When the Government works out the socio-economic policies relating to the aging of the population, the following characteristics of the elderly population should be taken into consideration: the increase in the size and proportion of the elderly, the rapid population transition and the prolongation of the life-span of people.
Moreover, changes in structure within the elderly population, such as, the increase in the very old elderly, change in sex ratio, regional distribution and various socio-economic characteristics of the elderly, should also be considered. Hence, the following points are important for policy formulation.
1. Health
The aging of the population has an inevitable impact on the whole society, and the impact is particularly evident on medical and health care services. Firstly, the increase in the size of the elderly will change the structure of diseases. A tremendously large amount of data show that cardiovascular diseases, cerebro-vascular diseases and cancers affect mostly the old people. Survey data from China's several cities showed that, in 1957, cerebrovascular diseases, heart diseases and malignant tumours ranked the sixth, fifth and seventh place among causes of death, but they jumped to the first, second and third places in 1975, 1980 and 1982. Next, the expenses for medical care of the elderly will grow with the increase in the size of the elderly because the old people pay more hospital visits, constitute a larger number of in-patients, and have a longer duration of hospitalization and higher hospitalization expenses as compared with people of other -ages of the population. Furthermore, the treatment cost of those diseases frequently seen in old people, such as cardio-, cerebro-vascular diseases and tumours, is higher than that of other diseases.
Thanks to the great concern for the elderly shown by government at all levels, the health care services for the elderly in the country have developed rapidly, particularly in the urban area. The following measures have been adopted:
(1) The old people enjoy "three priorities" (registration, examination and supply of medicines). This has been practised in most of municipal hospitals in Shanghai and in more than 100 hospitals in Beijing.
(2) The development of family beds was started in Tianjin Municipality, and the Ministry of Public Health held a meeting in 1984 in Tianjin to popularise the experience. As a result, 10,000 family beds have been developed for the elderly by the municipal hospitals in Shanghai.
(3) Geriatric hospitals have been set up and geriatric outpatient departments have provided advisory services and help for old people in the field of health care.
(4) Rehabilitation has been provided for the old people. In the suburbs of Beijing, 17 rehabilitation hospitals, equipped with nearly 800 beds, have been established.
(5) After the establishment of the China Geriatrics Society, provincial geriatric societies have also been set up to conduct research on geriatrics.
China has its own medical system in rural area. The medical and health care workers (called the barefoot doctors in the past) work in villages, and there are commune hospitals in townships, people's hospitals, hospitals of traditional Chinese medicine and other medical research institutions at county level. Despite all these institutions, there is still much to do to improve health services in rural area.
Thus, more efforts must be made to organise professionals in various specialities to improve treatment and prevention of diseases of the elderly in order to achieve better social and economic benefits. Moreover, as the aging of the population is proceeding and the number of the elderly population is increasing, it is necessary to increase the allocation of funds from the State's budget to medical and health care expenditures, particularly to increase the amount of investment in the improvement of rural medical and health care services.
Also, the medical insurance system of the elderly should be practised more widely.
Due to the gaps existing between different regions in the stages of economic development and the standards of health and medicare service, a health and medicare system for the aged should be instituted at the local administration levels according to the local needs. Rehabilitation centres and geriatric hospitals should be continuously established and improved. Services, such as, home-visit medical consultations and home helper programmes, should be applied widely.
Finally, the basic premise of medicare service for the elderly should be "prevention first". Educational activities on health should be promoted and disease prevention measures should be taken. Also, people should be encouraged to take responsibility for their own health.
2. Economic
The major economic problems brought about by the aging of the population are: social security, pension system, pension of agricultural workers, modification of legal age of retirement, preparations for retirement and retraining and re-employment of the old people. Policies should be worked out aiming at the solution of these problems.
China's social security system is a huge network consisting of the security system of governmental organizations, institutions and enterprises in urban area, security system of urban collective-run enterprises, security system in a small part of township-run enterprises, urban security system for childless single old people, rural old folks' homes and the five guarantees system. Moreover, the family supporting system in urban and rural areas serves as an important part of the elderly's life, although it is not included in the social security system.
China's current pension system has enjoyed only by staff members of state-own enterprises and insti-tutions. The staff members of large collective-own enterprises may enjoy a similar pension system while those of medium-sized and small collective-own enterprises in urban area as well as self-employed labourers and the majority of people in rural area do not enjoy a formal pension system. The staff members of medium-sized and small collective-own enterprises may enjoy a certain amount of pension depending upon actual conditions of the very enterprise.
So, China's pension system has to be improved. On the one hand, a very limited amount of old people enjoy a pension while the majority of the elderly who live in rural area do not. On the other hand, as the pension of the staff members of state-own enterprises is provided entirely by the State, it increases the burden on the government's budget greatly. Therefore, the pension system must undergo reform.
For state-own enterprises and institutions, it is suggested to build up a mixed type of pension fund, i.e.
"the basic portion plus the additional portion". The basic portion will still be provided by the State while the additional portion comes from insurance, including enterprise and individual insurances, and the amount of insurance may account for 3% or so of the wage.
For urban collective-own enterprises and institutions, similar measures can be adopted step by step.
For private enterprises and self-employed labourers in urban area, the State may stipulate regulations to force them to practise insurance.
In order to best accommodate the programme to the Chinese situation, separate pension schemes for public, enterprise, and self-employed workers in cities and rural areas should be set up. Pension plans currently administered on a company basis vary both in the amount of benefits and the burden on the employers.
Although it is quite difficult to integrate them in a unified operation, China is advised to lay a foundation for a future unified pension insurance system in order to avoid divergence and complications.
The overwhelming majority of the aged population in China live in rural areas. Due to the rapid reform of the economic system, the pension programme for the farm workers will become an increasingly pressing problem. Due to disparity in economy and the level of development among rural villages, the pension insurance scheme for rural areas should be started where it easily can take root and be expanded later to other areas.
For the time being, a cooperative old age insurance scheme to be administered on a county or township basis in areas with relatively highly developed economies is proposed. It should be operated as a pilot plan with most funds coming from groups and individuals, assisted by the government as necessary. Groups should make larger contributions than individuals at the beginning, raising the proportion of individual contributions gradually according to the income level.
As the pension system of rural elderly is the weakest link of China's security system, it is necessary to make greater efforts to develop the farmers* retirement system. This can be done by bringing the farmers'
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initiative into full play; in other words, to encourage the practice of insurance and saving insurance. It is expected that, in rural area, the currently prevalent way of supporting the elderly (also the traditional way) by families will remain unchanged for a rather long period of time. Thus, this way of supporting the elderly will be accompanied by the five guarantees, social relief, cooperative support and other measures. It is also important to provide legal protection for farmers' property rights and their relations' property inheritance. Fur-thermore, in practising land contract system, the rights and interests of the elderly must be taken into consideration because the problem of supporting the elderly in rural area cannot be solved only by ethical principles and administrative measures.
The re-employment of the elderly is a problem of importance only next to the problem of supporting them. As a result of socio-economic development and improvement in medical and health conditions, the life expectancy of human beings is increasing rapidly. In the meantime, more and more old people are still strong and vigorous. Also, the improved socio-economic development, changes in industrial structure and improve-ment in social services have provided favourable conditions for the re-employimprove-ment of the old people. On the other hand, the participation of the elderly in social development is important for both the society and the old people themselves. At present, the problem of participation of the elderly in socio-economic activities occurs only in some of the cities, but it will be a problem involving the whole society in the future when the retirement system will be practised step by step in a wider range. By that time, the Government will be faced with an increase in the number of pensioners as well as with a huge financial stress. It is, therefore, more practicable to provide the elderly with opportunities of taking part in socio-economic development. By this way, they will be able to share the achievements in social progress and make more contributions to the society.
In order to solve the problem, it is necessary to work out policies macroscopically and microscopically.
Macroscopically, the policy will provide opportunity of re-employment for the elderly, including modifica-tion of the legal age of retirement, preparamodifica-tions for retirement, investigamodifica-tions into the elderly labour resource, filing details of the elderly labour force, establishing information network about demands for elderly labour force (mainly professionals and technicians needed by newly-established urban collective-run enterprises and township-run enterprises) and organizing services to mediate between demands for and supply of elderly labour force. Microscopically, social service trades must be developed in order to reduce the amount of housework of those old people who are willing to be re-employed after their retirement. Moreover, it is necessary to stipulate rules to protect the elderly labour force and to provide them with opportunities of learning and training. By this way, the old people will be able to renew their knowledge in line with the rapid progress of science and technology.
3 . Family
The Chinese people, especially the elderly people, have a very strong concept of close family ties.
Supporting and respecting the elderly have been the Chinese tradition. In the feudal society, the old people were most lofty in the family. After the founding of the People's Republic, the Constitution and the Marriage Law have stipulated that supporting the elderly is the children's duty and the maltreatment of the old people is illegal.
At present, in China's urban area, 40% of the elderly people are in an economically dominant position in the family as against 20% in rural families. About 20% of the urban old people have to be supported economically by others in the family while the figure for rural old people is as high as 50% and over. Generally speaking, the elderly's position in the family depends upon their economic condition, health status and personality.
Thus, in order to improve the elderly's situation in the family, it is important to improve the elderly's economic status, their independence and educational attainments in addition to carrying on the Chinese tradition of respecting the elderly and loving the children.
As regards the family life of the elderly, there is a lack of recreation and sports, and the case is particularly serious in rural area. Therefore, the community should provide more chances of social contacts, such as, old folks' home, old people's post boxes, the elderly's college, the elderly's club and so forth, to make the old people enjoy a more colourful life and to learn more new knowledge.
To help reduce the burden on families taking care of the aged, the home helper system and provision of daily necessities for the aged are available in many other countries. It is proposed that China start an
experimental project and gradually spread such services in accordance with the economic standards and other criteria.
The Chinese government and society should encourage the inception of service industries for the aged, and help develop social service industries catering to families caring for the aged at home. The "Five-Guarantee System", which provides clothing, meals, housing, medical care and funerals for people without children in rural areas in China, is effective and should be continued.
4 . Housing
In China, 80% and over of the old people are living with their children or relatives, which has been taken as rational. So, the demand for living in a separate room is not prevalent in the country. Nevertheless, the housing condition in China's rural area is poor and about one-tenth of the elderly people in urban area are not ensured in terms of housing. The Government must give priority to the increase in the housing area for the urban elderly and to the improvement of housing conditions of the rural old people.
Housing for the aged should be improved. Even if the parents are living apart from their child's family, they should be encouraged to live close enough so that "the soup does not get cool" in order to maintain family life, yet enjoy separate household. In planning housing estates, care should be given to build two-generation houses in which habitats can maintain separate lifestyles yet live close together. In urban sectors, apartment houses for the aged should be built to help reduce the burden on children with lower financial capacities.
The State has set up old folks' homes for those childless single old persons and those who prefer to live isolatedly. However, very few of these homes are luxuriously equipped, serving only those retired cadres of high rank. On the contrary, some of the old folks' homes at village level can hardly ensure a basic living standard for the elderly. So, the policy must be worked out to improve thousands of the rural old folks' homes.
The future design and construction of buildings and roads should take the principle of free accessibility into consideration as many other countries have done. The construction of houses for the elderly should be convenient, of larger size and multiple styles.
5. Other issues
A policy regarding population migration favourable to family-care for the aged should be formulated.
It is advisable to adopt policies facilitating the moving-in and moving-out of the aged needing support, and for their supporters to arrange convenient care.
Along with the reform of the economic system of China, there is an exodus of rural population to cities and towns, and the mobile population in different regions is increasing daily. The separation of the aged and their supporters will become universal. This is contrary to the situation in the past, where the rural population was limited to one place due to the natural conditions of rural economies. The social support and the facilities for social services for the aged are all inadequate in view of current realistic needs, and the old people are mainly relying on their children for economic needs and care-giving. Therefore, there is a definite need for policy to facilitate the co-habitation of the elderly and their supporters.
Recreational facilities specially designed for the elderly have to be increased and improved. Moreover, social and family services should be organized to provide daily care for the very old and physically weak old people.
As regards transportation, it is suggested that free or half-fare train or ship tickets and other favourable treatments could be granted to old people.
The Government will do its best to narrow the gap between urban and rural elderly population. Not a few of the old people living in medium-sized and small cities or towns prefer to return to the countryside; the government at all levels should provide a better living environment for them. Also those urban problems which are harmful to the elderly, such as, overloaded traffic, very high buildings, atmospheric pollution and so forth, should be solved.
It is hoped that solutions to all these issues will be perfected gradually and constantly.
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