by Dr. Kevin Fickenscher

The looming tsunami of a growing elder population will challenge China….

One of the issues we discuss continuously in the United States is the impact of the looming demographic shift as our population ages.  While the issue is not inconsequential, it is even more of a problem in other places around for world.  For example, China is facing an even more severe impact on their society because of the aging population.  The latest Chinese government census reveals that 178 million Chinese are over age 60 as of 2009 or, about 8% of the total population.  The figure is projected to reach 437 million, or, one third of the population, by 2050.  The demographic shift represents a huge change which will have implications not only on healthcare but the economy as a whole and many other sectors in China.

Historically, in China, the elderly are looked after by their children.  But, two major trends have thwarted that traditional approach – urbanization and the adoption of the one-child policy.  Both of these trends have eroded the tradition of family care across the nation.  Joseph J. Christian, from the Harvard Kennedy School Asia Center describes the situation in China as “a demographic tsunami.”  In fact, the Chinese challenge is made even more complicated by the fact that it will grow older before it becomes rich enough to manage the situation.  To deal with the problem, China established the National Committee on Aging to develop a strategy (CHGE7) to assure the health and comfort for the nation’s aged.

The fact that care for the aged is traditionally managed by the family complicates the problem for the government.  Essentially, there is little current elder care industry in the country.  While still giving families a major role in caring for their parents, the latest five-year plan moves the Chinese government much more aggressively in pushing policies to increase private sector, nongovernmental organizations (NGO), and local community care delivery initiatives for the elderly.

Today, China has only about 38,000 long-term care institutions with 2.7 million beds or, enough capacity for about 1.6% of the population over 60, according to the World Bank. The number of institutional beds for developed countries is roughly capacity for about 8% of the population.  In the United States, we have a total of 16,995 total nursing facilities with 1,813,665 nursing facility beds.  The differential compared to China is very significant.  So, clearly, the Chinese are far behind in having sufficient capacity to care for the elderly.

As an example, the Beijing-based Pinetree Senior Care Services – a home care program – only employs 500 nurses who provide in-home support to 20,000 seniors across the city and, it is one of the very few programs in Beijing!  In a 2009 survey of 140 nursing homes in the eastern city of Nanjing by a group of Chinese academics, it was noted that less than a third of the institutions employed a doctor or a nurse and most of the staff were unskilled rural migrant workers with minimal training.   These findings are compounded by the fact that elder care in China currently has no industry standards and little government oversight.  And, finally the focus of most studies in China has been on the urban areas when, in fact, the majority of the population reside in rural areas.  The rural areas of China face an even more ominous situation.

This is not to say that there are no services but, rather, insufficient services.  Like many aspects of healthcare in China, one can find facilities and care programs that rival the best programs and establishments in developed nations.  Investments are beginning in the elder care market.  A number of foreign companies are moving into the country such as China Senior Care, a venture with U.S. backers.  The company is building a 64-bed assisted-living center in Hangzhou aimed at Chinese who can afford to pay more than 30,000 yuan per month. Right at Home, an Omaha company that introduced home-care franchises to China in June, aims to open dozens of affiliates by 2017. The company charges about 100 yuan per hour of service from caregivers trained in everything from vacuuming to CPR. However, these programs are aimed at the wealthy with the cost of participation far beyond the reach of the average Chinese citizen.  Mark Spitalnik, the founder of China Senior Care, clearly admits the problem in noting that, “International players are looking for high-net-worth clients.  The true problem for the government is people who don’t have money.”

So, while we must continue to address our own growing demographic problem in the USA, we should recognize that many other nations are at risk as well.  While I’ve highlighted China, the same problems exist in many other nations of the world.  The long and short is that globally, care of the elderly will become an increasingly important focus of government programs.  We should anticipate that new ideas, solutions, and delivery models will evolve in these nations – in part, because the problem is so much worse than the USA.

Dr. Kevin Fickenscher
Dr. Kevin M. Fickenscher is the Founder of CREO Strategic Solutions, LLC – an organization focused on senior executive strategic support, leadership development and assistance with evolving care delivery models. Previously, he served in a variety of leadership roles within the healthcare industry on both a domestic and international basis. He is a recognized physician executive with extensive experience in strategic and operational development in complex healthcare organizations. He is a thought leader related to technology and information management and holds extensive experience in organizational transformation and development, physician management, health policy analysis, leadership development, clinical quality and resource/care management, among other areas. Dr. Fickenscher is considered to be a dynamic, visionary leader in healthcare throughout the world has consistently been ranked among the Most Powerful Physician Executives in Healthcare by Modern Healthcare.


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