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Erschienen in: Zeitschrift für Gerontologie und Geriatrie 4/2015

01.06.2015 | Originalien

An apocalyptic vision of ageing in China

Old age care for the largest elderly population in the world

verfasst von: Dr. Tao Liu, Dr. Li Sun

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 4/2015

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Abstract

According to the National Bureau of Statistics of China, by 2010 the number of people aged 60 or over had reached 178 million in China or 13 % of its population. With the largest elderly population in the world in absolute numbers, China faces a challenge of providing care for the elderly both in the present and the future. Unlike old age pensions and health protection for the elderly, in Chinese society elderly care had never been considered to be a social problem but rather the individual familyʼs responsibility. After the turn of the millennium, as the repercussions of increasingly ageing demographics, the results of the One-Child Policy and drastic changes in traditional family structures gradually became more apparent, this issue of elderly care has increasingly become one of the most pressing concerns for the ageing society. As there is little existing research on this particular topic, this article aims to shed light on elderly care in China, focusing on the care of elderly needing assistance with activities of daily living, since this group of elderly are most in need of care, their numbers having risen to 33 million in 2010. This article argues it is urgent for China to switch from informal family-based elderly care to the stateʼs formal long-term care, illustrates that a model of social insurance (e.g. as in Germany) is advocated by many Chinese scholars and points out the ways in which it is different from both the commercialized models (e.g. as in the USA) and state organized “Beveridge” models (e.g. as in Sweden).
Fußnoten
1
The very popular newspaper “Global Times” addressed the issue through with a full-page spread including discussions and debates about searching for an institutional scheme for long-term care in their 18 May 2013 publication, inviting many experts and specialists from the area of gerontology and sociology to discuss this issue and introduce it to public.
 
2
Concerning the construction of different stages of life, like the pre-school stage, education, occupational career and retirement through statutory social policy by state see [16].
 
3
The ageing society is linked to the process of demographic transition and population ageing which are characterized through the increase of median age, the prolongation of the life expectancy and the growing share of old age people in the total population [3, 11].
 
4
See the results of the Fifth Population Census of the PR China, available on the webpage of National Bureau of Statistics in China: http://​www.​stats.​gov.​cn/​tjsj/​pcsj/​rkpc/​dwcrkpc/​.
 
5
Before the founding of the People’s Republic of China in 1949 life expectancy amounted to 42 years for both genders, and after the sharp increase in the last 6 decades it has risen to 73 years in 2010 according to the United Nation World Population Prospects: 2006 revision.
 
6
The number of senior citizens who live in empty-nest families peaked at 99 million in 2012 and will climb to 100 million in 2013. See the data provided by the Vice Minister of Ministry of Civil Affairs (MOC)—Dou, Yupei, on the webpage of the MOC: http://​fss.​mca.​gov.​cn/​article/​lnrfl/​ywjs/​201305/​20130500459697.​shtml
 
7
The number of loss-of-single-child (childless) families has reached nearly 1 million in China in the year 2012. Annually about 200,000 children in China are abducted and sold by organized criminal networks of trafficking in human beings. See the report about the loss-of-single-child families in China from the Xinhua News Agency on: http://​www.​zj.​xinhuanet.​com/​newscenter/​rb/​2013-03/​03/​c_​114868873.​htm.
 
8
‘Activities of daily living’ is a term used by health care professionals to refer to daily self-care activities, such as feeding ourselves, bathing ourselves, dressing ourselves and walking. The ability or inability to perform these tasks is generally used as a measurement of the ‘functional status’ of the elderly. Instrumental activities of daily living are not necessary for fundamental functioning, and people who are in need of care usually lead independent lives in their communities, the major assessment criteria are for instance: Assistance with housework, transportation within the community, use of telephone and handling finances [15, 19].
 
9
By comparison, in Germany there were about 2.54 million people who were care-dependent in 2012, of whom 79.6 % were 65 years of age or older, about 11.9 % of the elderly population in Germany (Bundesministerium für Gesundheit: Zahlen und Fakten zur Pflegeversicherung: http://​www.​bmg.​bund.​de/​pflege/​zahlen-und-fakten-zur-pflegeversicheru​ng.​html)
 
10
The term ‘completely disabled old people’ refers to those who have lost the ability to self-care entirely and require permanent care, while the term ‘partially disabled people’ describes those who have lost this ability only partially and need temporary care.
 
11
“Maodong” is a word from the northeast dialect in China, which means that the people prefer to stay indoors at home during a long and cold winter.
 
12
The rural MLSS was tried out by local communities in China since the millennium. From 2006 this programme has become a national programme through pressure from the State Council of China. It stipulated that rural residents whose income falls below the local poverty line can claim a monetary assistance from the local administration.
 
13
See the report of Ministry of Civil Affairs (2009) “The Statistical Report on Civil Affairs Matters in 2009”, available on: http://​finance.​people.​com.​cn/​nc/​GB/​11853946.​html.
 
14
However, it must be noted that this construction of three major models for long-term care insurance is only associated with a scientific observation of Chinese scholarly circles, and represents a form of social construction according to the cognitive exploration of these actors in the absence of a current international consensus in the domain of long-term care insurance on a mature global model. This cognition of the objective world in China is interconnected with a creation of an ideal type by scientific actors, for, as Max Weber has indicated: “An ideal type is formed by the one-sided accentuation of one or more points of view and by the synthesis of a great many diffuse, discrete, more or less present and occasionally absent concrete individual phenomena, which are arranged according to those onesidedly emphasized viewpoints into a unified analytical construct…” ([40], p. 90). The construction of an ideal type by social scientists also serves to reduce the complexity of social facts in the social world (see [28]).
 
15
In 1968, the Algemene Wet Bijzondere Ziektekosten (general law on exceptional medical expenses) was introduced in the Netherlands, which attempted to expand the health insurance system to cover the entire Dutch population against special health care needs. At the time, this programme also created one of the earliest forms of a type of long-term care [36].
 
16
However, another quite important system, that of Medicare in the United States, which shares features with the Beveridge model, appears to be of little concern to Chinese long-term care experts and is therefore in need of further exploration in the future. The Medicare system targets elderly Americans over 65 who are not covered by the health insurance system, for whom this system provides reimbursement of medical costs as well as some forms of assistance for those in need of care [32].
 
Literatur
1.
Zurück zum Zitat Barr N (2010) Long-term care: a suitable case for social insurance. Soc Policy Adm 44(4):359–374CrossRef Barr N (2010) Long-term care: a suitable case for social insurance. Soc Policy Adm 44(4):359–374CrossRef
2.
Zurück zum Zitat Berger PL, Luckmann T (1980) Die gesellschaftliche Konstruktion der Wirklichkeit. Eine Theorie der Wissenssoziologie. Fischer, Frankfurt a. M. Berger PL, Luckmann T (1980) Die gesellschaftliche Konstruktion der Wirklichkeit. Eine Theorie der Wissenssoziologie. Fischer, Frankfurt a. M.
3.
Zurück zum Zitat Birg H (1996) Die Weltbevölkerung: Dynamik und Gefahren. Beck, München Birg H (1996) Die Weltbevölkerung: Dynamik und Gefahren. Beck, München
4.
Zurück zum Zitat Bogner A, Torgersen H (2005) Wozu Experten? Ambivalenzen der Beziehung von Wissenschaft und Politik. VS Verlag für Sozialwissenschaften, Wiesbaden Bogner A, Torgersen H (2005) Wozu Experten? Ambivalenzen der Beziehung von Wissenschaft und Politik. VS Verlag für Sozialwissenschaften, Wiesbaden
5.
Zurück zum Zitat Castles F (1978) The social democratic image of society. Routledge & Kegan Paul, London Castles F (1978) The social democratic image of society. Routledge & Kegan Paul, London
6.
Zurück zum Zitat Dai WD (2007) Introduction of German long-term care insurance. Chinese J Nurs 42(1):85–86 Dai WD (2007) Introduction of German long-term care insurance. Chinese J Nurs 42(1):85–86
7.
Zurück zum Zitat Dai WD (2012) The construction of long-term care insurance system in China. Peopleʼs Publishing House, Beijing Dai WD (2012) The construction of long-term care insurance system in China. Peopleʼs Publishing House, Beijing
8.
Zurück zum Zitat Deacon B, Hulse M, Stubbs P (1997) Global social policy. International organizations and the future of welfare. Sage, London Deacon B, Hulse M, Stubbs P (1997) Global social policy. International organizations and the future of welfare. Sage, London
9.
Zurück zum Zitat Ding C, Qu QC (2008) Entstehungsgründe, Merkmale und Reformkonzept der deutschen Pflegeversicherung. Deutschland-Studien 23(3):42–47 Ding C, Qu QC (2008) Entstehungsgründe, Merkmale und Reformkonzept der deutschen Pflegeversicherung. Deutschland-Studien 23(3):42–47
10.
Zurück zum Zitat Haggard S, Kaufmann RR (2009) Development, democracy, and welfare states: Latin America, East Asia, and Eastern Europe. Princeton University Press, Princeton Haggard S, Kaufmann RR (2009) Development, democracy, and welfare states: Latin America, East Asia, and Eastern Europe. Princeton University Press, Princeton
11.
Zurück zum Zitat Harper S (2006) Ageing societies: Myths, challenges and opportunities. Hodder Arnold, London Harper S (2006) Ageing societies: Myths, challenges and opportunities. Hodder Arnold, London
13.
Zurück zum Zitat Hesketh T, Lu L, Xing ZW (2005) The effect of Chinaʼs One-Child family policy after 25 years. N Engl J Med 35(3):1171–1176CrossRef Hesketh T, Lu L, Xing ZW (2005) The effect of Chinaʼs One-Child family policy after 25 years. N Engl J Med 35(3):1171–1176CrossRef
14.
Zurück zum Zitat Jackson R, Howe N (2004) The graying of the Middle Kingdom. In Presentation at the CSIS/CASS Conference on Preparing for China’s Aging Challenge, Abridged Version, 25 May 2004 Jackson R, Howe N (2004) The graying of the Middle Kingdom. In Presentation at the CSIS/CASS Conference on Preparing for China’s Aging Challenge, Abridged Version, 25 May 2004
15.
Zurück zum Zitat Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. J Am Med Assoc 185(12):914–919CrossRef Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. J Am Med Assoc 185(12):914–919CrossRef
16.
Zurück zum Zitat Kohli M (1985) Die Institutionalisierung des Lebenslaufs: Historische Befunde und theoretische Arguments. Köln Z Soziol Sozialpsychologie 37(1):1–29 Kohli M (1985) Die Institutionalisierung des Lebenslaufs: Historische Befunde und theoretische Arguments. Köln Z Soziol Sozialpsychologie 37(1):1–29
17.
Zurück zum Zitat Korpi W (1978) The working class in welfare capitalism: work, unions and politics in Sweden. Routledge & Kegan Pau, London Korpi W (1978) The working class in welfare capitalism: work, unions and politics in Sweden. Routledge & Kegan Pau, London
18.
Zurück zum Zitat Korpi W (1983) The democratic class struggle. Routledge & Kegan Paul, London Korpi W (1983) The democratic class struggle. Routledge & Kegan Paul, London
19.
Zurück zum Zitat Lawton MP; Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186PubMedCrossRef Lawton MP; Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186PubMedCrossRef
20.
Zurück zum Zitat Leisering L, Liu T (2010) Globale Wissensdiffusion in der Sozialpolitik. Die Einführung einer Arbeitsunfallversicherung in der Volksrepublik China. Z Sozialreform 56(2):173–205 Leisering L, Liu T (2010) Globale Wissensdiffusion in der Sozialpolitik. Die Einführung einer Arbeitsunfallversicherung in der Volksrepublik China. Z Sozialreform 56(2):173–205
21.
Zurück zum Zitat Li JF, Hou HJ (2009) A study on the construction of long-term care insurance system for elderly in China. Insurance Stud 29(11):65–71 Li JF, Hou HJ (2009) A study on the construction of long-term care insurance system for elderly in China. Insurance Stud 29(11):65–71
22.
Zurück zum Zitat Li J, Hou A (2012) A study on the construction of long-term care insurance system for the elderly in China. Insurance Studies 32(11):65–71 Li J, Hou A (2012) A study on the construction of long-term care insurance system for the elderly in China. Insurance Studies 32(11):65–71
23.
Zurück zum Zitat Liu T (2005) Die Reform der Alterssicherung in der VR China. Entwicklung und Determinanten. Dissertation at Bielefeld University, Bielefeld Liu T (2005) Die Reform der Alterssicherung in der VR China. Entwicklung und Determinanten. Dissertation at Bielefeld University, Bielefeld
24.
Zurück zum Zitat Liu J, Chen S (2012) Construction of long term care insurance. Res Financial Econ Issues 33(3):78–82 Liu J, Chen S (2012) Construction of long term care insurance. Res Financial Econ Issues 33(3):78–82
25.
Zurück zum Zitat Liu T, Flöthmann EJ (2013) Die neue alternde Gesellschaft. Demographische Transformation und ihre Auswirkungen auf Altersversorgung und Altenpflege in China. Z Gerontol Geriat 46:1–12CrossRef Liu T, Flöthmann EJ (2013) Die neue alternde Gesellschaft. Demographische Transformation und ihre Auswirkungen auf Altersversorgung und Altenpflege in China. Z Gerontol Geriat 46:1–12CrossRef
26.
Zurück zum Zitat Liu L, Guo Q (2007) Loneliness and health-related quality of life for the empty-nest elderly in the rural areas of a mountainous county in China. Qual Life Res 16(8):1275–1280PubMedCrossRef Liu L, Guo Q (2007) Loneliness and health-related quality of life for the empty-nest elderly in the rural areas of a mountainous county in China. Qual Life Res 16(8):1275–1280PubMedCrossRef
28.
Zurück zum Zitat Luhmann N. (1997) Die Gesellschaft der Gesellschaft. Suhrkamp, Frankfurt a. M. Luhmann N. (1997) Die Gesellschaft der Gesellschaft. Suhrkamp, Frankfurt a. M.
29.
Zurück zum Zitat Luo R (2012) Across the institutional passage of migration: the hukou-system in China. InterDisciplines 3(1):120–147 Luo R (2012) Across the institutional passage of migration: the hukou-system in China. InterDisciplines 3(1):120–147
30.
Zurück zum Zitat Meyer JW (2005) Weltkultur: wie die westlichen Prinzipien die Welt durchdringen. Suhrkamp, Frankfurt a. M Meyer JW (2005) Weltkultur: wie die westlichen Prinzipien die Welt durchdringen. Suhrkamp, Frankfurt a. M
31.
Zurück zum Zitat Offe C (1987) Democracy against the welfare state? Structural foundations of neoconservative political opportunities. Political Theory 15(4):501–537CrossRef Offe C (1987) Democracy against the welfare state? Structural foundations of neoconservative political opportunities. Political Theory 15(4):501–537CrossRef
32.
Zurück zum Zitat Pearman WA, Starr P (1988) Medicare: a handbook on the history and issues of health care services for the elderly. Garland, New York Pearman WA, Starr P (1988) Medicare: a handbook on the history and issues of health care services for the elderly. Garland, New York
33.
Zurück zum Zitat Pellissery S, Sun L (2012) Rural Development. In: Anderson R (ed) Berkshire Encyclopedia of Sustainability: Vol. 7: China, India, and East and South East Asia: Assessing Sustainability, Berkshire Publishing Group, Beijing, pp 324–27 Pellissery S, Sun L (2012) Rural Development. In: Anderson R (ed) Berkshire Encyclopedia of Sustainability: Vol. 7: China, India, and East and South East Asia: Assessing Sustainability, Berkshire Publishing Group, Beijing, pp 324–27
34.
35.
Zurück zum Zitat Rogers EM (1962) Diffusion of Innovations. The Free Press of Glencoe, New York Rogers EM (1962) Diffusion of Innovations. The Free Press of Glencoe, New York
36.
Zurück zum Zitat Saltman RB, Dubois HFW Chawla M (2006) The impact of aging on long-term care in Europe and some potential policy responses. Int J Health Serv 36(4):719–746PubMedCrossRef Saltman RB, Dubois HFW Chawla M (2006) The impact of aging on long-term care in Europe and some potential policy responses. Int J Health Serv 36(4):719–746PubMedCrossRef
37.
Zurück zum Zitat Schetsche M (1996) Die Karriere sozialer Probleme: Soziologische Einführung. Oldenbourg, München Schetsche M (1996) Die Karriere sozialer Probleme: Soziologische Einführung. Oldenbourg, München
38.
Zurück zum Zitat Schubert K, Bandelow NC (2003) Lehrbuch der Politikfeldanalyse. Oldenbourg, München Schubert K, Bandelow NC (2003) Lehrbuch der Politikfeldanalyse. Oldenbourg, München
39.
Zurück zum Zitat Shi SJ (2008) Emergence of the notion of retirement in rural China: the case of rural districts of Shanghai. Z Gerontol Geriat 41:334–344CrossRef Shi SJ (2008) Emergence of the notion of retirement in rural China: the case of rural districts of Shanghai. Z Gerontol Geriat 41:334–344CrossRef
40.
Zurück zum Zitat Shils EA, Finch HA (1997) The methodology of the social sciences. Free Press, New York Shils EA, Finch HA (1997) The methodology of the social sciences. Free Press, New York
41.
Zurück zum Zitat Steffen M (2010) The French health care system: liberal universalism. J Health Polit Policy Law 35(3):353–387PubMedCrossRef Steffen M (2010) The French health care system: liberal universalism. J Health Polit Policy Law 35(3):353–387PubMedCrossRef
42.
Zurück zum Zitat Stepan M, Müller A (2012) Welfare governance in China? A conceptual discussion of governing social policies and the applicability of the concept to contemporary China. J Camb Stud 7(4):54–72 Stepan M, Müller A (2012) Welfare governance in China? A conceptual discussion of governing social policies and the applicability of the concept to contemporary China. J Camb Stud 7(4):54–72
43.
Zurück zum Zitat Sun L (2012) Women, public space, and mutual aid in rural China. Asian Women 28(3):75–102 Sun L (2012) Women, public space, and mutual aid in rural China. Asian Women 28(3):75–102
46.
Zurück zum Zitat Ullrich, CG (2005) Soziologie des Wohlfahrtsstaates. Campus Verlag, Frankfurt a. M. Ullrich, CG (2005) Soziologie des Wohlfahrtsstaates. Campus Verlag, Frankfurt a. M.
47.
Zurück zum Zitat Wang XC, Shao H (2012) Consideration about installment of a long-term care insurance system with Chinese characteristics. Manag Technol SME 04(2):196 Wang XC, Shao H (2012) Consideration about installment of a long-term care insurance system with Chinese characteristics. Manag Technol SME 04(2):196
48.
Zurück zum Zitat Wang L, Ye X (2011) Development of Japan elderly care insurance system and its referential significance for China. Jpn Stud Forum 47(1):145–150 Wang L, Ye X (2011) Development of Japan elderly care insurance system and its referential significance for China. Jpn Stud Forum 47(1):145–150
49.
Zurück zum Zitat Wu C, Du P (2012) Ageing society and harmonious society. China Population Publishing House, Beijing Wu C, Du P (2012) Ageing society and harmonious society. China Population Publishing House, Beijing
50.
Zurück zum Zitat Wu H, Zhang R (ed) (2011) Gerontological social work. Peking University Press, Beijing Wu H, Zhang R (ed) (2011) Gerontological social work. Peking University Press, Beijing
51.
Zurück zum Zitat Wu GM, Zhong HL (2010) The models of long-term care insurance in Germany and Japan and their implications for China. J Nurs Sci 25(23):76–78 Wu GM, Zhong HL (2010) The models of long-term care insurance in Germany and Japan and their implications for China. J Nurs Sci 25(23):76–78
52.
Zurück zum Zitat Yao, H (2006) The long term care insurance abroad and its inspiration for China. Mod Econ Res 6:41–44 Yao, H (2006) The long term care insurance abroad and its inspiration for China. Mod Econ Res 6:41–44
53.
Zurück zum Zitat Zhang X, Li D (2011) Sociology of ageing. Social Sciences Academic Press, Beijing Zhang X, Li D (2011) Sociology of ageing. Social Sciences Academic Press, Beijing
54.
Zurück zum Zitat Zhang ZG, Jiang Q, Zhao YX, Yu LH, Zhang ZZ, Lang QQ (2011) Long-term care insurance policies in Germany and its implications for China. Chin J Nurs Education 08(8):93–94 Zhang ZG, Jiang Q, Zhao YX, Yu LH, Zhang ZZ, Lang QQ (2011) Long-term care insurance policies in Germany and its implications for China. Chin J Nurs Education 08(8):93–94
55.
Zurück zum Zitat Zhang K, Sun L, Mou X et al (2011) Research on situation of urban and rural disabled elderly. Monogr Study 2:11–16 Zhang K, Sun L, Mou X et al (2011) Research on situation of urban and rural disabled elderly. Monogr Study 2:11–16
57.
Zurück zum Zitat Zhi XX, Zhou L (2012) The German long-term care insurance and its implications for the work of long-term care in China. Using Pract Res 09(8):93–94 Zhi XX, Zhou L (2012) The German long-term care insurance and its implications for the work of long-term care in China. Using Pract Res 09(8):93–94
58.
Zurück zum Zitat Zhong W, Zheng Y, Zhang M (2013) The collapse of the state. Research on the sovereign debt restructuring. Shanghai University of Finance and Economics Press, Shanghai Zhong W, Zheng Y, Zhang M (2013) The collapse of the state. Research on the sovereign debt restructuring. Shanghai University of Finance and Economics Press, Shanghai
Metadaten
Titel
An apocalyptic vision of ageing in China
Old age care for the largest elderly population in the world
verfasst von
Dr. Tao Liu
Dr. Li Sun
Publikationsdatum
01.06.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 4/2015
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-014-0816-5

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