China has seen its aging population growing rapidly. This trend is expected to last for a long time. In 2018, the number of people over the age of 65 in China reached 166 million, accounting for 11.9 percent of the total population. It is projected that the number of elderly people aged 65 and over in the country will exceed 400 million by 2050. There is therefore an urgent need to establish a comprehensive eldercare system combining pensions and medical care and nursing care.

To cope with its growing elderly population, Japan has established a community-based integrated care system for the elderly that provides long-term nursing care, medical care services and social care, providing experience that China can draw from.

The sophisticated community-based integrated care system of Japan provides nursing care, medical care, preventive care and in-home care for patients in acute, recovery and chronic phases. Based on the long-term care insurance system, the nursing system allows elderly people to enjoy services in their homes, elderly care organizations and communities. The preventive care system provides life assistance and preventive care for the elderly. Japan has also established community general support centers to meet the demand for services for the elderly. With the medical care, nursing care, preventive care and in-home care systems linked, the elderly who need medical and nursing care services can get them within 30 minutes, while still enjoying their later life in an environment they are familiar with.

As China's population is rapidly aging, demand for elderly care is rising. However, supplies of medical and nursing care services are inadequate. First, domestic hospitals offer no nursing care services for the elderly and fail to conduct effective management of healthcare workers as patients paying high fees may still receive low-quality services. Second, the division of the pension for medical care and nursing care is still unclear. Medical care insurance has been utilized for nursing care, leading to long stays for some patients that cause a shortage of hospital beds. Third, adding more rehabilitation medicine into China's medical insurance system would significantly ease the medical expenditure burden on families while the proportion of rehabilitation medicines in the system is still low and rehabilitation and medical care organizations across the country are inadequate. Fourth, the current supplies of medical care for those elderly that are disabled or have dementia cannot meet the actual demand. Fifth, hospice and palliative care services and death education need to be further promoted in China. Sixth, community-based integrated service centers are not in place. Seventh, the long-term care insurance system is incomplete. Meanwhile, it is not yet a good time for across-the-board implementation of a nationwide pilot program as it remains fragmented. Therefore, China should draw on Japan's experience and improve its community-based integrated care system to cope with its aging population.

First, China needs to establish a community-based integrated care system consisting of nursing care, medical care, preventive care and in-home care. The government can establish service centers in communities to provide medical care, rehabilitation and nursing care services for the elderly. A "community+internet" platform for integrated care services should also be established.

Second, a long-term care insurance system should be established. As an independent social insurance system, it is a fund-raising mechanism that clarifies the responsibilities of government, enterprises and individuals. China needs to settle payment standards in line with its financial capacity, improve rating systems for nursing care services and make procedures for the services more standardized. Individuals and households in China should be financially prepared for elderly care.

The scope of medical insurance and long-term care insurance should be clearly separated. In Japan, the insurances are clearly distinguished as acute medical care is covered by medical insurance and long-term care focuses on the needs of people whose physical functions fail to fully recover after rehabilitation periods. Long-term daily care requires healthcare workers who are equipped with professional knowledge.

In addition, China needs to improve the supply of care for disabled and partly disabled elderly people, increase the support for relevant organizations and promote the idea of self-reliance among the elderly to reduce the care burden on health workers.

It can also establish service centers for the elderly with dementia. The government needs to introduce supporting policies to encourage communities to build care centers for such elderly people, provide them with a safe environment, set standards for the environment and healthcare services, and improve governmental subsidies for professional elderly care organizations. Subsidies can be provided according to the performances of the organizations. Meanwhile, professional training for the care of elderly people with dementia needs to be organized to help ease the pressure on their families.

Efforts are also needed to promote hospice and palliative care services in China. Related departments should build hospice and palliative care service frameworks, develop complete assessment standards and medical guarantees, and establish transfer mechanisms between care service organizations and terminal care hospitals. More focus needs to be laid on death education by incorporating death-related courses into China's current education system, promoting the public to live and die well and guiding them to face death.

The author is a researcher with China Center for International Economic Exchanges.

The author contributed this article to China Watch exclusively. The views expressed do not necessarily reflect those of China Watch.

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