Population ageing challenges health care in China

According to China Research Center on Ageing, 202 million elderly people live in China in 2013; among which, more than 100 million have non-communicable diseases, more than 37 million have disabilities, and about 23 million are older than 80 years. Health care for elderly people is under pressure and this pressure has generated widespread social concern. First, the health-care insurance system is unfair. Such insurance covers 95% of Chinese, but large disparities exist for elderly people among the New Cooperative Medical Scheme, Urban Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance, and Offi cial Medical Insurance system. Second, insufficient resources are available for the care of the elderly. Too few geriatric hospitals and nursing homes are available, which could lead to suboptimum geriatric medicine, rehabilitation, psychiatric, and palliative care services. China should accelerate the development of community-based primary health care for the elderly. A questionnaire-based survey among elderly people showed that doctors’ skills, service provided, medical equipment, and outpatient waiting time need to be improved in community-based primary health care. Moreover, basic knowledge about health is quite low among elderly Chinese people. According to the Chinese Ministry of Public Health, people aged 65–69 years had the lowest health literacy (3·81%). Health education and promotion of healthy behaviours have not been widely popularised among the elderly Chinese population, both in urban and rural areas. Importantly, disability and chronic illness in older individuals can be prevented and delayed through health education and promotion, which should be considered as important as cure. According to China’s Social Security Fund Chairman, Dai Xianglong, China’s pension reserves account for 2% of GDP, which is too low for the goal of scientifi c development. In the coming decades, China will face unprecedented challenges caused by population ageing. Population ageing will lead to comprehensive, profound, and lasting changes in an already overburdened health-care system.