Table 1.
Functional positioning and inadequate preparation for healthcare delivery and long term care services
| Category | Healthcare delivery | Long term care services |
|---|---|---|
| Institutions | ||
| Functional position | Healthcare system reform prioritises transforming hospital centred treatment to integrated and continued care through a three tier healthcare delivery system*: tier 3 includes county and city hospitals; tier 2 includes township health centres and community health centres/stations; tier 1 includes village and community clinics | Three main types include public social welfare facilities, nursing homes, and other residential care facilities (eg, senior apartments, assisted living facilities, and retirement communities) |
| Characteristic | Changing from treatment oriented to rehabilitation and prevention oriented | Growing residential (institutional) care sector, slow development of HCBS, and insufficient organised funding |
| Challenges | Ageing adds burdens on primary healthcare institutions (including tier 2 and tier 1). Primary healthcare institutions account for 94.8% of all three tier healthcare institutions, which account for only 53.2% of treatment visits and 16.1% of hospital admissions for all institutions† | New family structures, rapid urbanisation, and increased labour mobility, which increased the burden of care from relatives have weakened the family based long term care model of China‡ |
| Workers | ||
| Provider | Professional doctors or nurses | Nursing or social work staff |
| Challenges | Inadequate professional and technical skills, qualifications, and incentives of workers in primary healthcare institutions. The education level in primary healthcare institutions is much lower than in tier 3 healthcare institutions. Professional training in geriatrics and nursing provided by medical schools is limited. The incentive mechanism for primary healthcare institutions is relatively weak (eg, income is not linked with jobs) and relies more on the number of patients seen and medicine used | Shortage of long term care workers. Qualification certification, professional title evaluation, and promotion ladders. Challenges remain to improve working conditions and management systems and to increase the social values and reputation of the profession |
| Care and services | ||
| Services | Diagnosis and treatment of diseases, training and guidance. Tier 3 healthcare institutions: diagnosis and treatment of diseases, training and guidance to workers of primary medical institutions, public health, and emergency medical services. Primary medical institutions: basic public health services, diagnosis and treatment services for common diseases, rehabilitation and nursing services for some diseases, and transferring patients with critical and difficult cases beyond their own service capabilities to hospitals§ | Daily care, nursing care, risk prevention, and guide function maintenance. Daily care: cleaning, food/water assistance, etc. Nursing care: health guidance, blood glucose monitoring, etc. Risk prevention: prevention of pressure sores, choking, falls, burns, etc. Guide function maintenance: rolling training and guiding passive joint activities, etc |
| Challenges | Ageing has brought diverse overuse and overprovision of health services. Patients with NCDs bypass primary health facilities and seek perceived good quality of care in high level hospitals. For patients in the recovery period, community and home based rehabilitation services are more important but less used. For comorbidities, the use of traditional Chinese medicine could reduce the side effects of combined western medication | Professional long term care services are underdeveloped in China, and NCDs due to ageing put a higher demand on specialised and professional services. Long term care services are still not easily accessible or of high quality. Insufficient utilisation of beds in professional long term care institutions |
HCBS=home and community based services; NCD=non-communicable disease.
*
Meng Q, Mills A, Wang L, Han Q. What can we learn from China’s health system reform? BMJ 2019;365:l2349.
†
National Health Commission of the People’s Republic of China. Statistical Bulletin of China's Health Development in 2020. https://www.gov.cn/guoqing/2021-07/22/content_5626526.htm.
‡
Fang EF, Scheibye-Knudsen M, Jahn HJ, et al. A research agenda for ageing in China in the 21st century. Ageing Res Rev 2015;24:197-205.
§
Office of the State Council. National healthcare policy announcement of strategic plan on national healthcare service system (2015–2020). 2015. https://www.gov.cn/zhengce/content/2015-03/30/content_9560.htm.