Optimizing supply and advancing simultaneously to improve the rural elderly care service system

Source: China Labor Security News (Theoretical Edition), March 19, 2024, 3rd edition

Xue Huiyuan, Li Anqi

The issue of rural elderly care security is an important challenge faced by China in implementing the rural revitalization strategy. The 2024 Government Work Report proposes to increase the monthly minimum standard for basic pension for urban and rural residents by 20 yuan, strengthen the construction of urban and rural community elderly care service networks, and increase efforts to fill gaps in rural elderly care services. Solutions are provided from two aspects: pension insurance and elderly care services.

At present, China's rural pension insurance system has made progress from scratch, from broad coverage to full coverage; We have initially established a rural elderly care service system based on family elderly care, supplemented by community elderly care, and with special difficulties as the focus of protection, continuously expanding to all rural elderly people. In the future, in rural areas, both pension insurance and elderly care services should be promoted simultaneously, effectively improving the sense of achievement, happiness, and security of rural elderly people's lives. However, in comparison, the contradiction between supply and demand of elderly care services in rural areas of China is more prominent. The supply of elderly care services is extensive, and the elderly lack purchasing power. The rural elderly care service system needs further development and optimization.

Rural elderly care services face development challenges

There are prominent shortcomings in China's rural elderly care service system, and the structural problem of uneven supply and demand still exists for a long time. Under the existing rural elderly care service system, how to expand service scope, improve service efficiency, and optimize service quality needs to be given key attention and effectively addressed.

From the supply side, rural elderly care services lack accessibility and sustainability. On the one hand, many rural areas in China suffer from severe hollowing out of villages, hollowing out of collective economies, insufficient grassroots support, inadequate resource integration, and a lack of economic foundation, hardware facilities, and human resources for elderly care service construction, resulting in a serious shortage of elderly care services in some areas. On the other hand, the supply of rural elderly care services is extensive and lacks development momentum. The elderly population in rural areas is large and scattered, resulting in high supply costs and difficult operations, making it difficult to provide precise services for different groups such as elderly people living alone, disabled elderly people, and elderly people; However, centralized elderly care services have high initial investment costs and long investment return cycles, with little social capital intervention. In addition, public elderly care institutions in rural areas generally have simple hardware equipment, poor hygiene conditions, few caregivers, and lack of professional training, while private elderly care institutions have high prices, low occupancy rates, and difficulties in long-term operation.

From the demand side, rural elderly care services lack purchasing power. The purchasing power of rural elderly is not strong, and the demand for elderly care services has not been fully released and met. Compared to retired urban elderly, rural elderly not only have a single source of income, but also have a lower level of pension. According to the "2022 Statistical Bulletin on the Development of Human Resources and Social Security", the per capita pension level of basic pension insurance for urban and rural residents in China in 2022 is 205 yuan/month. According to the seventh national census data, in 2020, 42% of rural elderly people relied on other family members for support, 33.6% relied on their own labor to make a living, and 6.4% relied on subsistence allowances for their livelihood. Due to the high cost of professional elderly care institutions, and the higher fees for elderly people with disabilities and dementia who require round the clock care, most rural elderly people cannot afford private elderly care institutions, while public elderly care institutions often have difficulty finding a bed. In addition, the elderly in rural areas have weak awareness of elderly care, lack commercial pension insurance, have insufficient understanding of disease prevention, chronic disease treatment, and professional nursing, and have low family investment, resulting in suppressed demand for elderly care services in rural areas.

Further optimize the rural elderly care security system

Firstly, taking the county as the basic planning and action unit, we will coordinate and promote the establishment of a multi-level rural elderly care service system based on home care, supported by communities, and supplemented by institutions. To give full play to the leading role of the government, the supporting role of rural collectives, and the auxiliary role of social organizations, orderly promote community construction, village mergers, land transfer and other related work in rural areas, promote the transformation of rural elderly care services to community-based, autonomous and integrated, build elderly care service centers, achieve economies of scale, and reduce average costs. In terms of specific implementation, it is recommended to build rural regional comprehensive elderly care service centers at the township level, provide differentiated and rationalized funding based on the scale, fully leverage the role of existing grassroots organizational structures, organize relevant department personnel to undertake rural elderly care service work, and expand the scope of rural elderly care services.

Secondly, strengthen the precise supply of rural elderly care services and improve the efficiency of elderly care services. Firstly, it is necessary to conduct a detailed analysis of the elderly care service needs of different groups and provide diversified and differentiated services for the elderly. Secondly, in response to the problem of extensive supply and low utilization of rural elderly care services, we can leverage the advantages of rural land resources, encourage village collective construction land to be prioritized for building elderly care service infrastructure and activity spaces, and organize enjoyable elderly activities; Maximizing the utilization of medical resources, promoting new medical models such as family doctors, on-site consultations, and the integration of medical care and elderly care, providing medical rehabilitation, health counseling, and psychological counseling services for the elderly; Revitalize idle human resources in rural areas, promote mutual aid elderly care services, and adopt forms such as time banks, love supermarkets, point exchanges, rewards and commendations to enable young elderly people, left behind women, and volunteers to provide services for the elderly, those living alone, and those with disabilities. Finally, in response to the problems of outdated infrastructure, insufficient beds and operating funds, and low management service performance in rural elderly care institutions, measures such as tax deduction policies, promotion of naming rights, direct purchases, and government enterprise joint ventures can be taken to leverage state-owned capital, private capital, and charitable funds to jointly invest in the rural elderly care service industry.

Thirdly, continue to raise the minimum standard for basic pension for urban and rural residents, enhance the economic security of rural elderly, and promote the long-term development of rural elderly care service institutions. In response to the situation where some elderly people in rural areas are unable to pay for elderly care services, the responsibility of the government and village collectives should be implemented, and efforts should be made jointly from the aspects of pension insurance and elderly care services. Due to the fact that the handling of pension insurance is the responsibility of the human resources and social security department, while the work of pension services is led by the Ministry of Civil Affairs, the two departments should strengthen cooperation to ensure optimal allocation of pension and pension services. On the one hand, the per capita pension level for urban and rural residents is relatively low. After a 20 yuan increase in 2024, the minimum standard for basic pension for urban and rural residents will be 123 yuan/person/month. In the future, we should increase fiscal subsidies, improve the basic pension insurance benefits for urban and rural residents, and provide financial support for rural elderly people to purchase pension services. In addition, various regions can increase cash subsidies or in kind assistance for disabled, demented, alone, and elderly people according to actual situations, to enhance the purchasing power of rural elderly in need. On the other hand, village collectives should do a good job in ensuring the "last mile" by giving preferential treatment to elderly people in need in areas such as collective industry dividends and profit distribution from commercial construction land transactions, and prioritizing the allocation of beds in public nursing homes and sanatoriums to elderly people in need.

(Author affiliation: Wuhan University Social Security Research Center)