Such an embarrassing situation has led some experts to have different opinions on how to incorporate medical services into elder care. Zhu Hengpeng, deputy director of the Institute of Economics, Chinese Academy of Social Sciences, for example, suggested promoting private community-level clinics rather than encouraging nursing homes to set up their own clinics.
“Medical care is the crux of elder care, which should be attributed to our lack of community-level outpatient services – it is unreasonable that in Chinese cities, over 60 percent of outpatient services are in big hospitals,” he said. “When the government loosens control on the founding of small- and medium-sized private clinics, and when such clinics are rolled out in residential communities to provide door-to-door medical services, it won’t be an issue whether seniors are taken care of by families, communities or nursing homes,” he added.
However, supervision and expense are two big concerns of those against the idea – complaints have already arisen among the public that most nursing homes are unaffordable for ordinary families, and the few that target ordinary families always run out of beds.
Moreover, to lighten the economic burden of medical care for seniors, the government included nursing homes in the medical insurance system, only to find that many nursing homes have allegedly been involved in insurance fraud. An anonymous operator of an elder care home told NewsChina that many nursing homes are involved in coaxing the residents to undergo unnecessary treatment and even to buy non-medical services, like foot baths with traditional Chinese medicine. This is all charged to their medical insurance.
Wu Danxing attributed the alleged fraud to misunderstanding of the incorporation concept. “Regular hospitals aim to cure disease and discharge patients, but medical care in nursing homes targets seniors who have lost some abilities due to chronic disease… The incorporation idea was initiated in China, which the international community interprets as nursing and caring for seniors by both non-professionals and professionals to ensure they have the best quality of life with maximum independence and self-esteem,” she said.
“The misunderstandings about medical care in the elder care system means too many clinics will be built, and the insurance system will be overburdened with treatments that should not be included,” she added.
The government is aware of the situation, and has adopted some expert suggestions to try out a system of “long-term nursing social insurance.” Mi Hong, a public management professor from Zhejiang University who has tracked the implementation of this long-term insurance in Qingdao, Shandong Province, told NewsChina that Qingdao started offering the insurance in 2012, and it has been very successful in relieving families of the burden of caring for physically or mentally disabled people and optimizing medical resources.
In July 2016, the NHFPC issued a guidance document on launching a pilot long-term nursing insurance program, announcing it would test it in 15 cities in the following two years, and then roll it out nationwide by 2020.
Wu Danxing, however, expressed caution, and has repeatedly appealed for the government to undertake a deeper study of the payment and assessment systems of the insurance before officially launching it.
“The incorporation policy is the right direction for our elder care system, and it well meets seniors’ demands and expectations, but the support measures and detailed implementation rules lag far behind the general policy. We need to issue clear and unified criteria, assessment and supervision systems for the new policy,” she said. “The market would not have been chaotic if we had the [said] regulations.”