Samuel’s Note: This series of articles will address the issues that effect the ’99′ segment of the rural population; the elderly. It will be a holistic look at the myriad of problems the elderly face in rural areas and in conclusion will provide ideas which could alleviate the pressure that China is bound to face in the future.  (Part 2 is HERE, Part 3 is HERE, Part 4 is HERE).

The typical rural resident has gotten old. Source: ChinaHB

The Chinese health care system undoubtedly has problems which prevent it from matching the health outcomes of a developed nation, although it could be argued that no developed nation has circumstances as extreme as China’s. The nation’s size and substantial income disparities create a number of problems that developed systems rarely have to deal with. These problems are not trivial, so perhaps it is unfair to rank China’s healthcare system against more developed nations’ without putting any comparison within a proper context, taking into account China’s population.

Migration is one such problem that deserves a proper context. Figures from January 2009 show rural-urban migration at 140.41 million[1], 10.68% of the total population of China. Migration is an important and complex subject regarding Chinese health care reform and is likely to be the basis for a number of future articles on China HB.

Population composition in rural China is unnaturally skewed due to internal migration, resulting in the majority of rural peoples being women, children or the elderly (Biao, 2007)[2]. The rural population is sometimes referred to as the ‘38-61-99 Army’.

March 8^th (38): Women’s Day
June 1^st (61): Children’s Day
September 9^th (99): The day of honouring the elderly in China

This has a number of social consequences, including many debates on the ‘Agriculturalisation of Females’ (Or the ‘Feminisation of Agriculture’) and the social well-being of children (see Biao, 2007)[3].  More than 13% of the Chinese population was over sixty years of age in 2008 (National Bureau of Statistics of China, 2008)[4], and more than 70% of them live in the countryside (Biao, 2007)[5]. The elderly are a heavy burden on health care systems. The morbidity profile of the population shifts from acute to chronic illness (which is considerably more expensive to treat in the long term). Furthermore, a longer life span increases the possibility that new and costly diseases will occur, such as Alzheimer’s disease and Cancer (Gandjour, 2009)[6]. Not only is the cost of healthcare considerably higher for elderly people, access to care (both physically and financially) is much harder than for a younger population.

The New Cooperative Medical Scheme (NCMS) has considerably increased access to basic care in rural China. The coverage, however, only extends to inpatient acute care. This results in a system that is not geared to the health profile of a substantial proportion of its population. Thus healthcare costs increase with age, as health insurance coverage effectively decreases. In rural areas where health resources are already lacking in quantity and quality, the prospects of the elderly living a healthy life past sixty are rather bleak.

In the next article we will take a more personal look at the plight of the rural elderly, discussing how they receive care and what the effect of migration has on their emotional well-being.

FOOTNOTES
1. National Bureau of Statistics of China (2009) ’2008年末全国农民工总量为22542万人’: http://www.stats.gov.cn/tjfx/fxbg/t20090325_402547406.htm↑
2. Biao, X. (2007) ‘How Far are the Left-Behind Left Behind? A Preliminary Study in Rural China’. Population Space Place, 13, 179-191↑
3. ibid↑
4. National Bureau of Statistics of China (2008) ‘China Statistical Yearbook 2008′: http://www.stats.gov.cn/tjsj/ndsj/2008/indexeh.htm↑
5. Biao, X. (2007) ‘How Far are the Left-Behind Left Behind? A Preliminary Study in Rural China’. Population Space Place, 13, 179-191.↑
6. Gandjour, A. (2009) Aging diseases — do they prevent preventive health care from saving costs? Health Economics, 18(3), 355-362↑