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A Study on Population Aging in China from the Perspective of Public Policy

[Abstract] This paper reviews the demographic changes, especially the problems brought by the "baby boom", in order to reveal the meaning of population aging in China. Under the overall public policy framework of "economic country transformation", the family structure, lifestyle, long-term care needs and social responsibilities of the elderly are re-examined. At the same time, the development of income security, medical care and personal social services for the elderly was investigated through the analysis of the white paper "The Development of China's Aging Cause" in 2006 and related research. Under the framework of the active aging policy implemented by the United Nations, the employment, education and lifestyle of the elderly are further discussed. Finally, the policy, practice and theoretical issues related to the realization of the country's clear goals are discussed. The article emphasizes that the role of individuals, families, practitioners and decision makers should be considered in order to make full preparations for aging.

[Keywords:] China, aging, public policy, social welfare and services, pension

I. Introduction

As an important process of population change, the aging problem in China has the characteristics of large population base and explosive growth, and the government has adopted family planning to deal with it. Nowadays, the "baby boomer" generation has begun to enter the old age, and the consequence is the rapid aging of society, and some social problems have also emerged. At present, the family structure in China is an inverted pyramid structure of 4-2- 1. Judging from the long-term care needs (LTC) of the elderly, the younger generation is now under great pressure. However, due to the implementation of the overall policy of depoliticized "economic country" (which is the primary goal and preferred means to guide a policy system) and the policy of reform and opening up (Chen, 1996), China has accumulated a lot of resources, so it has the ability to deal with such problems. But at the same time, the reform inevitably brought another process of de-economization, that is, with the development of economy, the role of the government began to change into a provider of social services (the transition period of economic countries) (Chen, 2004). With the increasing burden of aging population, the social "dependency ratio" is rising, which is considered as a major obstacle to China's economic development and the goal of becoming rich. Moreover, in China (especially in cities), people usually retire early, so their demand for social security and medical insurance is very important for a long time after retirement. However, China's conditions in this respect are still very limited, and it is still at a backward level compared with the United States and some developed countries (regardless of some substantive differences in welfare projects). By reviewing the challenges and opportunities faced by China, this paper reveals the meaning of population aging from China's own perspective, aiming to clarify the current situation of measures taken by China to deal with the aging problem by understanding the unique internal relations of China, so as to determine relevant important topics for reference in research, practice and policy formulation.

Second, China's aging population and population explosion.

In the 30 years after the founding of the People's Republic of China, there was basically no problem of emigration or emigration in China. China, like other developing countries and newly industrialized countries, is undergoing a rapid demographic transition in the process of social and economic development, that is, from a stage of high mortality and high birth rate to a stage of decreasing mortality and prolonging life expectancy (due to the improvement of medical conditions and living standards) while maintaining a high birth rate. This period (1950s to 1960s) was characterized by a high population growth rate. The period of high population growth after the founding of New China coincided with the "baby boom" in developed countries such as the United States after World War II, but in the process of population transformation, China's population grew faster and larger. However, in this period of development, the highly politicized overall public policy overemphasizes the political initiative in the economy (Chen, 2004). At that time, Malthus' population theory was completely denied, but there was no better way to solve this problem. As a result, the unrestricted population growth rate exceeded the planned economic development, which later became an increasingly headache in policy making. Finally, under the pressure of hidden unemployment and other related problems, especially the failure of "going to the countryside" as an expedient measure to solve the unemployment problem, the China government finally woke up and strictly implemented the family planning policy to reduce the population growth rate, especially the urban population growth rate, even at the expense of "overcorrecting".

Strict control of population growth and implementation of family planning policy have been the characteristics of China's population policy since the late 1970s. This policy helps to reduce the birth rate in crowded cities, but it also accelerates the pace of China's entry into an aging society. As many people say: China is not ready to deal with the aging population. At the end of the 20th century, the proportion of people over 60 years old in China exceeded 10%. According to the internationally accepted standards, the age structure of the population in China has entered an aging stage (the State Council, China, 2006).

We can see China's shortcomings in dealing with the aging society from many aspects. The first category is the baby boomers in China, who have just reached the legal retirement age in China (60 years old for men and 55 years old for women). The huge scale of this group and their needs are a severe test for the whole society and affect all aspects of society. In addition, their families, communities, related systems and labor market will all be affected by this rapidly aging society (Frazier, 2006).

Third, family structure and long-term care needs.

The family planning policy has brought great changes to the family structure in China. The traditional China family is blessed with many children and four generations living under one roof. However, with the urbanization and modernization, this family structure is gradually disappearing (Chen, 1996), and the aging population has turned the population structure of China into an inverted pyramid structure. Now in China, the typical family structure (especially in the city) is one child, two parents and four grandparents. Now that the medical conditions are good, maybe grandparents are still alive. In addition, modern life, especially city life, makes it difficult (though not impossible) for generations to live under one roof, which makes it more difficult for only children to take care of their elderly parents and grandparents. With more and more "empty nest" families, China people can no longer take their traditional lifestyle and family structure for granted, which has a great impact on the elderly trapped in the old, the weak and the sick. Here, we can read a realistic report. This report is about the potential nursing needs of 20,255 elderly people surveyed in 20 different provinces and cities in China in 2000. According to the report, about 65,438+0/3 (35% in urban areas and 29.6% in rural areas) elderly people aged 85 and above need daily care (Pei, 2007).

However, it is worth noting that for policy makers, theorists and ordinary people in China, no matter how much traditional home care is needed, it is not the only way to meet the potential nursing needs of the aging population. With the economic reform and the development of market economy in China, people can get almost all the resources they need from the market, and services for the elderly, including long-term care, can also be obtained from the market. Therefore, as long as you have a certain economic ability to pay, such a problem can be solved. The following two examples briefly illustrate this situation.

I once witnessed a wealthy businessman in China telling a global satellite TV program in 2008 that he hired three home care workers for his elderly mother with high salary. Nurses provide meticulous long-term care for the elderly. Although he didn't do it himself, it didn't prevent him from being a dutiful son and wholeheartedly. In the end, her mother died peacefully, and the millionaire was filial.

The author has also seen a real report. In the countryside, an 84-year-old woman has no children or daughters, a dilapidated house and no family, and her life is very difficult. She spent her old age in such an environment. This situation is shocking.

Comparing these two real cases, the former is certainly expected by everyone, but it seems that not most elderly people in China can enjoy it because the cost is too high. Perhaps no one in China wants to see the plight of the poor old people in the second case, but society cannot ignore such a group of old people who are at the bottom of society and live in poverty. Therefore, it is necessary to carefully study how public and social strategies should deal with such problems.

Four. Social welfare and economic transformation

After the founding of New China, as an "economic country" (Chen, 1996), the welfare of employees is either managed by their work units or by relevant local government departments, while in rural areas it is managed by the production teams of people's communes. Due to the planned economy at that time, everyone's living standard was at a very low level, and the demand for old-age security for the general public did not appear particularly prominent (Chen, 2004). Thanks to the relatively young population of China at that time, although the political desire at that time was to catch up with the developed countries economically, the fact of economic retrogression was concealed under the vigorous political movement, the so-called class struggle.

Since the end of the Cultural Revolution in the late 1970s, the new leadership of China, headed by Deng Xiaoping, has boldly implemented new public policies, shifted its focus from class struggle to economic construction, and hoped to find a way out of the country's development dilemma through reform, while rapidly improving its own economic strength. First of all, what economic reform needs to do is to reform the welfare system in state-owned enterprises, because these systems hinder social fair competition and work efficiency. The original unit welfare system was once considered as the greatest advantage of socialism in China, but it was an obstacle to economic reform. Its characteristic is that everyone is holding an "iron rice bowl" and eating "big pot rice" together, which was the direct cause of China's economic depression at that time. The author once pointed out that the economic reform in China is the reform of the welfare system (Chen, 2004). China's reform is more about separating the welfare supply system than combining it with the economy as expected by the western welfare reform. In this way, China hopes to ensure that enterprises focus on economic development, thus improving the market vitality of enterprises and providing a fairer competitive foundation. From the economic point of view, the government originally concentrated all resources and then distributed them through planning, which is the planned economy. Now it is regulated by collecting a unified tax. An independent social security system is based on the risk dispersion mechanism, but a mechanism itself cannot guarantee good results. For example, many people who used to work in state-owned units were laid off because of the reform of state-owned enterprises, that is, institutional factors (Hassard et al., 2006). At that time, the perfect welfare system had not been established, and their original welfare was destroyed with the laid-off and separation from the social security system.

Just like every economic and social change in history, there are winners and losers in China's economic reform. Under the policy of "Let some people get rich first" in Deng Xiaoping, the biggest winner is undoubtedly the entrepreneurs who dare to take risks and innovate. In the period of rapid economic transformation, some people take advantage of the imperfection of the system, exploit the loopholes of the system through special relations and even illegal means, and embezzle state-owned and collective assets during their transition to the market. For some ordinary people, including those who have just entered retirement age, their biggest loss is the gap between the reformed unit security system and the socially independent social security system, which puts them in an embarrassing position. Fortunately, the government of China is trying to bridge this gap.

The overall improvement of China's economy is the result of implementing new public policies and reforms (including the policy of opening to the outside world). However, countries with abundant resources and strong national strength must also focus on dealing with many social problems, such as population aging. Compared with the initial stage of economic reform, China's overall public policy has changed from the initial focus on protecting the economic development of enterprises to social protection (Whiteford, 2003). This is a signal that all people are guaranteed before returning to reform. But different from the past, China now hopes to establish a brand-new national security system on the basis of a more dynamic and developed economy. At the same time, the whole country is paying attention to whether the next step of "all-round prosperity" can be realized in time after Deng Xiaoping adopts the market economy policy of "let some people get rich first". In this case, it is more meaningful to study China's aging social policy.

The white paper "The Development of the Cause for the Aged in China" reflects the changes in the overall public policy of the country to meet the needs of 654.38+440 million people over the age of 60 (1 1% of the total population at the end of 2005), recognizes the unbalanced development of the country and clarifies the responsibility of the state to protect the legitimate rights and interests of the elderly population. At the same time, it is also given that in the white paper, the national goal has been repeatedly reiterated, that is, "the state attaches importance to and cherishes the knowledge, experience and skills of the elderly, respects their fine moral character, actively creates conditions, gives play to the expertise and role of the elderly, and encourages and supports the elderly to integrate into society and continue to participate in social development" (the State Council, China, 2006, sec. I). Over the past 20 years, the National People's Congress and its Standing Committee, the State Council and its relevant departments have promulgated more than 200 laws, regulations, rules and related policies on aging, and initially formed the law of the People's Republic of China on the protection of the rights and interests of the elderly based on the Constitution of People's Republic of China (PRC), including relevant laws, administrative regulations, local regulations, the State Council departmental regulations, local government regulations and related policies. 1996, 12 February 12 February, the State Council established the National Working Committee on Ageing to make overall plans, coordinate and guide the national ageing work, study and formulate development strategies and major policies for the ageing cause, coordinate and promote relevant departments to implement the development plan for the ageing cause, and guide, supervise and inspect the ageing work in various places. Established a statistical index system for the cause of aging and an aging statistical work system. Since the 1980s, three national surveys of the elderly population have been conducted, providing an important basis for scientific decision-making in the cause of the elderly. At the same time, encourage society to participate in the development of the cause of aging and carry out international exchanges and cooperation (the State Council, China, 2006, Sec. Ⅰ).

Analyzing the white paper as an important policy document can not only better understand the real goals of the China government, but also discover potential problems through relevant research.

Verb (short for verb) Income support, health care and social services.

In 2006, the white paper "The Development of China's Aging Cause" focused on the consistency of economic development since the founding of New China. However, building a new social security system to separate it from enterprises and become a "supporting reform" of economic reform is not an easy way to eliminate social gaps and unfairness. Comparing the objects of research and observation in the white paper, while discriminating some deep-seated events, we should also recognize the achievements and existing problems of these years' efforts. Among them, the most important thing is about the basic needs of the elderly, namely income security, medical care and social services.

(a) Social security for the elderly

China regards ensuring the basic living standard of the elderly population as the top priority. The "White Paper on the Elderly Population" emphasizes that we should vigorously build a security system for the elderly population covering all aspects of the government, society, families and individuals.

First, establish a sound urban old-age security system. When the staff of state organs and institutions retire, the state finance or units will continue to pay according to the standards set by the state. In contrast, the original unit welfare system of enterprises has undergone fundamental changes. In recent years, the government of China has gradually established a unified basic old-age insurance system for employees of urban enterprises, covering all kinds of employees of urban enterprises, individual industrial and commercial households and flexible employees. By the end of 2005, the number of people participating in basic old-age insurance in China had reached 654.38+75 million, including 43.67 million retirees who enjoyed old-age insurance benefits. The state establishes a normal adjustment mechanism of basic pension, and adjusts the basic pension level of enterprise retirees in a timely manner according to the wage growth of employees and price changes (the State Council, China, 2006). By the end of 2005, the accumulated balance of the national basic old-age insurance fund reached 404,654.38+0 billion yuan, and the basic old-age insurance fund was subsidized by all levels of finance in that year, with a total income of 436,543.8+0.2 billion yuan (the State Council, China, 2006). The state actively develops supplementary old-age insurance, guides and supports qualified enterprises to establish enterprise annuities for their employees, with contributions from both enterprises and employees, full accumulation of funds and personal account management. By the end of 2005, 24,000 enterprises in China had established enterprise annuities, with 9.24 million employees (the State Council, China, 2006). In order to alleviate and eliminate the poverty of the elderly. The state has established a minimum living security system for urban residents, giving subsidies to families whose per capita income is lower than the local minimum living security standard. In 2005, 22.33 million urban poor people, including poor elderly people, received the minimum living security and basically achieved all the coverage they should have (the State Council, China, 2006).

Secondly, explore the establishment of rural social endowment insurance system. About 60% of the elderly in China live in rural areas, but their living security is very limited. By the end of 2005, about 65,438+0,900 counties (cities, districts and banners) in 365,438+0 provinces (autonomous regions and municipalities directly under the Central Government) had carried out rural social endowment insurance, with more than 54 million farmers participating in the insurance, accumulated insurance funds of about 36,543.8 billion yuan and more than 3 million farmers receiving pensions. In 2005, the endowment insurance payment was 210.30 billion yuan (the State Council, China, 2006). At present, 8.65 million rural people have been included in regular quantitative assistance for poor rural households, and 9.85 million rural people have been included in the rural minimum living guarantee, including poor elderly people who do not meet the conditions of "five guarantees" (the State Council, China, 2006). For the "three noes" elderly people (urban elderly people who have no ability to work, no source of income, no legal or legal dependents, and whose dependents really have no ability to support and support), the state implements the "five guarantees" support system, providing life care and material assistance in food, clothing, housing, medical care and burial. At present, more than 4.6 million elderly people in China enjoy the "five guarantees". For rural only children or two-woman couples who implement the family planning policy, after reaching the age of 60, the central or local finance will arrange special funds to implement the family planning reward and assistance system. By the end of 2005, the number of people enjoying this award and assistance reached 654.38+350,000. II)。

The white paper focuses on the achievements made in rural areas, while scholars focus on the challenges faced by rural areas (James, 2002). Wang (2006) pointed out in 2006 that the coverage rate of old-age security in rural areas in China is far lower than that in cities, and questioned the feasibility of establishing a sustainable old-age security system in China. The shortage of funds and many personal accounts exposed the heavy burden of the urban old-age insurance system. However, due to the low income in rural areas, young rural laborers go out to work, and the desire of rural elderly to rely on their families to provide for the elderly has become an empty talk. The separation of urban and rural pension system has also brought heavy pressure to the life of urban landless farmers in the process of urbanization. Therefore, it is necessary to speed up the reform of the old-age insurance system and provide long-term and effective institutional guarantee for economic development and social progress. II)。 Through case study, even in the urban endowment insurance, there are many differences (Chen &; Chen, 2007). Those employees who retired from ordinary enterprises in the early days (worked hard all their lives and had little savings) received much less pension than those who retired from government institutions (only about 1/3 pension). Obviously, such a big gap is not good for the whole economic development, and may cause a greater crisis or even social unrest.

(2) medical care

The basic medical insurance system in China is based on the combination of social pooling and individual accounts. By the end of 2005, the number of retirees participating in basic medical insurance in China reached 37,665,438+10,000. "It is stipulated that retirees do not pay the basic medical insurance premium, and give appropriate care to the amount included in personal accounts and the proportion of personal burden of medical expenses. Large medical expenses such as common diseases and chronic diseases of the elderly are generally included in the scope of social pooling funds to reduce the proportion of personal burdens of retirees "(the State Council, China, 2006, sec. III)。 In addition, the government has also promoted the establishment of large subsidies for medical expenses in various places, with individuals or enterprises paying to raise funds to solve the medical expenses of employees and retirees suffering from serious illness, serious illness and long-term chronic diseases that exceed the maximum payment limit of the overall fund. At the same time, the China Municipal Government actively explores the establishment of urban social medical assistance system, raising medical assistance funds through various channels such as financial allocation, lottery public welfare fund and social donation, and giving subsidies to people who need medical treatment. "By the end of 2005, there were119 pilot counties (cities, districts and banners) for medical assistance, with a total of1633,000 person-times" (the State Council, China, 2006, Chapter II). III)。

Since 2003, the country has started the pilot work of the new rural cooperative medical system, which combines individual contributions, collective support and government funding. "By the end of June 2006, the pilot counties (cities, districts and banners) of the new rural cooperative medical system in China had been expanded to 1399, covering 495 million agricultural people and 396 million farmers, and the participation rate of the elderly in the pilot areas exceeded 73%" (the State Council, China, 2006, second edition). III)。 * * * compensated 282 million farmers who participated in the new rural cooperative medical system nationwide, and the compensation fund expenditure was144120,000 yuan. In addition, the state has established a nationwide rural medical insurance system. "In 2005, rural medical assistance reached1120,000 person-times, and the total expenditure of assistance funds was/kloc-0.08 billion yuan" (the State Council, China, 2006, Chapter II). III)。

All localities actively guide grassroots medical and health institutions to transform into community health service institutions, and carry out services such as health care, medical care and rehabilitation for the elderly. "By the end of 2005, 65,438 community health service centers (stations) had been established in cities across the country, exceeding 500,000, and 95% of cities above the prefecture level, 86% of municipal districts and some county-level cities had developed urban community health services" (the State Council, China, 2006, Part II). III)。 It is believed that primary medical institutions can provide home visits, home care, day observation, hospice care and other services according to the special needs of the elderly. Some basic health problems of the elderly have been solved in the community.

Medical service is one of the important issues that China scholars pay attention to aging. As Kaneda(2006) pointed out, China's medical service system was once a model of low-income agricultural society, but the price of medical service has been rising since 1980s. In other words, "a system that used to rely on public subsidies and provide basic medical services equally has been transformed into a market system for individuals to make capital investment" (Kaneda, 2006). In the empirical study, Meng and Yeo(2005) studied the influence of age effect (positive correlation and negative correlation) on medical service expenditure of extra-budgetary funds through household survey data. The results show that the age effect has obvious indirect influence on medical security conditions and medical and health expenses. Through a complete study of the age effect, it is concluded that the extra-budgetary medical expenses will increase with the age. For the general elderly, general expenses will account for a large part of their income, especially women. Even in the 60-year-old group, the out-of-pocket part of medical care will account for 20% of their normal income. Judging from this result, the reformed medical service system has brought great economic pressure to the elderly, especially women. The increase in the self-funded part has increased the obstacles for ordinary people to seek early prevention and treatment, which has made it difficult to see a doctor, especially between towns and rural areas. "This trend is very important for the elderly, who need high-quality health care services, but can't afford high fees, and their proportion in the rural population has surpassed that of young people" (Kaneda, 2006). If a person is seriously ill, the current level of medical security system cannot meet their medical needs. At the same time, the country has been trying to improve the healthy lifestyle of the elderly in various ways, such as through sports activities and fitness. However, due to various reasons, such as smoking, alcoholism and other bad habits that induce diseases still account for a large proportion in the lives of the elderly (Kaneda, AFP, 2006).

(3) Personal social services

Compared with the social security reform after 1980s, the former unit welfare or rural production team is an important social support for China people besides family security, and it is also an informal social security support network system. In the economic reform, the responsibility of social security has shifted from the unit to the society (Chen, 1996). Local governments at all levels in China (districts, sub-district offices and neighborhood committees) have made some outstanding achievements in this regard (Derleth &; Koldyk, 2004). In the mid-1980s, through the innovative leadership of local governments in civil affairs, China introduced the community service movement, and the elderly in the community were the main service targets (Chen, 1996). This initiative has experienced ups and downs in the past 20 years, and now its new name is "Community Building". Spread from metropolis to small and medium-sized cities, with the goal of eventually covering all urban areas. Since 200 1, China municipal government has implemented the "Starlight Plan" for three consecutive years, building community welfare service facilities for the elderly, with a total investment of 654.38+0.34 billion yuan (the State Council, China, 2006). At the same time, the rapid development of social organizations not only helped the society, but also regarded the cause of serving the elderly as a golden sunshine industry, which flourished throughout the country.

The white paper also includes a chapter entitled "Serving the Old Society". It is pointed out that in recent years, China Municipal Government has actively promoted institutional pension services, strived to meet the diversified needs of the elderly for serving the aging society, and initially formed a social service system for the elderly based on home-based pension, supported by community services and supplemented by institutional pension. By the end of 2005, there were195,000 urban community service facilities and 8,479 comprehensive community service centers in China. All localities provide free and low-cost services such as life care, domestic service and emergency rescue for the elderly by means of on-site service, fixed-point service and roving service. Since 20001,China municipal government has implemented the "starlight plan" for the construction of community welfare service facilities for the elderly for three consecutive years, with a total investment of 654.38+0.34 billion yuan, and 32,000 "starlight homes" have been built, covering various functions such as home-based aged care, emergency assistance, day care, health care and rehabilitation, and recreation, benefiting more than 30 million elderly people. In 2005, there were 1.32 urban welfare institutions for the elderly in every street and 1 urban welfare institutions in every 9.8 community neighborhood committees (the State Council, China, 2006, Chapter II). Ⅳ). At the same time, voluntary service also covers many communities, including daily care, medical care, legal care in social nursing homes, and one-on-one exclusive family care services. "Up to now, there are130,000 volunteers in China * * * who have provided more than 630 million hours of volunteer service for more than 2.8 million elderly people and established more than 60,000 volunteer service stations" (the State Council, China, 2006, sec. 4). Since 1989 (when I hosted the first national training course for social work teachers in Sun Yat-sen University), with the rapid development of social welfare education, the state has also strongly advocated the training of professional nursing staff for the elderly.

Both community nursing and institutional nursing have been a long-standing problem in western countries, but community nursing has never eliminated the demand for institutional nursing (Chen, 1996). In recent years, the state has increased capital investment and established social welfare homes for the elderly in cities and towns. Provide centralized support places and living services for the rural "five guarantees" elderly. Generally speaking, "vigorously develop apartments, nursing homes and nursing homes for the elderly, and provide institutional services for the elderly with different economic conditions and living abilities, especially the elderly, the weak, the sick and the disabled ... Encourage and mobilize social forces, and take various forms such as public construction and private operation, government subsidies, and purchase of services to promote the rapid development of pension institutions" (the State Council, China, 2006, sec. 4). By the end of 2005, there were 39,546 social welfare homes, nursing homes for the elderly, apartments for the elderly and nursing homes for the elderly in urban and rural areas, with a bed1497 million, including 2,9681home for the elderly in rural areas with a bed of 895,000 (the State Council, China, 2006, sec. 4).

These statistics are very important for the living arrangements and long-term care of the elderly who have the most urgent needs. In the summer of 2009, the author returned to China and visited some private and public pension institutions. Their development is remarkable, but they also face the same problems as western countries, such as supply and demand, charging standards, nursing quality and so on. Through the case study, we can know that there are obvious differences between home-based care and institutional care. For example, a family left an 88-year-old mother at home to take care of her, but because the elderly often need medical treatment, the family still has to send the elderly to medical institutions frequently, which has brought great economic burden to the whole family. After understanding the conditions and services of old-age care institutions, it is found that most of them only provide accommodation for the elderly, and the professional services and medical services needed for old-age care can be said to be basically absent. When the elderly need 24-hour all-round care, they still need family care, even though they have paid a considerable nursing home fee.