-Age Care Workers (in Chinese). 11 February. Beijing.Google Scholar
Mor, V. (2005). Improving the quality of long-term care with better information. The Milbank Quarterly, 83(3): 333–64.CrossRefGoogle ScholarPubMed
PRB (2011). 2011 World Population Data Sheet. Washington, DC: Population Reference Bureau.Google Scholar
Shang, X. (2001). Moving toward a multi-level and multi-pillar system: changes in institutional care in two Chinese cities. Journal of Social Policy, 30(2): 259–81.Google Scholar
Sher, A. E. (1984). Aging in Post-Mao China: The Politics of Veneration. Boulder: Westview Press.Google Scholar
State Council (2011). The 12th Five-Year Plan for the Development of Social Services for the Aged (2011–2015) (in Chinese). Beijing.Google Scholar
State Council (2006). Opinions on Strengthening and Improving Community Services (in Chinese). 9 April. Beijing.Google Scholar
State Council Information Office (2006). China publishes a White Paper on its undertakings for the aged. Available at: . Accessed 21 August 2013.
Tianjin Municipal Government (2007). Measures for the Management of Elder Care Institutions in Tianjin (in Chinese). Tianjin.Google Scholar
Treas, J. (1977). Family support systems for the aged: some social and demographic considerations. The Gerontologist, 17(6): 486–91.CrossRefGoogle ScholarPubMed
United Nations (2007). World Population Prospects: The 2006 Revision. New York: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat.Google Scholar
Wang, H., Ge, Y., Gong, S. and Mem, M. (2007). Regulating Medical Services in China. New York: Milbank Memorial Fund.Google Scholar
Wong, L. and Tang, J. (2006). Non-state care homes for older people as third sector organisations in China’s transitional welfare economy. Journal of Social Policy, 35(2): 229–46.CrossRefGoogle Scholar
Wu, B., Carter, M. W., Goins, R. T. and Cheng, C. (2005). Emerging services for community-based long-term care in urban China: a systematic analysis of Shanghai’s community-based agencies. Journal of Aging and Social Policy, 17(4): 37–60.CrossRefGoogle ScholarPubMed
Wu, B., Mao, Z. and Xu, Q. (2008). Institutional care for elders in rural China. Journal of Aging and Social Policy, 20(2): 218–39.CrossRefGoogle ScholarPubMed
Wu, B., Mao, Z. F. and Zhong, R. (2009). Long-term care arrangements in rural China: review of recent developments. Journal of American Medical Directors Association, 10(7): 472–7.CrossRefGoogle ScholarPubMed
Xinhua (2005). Beijing encourages private nursing homes. Available at: . Accessed 2005.
Xinhua (2007). More personnel needed in Chinese nursing homes. Available at: . Accessed 2007.
Xinhua (2008). Fire killed 7 in a Wenzhou senior apartment alleged in operation illegally (in Chinese). Available at: . Accessed 2008.
Xinhua (2009). Converting a community hospital into elderly rehab centre should not be that difficult (in Chinese). Available at: . Accessed 2009.
Xinhua (2011). Vast ‘empty nests’, disabled aging population challenging China’s social network. Available at: . Accessed 2011.
Xuyang, J. (2011). Age old issues. Available at: . Accessed 2011.
Zeng, Y. (1986). Changes in family structure in China: a simulation study. Population and Development Review, 12(4): 675–703.Google Scholar
Zhan, H. J. (2002). Chinese care giving burden and the future burden of elder care in life-course perspective. International Journal of Aging and Human Development, 54(4): 267–90.CrossRefGoogle Scholar
Zhan, H. J. (2004). Willingness and expectations: intergenerational differences in attitudes toward filial responsibility in China. Marriage and Family Review, 36(1/2): 175–200.CrossRefGoogle Scholar
Zhan, H., Liu, G. and Guan, X. (2006a). Willingness and availability: explaining new attitudes toward institutional elder care among Chinese elderly parents and their adult children. The Journal of Aging Studies, 20(3): 279–90.CrossRefGoogle Scholar
Zhan, H. J., Feng, X. and Luo, B. (2008). Placing elderly parents in institutions in urban China: a reinterpretation of filial piety. Research on Aging, 30(5): 543–71.CrossRefGoogle Scholar
Zhan, H. J., Feng, Z., Chen, Z. and Feng, X. (2011). The role of the family in institutional long term care – cultural management of filial piety in China. International Journal of Social Welfare, 20: S121–S134.CrossRefGoogle Scholar
Zhan, H. J., Liu, G., Guan, X. and Bai, H. G. (2006b). Recent developments in institutional elder care in China: changing concepts and attitudes. Journal of Aging and Social Policy, 18(2): 85–108.CrossRefGoogle ScholarPubMed
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): 209–29.CrossRefGoogle Scholar
Zhang, H. (2007). Who will care for our parents? Changing boundaries of family and public roles in providing care for the aged in urban China. Care Management Journals, 8(1): 39–46.CrossRefGoogle ScholarPubMed
Zhang, K. (2011). News release on the National Study of Disability and Functional Limitations of the Elderly. 1 March. Beijing: China National Committee on Ageing.Google Scholar

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