China’s Rapidly Aging Population Creates Policy Challenges In Shaping A Viable Long-Term Care System

Feng, Zhanlian; Liu, Chang; Guan, Xin; Mor, Vincent

doi:10.1377/hlthaff.2012.0535

Cited by 324 publications

(340 citation statements)

References 23 publications

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“…In 2011, only 8.5% of the disabled elderly received informal care from family members (Peking University 2012). Chinese families-the traditional bedrock of old-age support-are increasingly strained as the number of older people grows while the number of potential caregivers shrinks (Feng et al 2012).…”

Section: Ltc Service Provisionmentioning

confidence: 99%

“…Multiple strategies are in play, ranging from state-built/state-owned facilities to privately operated facilities with government support and subsidies for construction and operations (Feng et al 2012; National Committee on Ageing 2012). In 2012, China had 45 000 institutional care facilities and 4.3 million care home beds.…”

Section: Ltc Service Provisionmentioning

confidence: 99%

“…In 2012, China had 45 000 institutional care facilities and 4.3 million care home beds. The number of beds per 1000 elderly reached 22.24 in 2011 (Feng et al 2012).…”

Section: Ltc Service Provisionmentioning

confidence: 99%

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Financing institutional long-term care for the elderly in China: a policy evaluation of new models

Yang

Fang

et al. 2016

Health Policy Plan.

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A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao a n dam e a n s -t e s t e dm o d e li nN a n j i n g .Af o c u s e ds ystematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers.

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Section: Ltc Service Provisionmentioning

confidence: 99%

Section: Ltc Service Provisionmentioning

confidence: 99%

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Financing institutional long-term care for the elderly in China: a policy evaluation of new models

Yang

Fang

et al. 2016

Health Policy Plan.

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“…Chronic kidney disease (CKD) is one of the most significant of these noncommunicable diseases because its burden has become increasingly severe [2]. At present, there are over 100 million people with CKD in China [3], a prevalence that most likely will continue to increase due to the increasing incidence of hypertension [4], obesity [5], and type 2 diabetes mellitus [6,7] and due to the increasing average age of the population [8]. Therefore, updated epidemiological studies evaluating the spectrum of kidney diseases that lead to CKD are needed for the purposes of improving patient care, disease prevention, and public health interventions.…”

Section: Introductionmentioning

confidence: 99%

Changes in the Spectrum of Kidney Diseases: An Analysis of 40,759 Biopsy-Proven Cases from 2003 to 2014 in China

et al. 2017

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Objectives: To evaluate the changing spectrum of kidney diseases over time in China using renal biopsy-proven cases. Methods: All patients over the age of 14 years who were diagnosed with a kidney disease by renal biopsy in the Renal Biopsy Registry of the National Clinical Research Center of Kidney Diseases in Jinling Hospital, Nanjing, from 2003 to 2014 were included. Results: In total, 40,759 cases of renal biopsy were analyzed. The mean age of the patients was 36.59 ± 14.12 years. 52.0% of the patients were male. Primary glomerulonephritis (PGN), secondary glomerulonephritis, tubulointerstitial disease, and hereditary renal diseases accounted for 67.1, 26.4, 2.9, and 2.5%, respectively. IgA nephropathy (IgAN), membranous nephropathy (MN), minimal change disease, and focal segmental glomerulosclerosis were the leading PGN diagnoses. The frequency of MN increased significantly (p < 0.001) by doubling from 2003 to 2014. An analysis by age category indicated that the frequency of MN increased significantly over time (p < 0.001) in all age categories and increased by more than 2 times in the 14-24 age category. Lupus nephritis (LN) and Henoch-Schönlein purpura nephritis (HSPN) decreased significantly (p < 0.001), diabetic nephropathy (DN) increased nearly twice (p < 0.001), monoclonal immunoglobulin deposition disease (MIDD) tripled (p < 0.001), and hypertensive nephropathy (HT) (p < 0.001) and renal amyloidosis (AMY) (p < 0.05) showed an upward trend. An analysis by age category showed that hepatitis B-related nephritis has significantly decreased in the 14-24 age category (p < 0.001). Conclusion: PGN continued to be the predominant kidney disease in China with IgAN being the most common PGN. The frequency of MN increased significantly, with a maximum increase in young adults. LN and HSPN decreased significantly, DN and MIDD increased significantly, and HT and AMY also showed an increasing trend. The kidney disease trends presented in this study serve as a reference point for patient care, disease prevention, and public health interventions.

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“…In the past decades, economic development, accelerated industrialization, urbanization, and behavioral factors as well as the aging population of China [1] have resulted in a vast change in the disease spectrum. The incidence and associated mortality of chronic, noncommunicable diseases is increasing [2], with examples being chronic kidney disease and tumors [3].…”

Section: Introductionmentioning

confidence: 99%

The Clinical Presentation and Management of Systemic Light-Chain Amyloidosis in China

Huang

Liu

2016

Kidney Dis

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Background: Amyloidosis includes a group of diseases characterized by the extracellular deposition of various fibrillary proteins that can autoaggregate in a highly abnormal fibrillary conformation. The amyloid precursor protein of systemic light-chain (AL) amyloidosis is comprised of monoclonal light chains that are due to plasma cell dyscrasia. The clinical presentation of patients with AL amyloidosis varies from patient to patient. Current treatment strategies target the clone in order to decrease the production of the pathologic light chains. Recent advances in therapy have helped many patients with AL amyloidosis achieve hematologic and organ responses. Summary: AL amyloidosis is the most common type of systemic amyloidosis in China with increasing morbidity and a high mortality rate. The clinical presentation of AL amyloidosis is variable, and the median overall survival was found to be 36.3 months. The disease prognosis and risk stratification are linked to serialized measurement of cardiac biomarkers and free light chains. The treatment of AL amyloidosis is mainly based on chemotherapy and autologous hematopoietic stem cell transplantation (ASCT). The use of novel agents (thalidomide, lenalidomide, and bortezomib) alone and in combination with steroids and alkylating agents has shown efficacy and continues to be explored. Key Messages: AL amyloidosis is the most common type of systemic amyloidosis in China with increasing morbidity and a high mortality rate. The lack of prospective clinical trials using the current therapies is a challenge for evidence-based decision making concerning the treatment of AL amyloidosis. Facts from East and West: (1) AL amyloidosis is the most prevalent type of amyloidosis accounting for 65% of the amyloidosis-diagnosed patients in the UK and for 93% of the amyloidosis-diagnosed patients in China. The predisposition of men over women to develop AL amyloidosis might be higher in China than in Western countries (2:1 vs. 1.3:1). Both in the East and West, incidence increases with age. At the time of diagnosis, edema is twice as frequent and the proportion of renal involvement is higher in Chinese compared to Western patients. (2) Melphalan followed by ASCT is the current standard therapy but is restricted to eligible patients. The efficacy and safety of bortezomib combined with dexamethasone were proven in Western patients and recently confirmed in a Chinese cohort. Recent studies in China and the US indicate that bortezomib induction prior to ASCT increases the response rate. Thalidomide and lenalidomide have shown benefit, but toxicity and lack of clinical evidence exclude these agents from first-line therapy. The green tea extract epigallocatechin-3-gallate is under investigation as an inhibitor of AL amyloid formation and a compound that might dissolve amyloid.

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China’s Rapidly Aging Population Creates Policy Challenges In Shaping A Viable Long-Term Care System

Cited by 324 publications

References 23 publications

Financing institutional long-term care for the elderly in China: a policy evaluation of new models

Financing institutional long-term care for the elderly in China: a policy evaluation of new models

Changes in the Spectrum of Kidney Diseases: An Analysis of 40,759 Biopsy-Proven Cases from 2003 to 2014 in China

The Clinical Presentation and Management of Systemic Light-Chain Amyloidosis in China

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