The future of medical and long-term care in China and Europe

With ageing societies through century-low fertility rates and increasing life expectancies, a sustainably shaped health system becomes increasingly demanded, but at least evenly challenging. FES Shanghai, together with Center of European Studies at Fudan University, have tried to contribute new approaches for long-term care and health systems in a two-day conference.

Long-term and health care in Germany and China are facing major challenges. As both economies accommodate societies with progressing average in age, the struggle with lower contribution rates but rising demand in the social security system gets increasingly prevalent, experts from both countries pointed out during their presentations. Reforms were needed that protect the population holistically and minimize social inequality.

A comprehensive long-term care system in China is still in its infancy. It has only been existing since 2016 and has so far been implemented in a very fragmented manner, both spatially and qualitatively, as one expert illustrated in his speech. A small part of the Chinese population has a long-term care insurance that simultaneously guarantees quality and needs, and just the higher income groups currently have the opportunity to afford professional care.

Moreover, there is a lack of both quality and supply, and financing mechanisms are only rudimentarily developed. Chinese and German participants agreed, that nursing in both countries is characterized by long working hours and low wages. Informal care, mostly provided by female family members, remains the first choice for most of the elderly and limited population cohort. Comprehensive education and training campaigns were needed to attract more people into nursing, one Chinese expert added.

With the introduction of a cooperative medical system in 2013 and large expenditures, China has managed to provide its population with basic medical care. However, it is distinct that there are significant regional disparities between urban and rural areas. Chinese experts advised for more medical facilities across the country to be supported by the national health care system. Financially, there was a need for more inter-provincial transfers, which would be solidarity-based. During the conference, there have also been calls for health insurance contributions to be linked to personal income and for the defined contribution system to be converted into a tariff system.

The financing of the systems remains the big question to be answered. Germany can serve as a positive example of social insurance for China, but will itself, according to one of the German presentations, reach the limits of its contribution-based financing in the near future. The role of the state will become increasingly important when it comes to protecting the health of the population. The implication of another German expert drew to the advice that both countries must draw inspiration from good experiences and models of other countries, such as Sweden or the United Kingdom, that operate with social and sustainable approaches.

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