Ash Center: Mind Your Elders

December 1, 2012
Ash Center: Mind Your Elders
"By 2050, China's elderly population is projected to reach over 450 million – over 33 percent of the total population. Reliance on the family network for elderly care is not sustainable in the long term, and my research explored alternative models of care." ~Shannon Ding

HKS Student Evaluates Public-Private Partnership Solutions to Elder Care in China

By Shannon Ding

This summer, I participated in a 12-week internship in Beijing, China, sponsored by Abbott Laboratories that allowed me to conduct research on elderly care in China. This project grew out of my participation in the Ash’s Center weekly Public-Private Partnership (PPP) Study Group, where I had been inspired by another PPP case study dealing with multi-drug resistant tuberculosis and the management issues facing that partnership in China.

Setting the Context
Elderly care has become an increasingly urgent topic in recent years due to shifts in China’s demographic composition. China has successfully lowered its population growth rate over the past three decades, allowing it to achieve the kind of demographic transition that historically took more than 100 years in developed countries.[1] Today, however, China faces the opposite problem: its population is aging too quickly. By 2050, the population aged 60 and over is projected to reach over 450 million, accounting for over 33 percent of the total population.[2] As is the case in my own family, Chinese seniors traditionally live in the same household as their children and receive care from family members in their old age. Going forward, however, this reliance on the family network will no longer be sustainable. The number of elderly is rapidly increasing, particularly those with chronic diseases that require long-term care. At the same time, there are fewer young people who can serve as caretakers, as more of them migrate to urban areas in search of work.

The question that followed was what to do about it? What were some practical things that we could do to help ease the burden on the elderly and their families? And moreover, what kind of strategic partnerships between the public and private sectors that could be formed to realize these goals?

Navigating the Landscape of Elderly Care
I first researched what elderly patients and families actually wanted and relied on existing household data, such as Peking University’s China Health and Retirement Longitudinal Study, as well as qualitative field work. With the help of Abbott’s Global Market Access and China Market Access teams, I arranged visits with seniors, doctors, nurses and hospital administrators to understand the landscape of the current system. What I learned during these conversations was critical. First, they underscored the importance of self-reliance to many Chinese elderly, who were fiercely opposed to the idea of moving to nursing homes and away from their families and existing social networks.

This motivated me to focus instead on exploring non-institutional options, such as home-based nursing care and linking those services to community health clinics that offer primary care. In trying to define the problem and scope out the boundaries of potential solutions, I came to appreciate the complexity of the issue and the limitations of both the public and private sectors to adequately address this problem. For example, the term “care” itself offered significant challenges because not only were we dealing with medical care for patients with acute and chronic diseases, there was also a need for non-medical and non-pharmaceutical services, such as assistance with daily chores and providing education on nutrition and disease prevention.

A Structure of Public and Private Players
Addressing the challenges posed by China’s aging population in a meaningful way requires a useful structure to productively unite a host of public and private stakeholders. These include government agencies that supervise healthcare facilities and set the policy direction for potential financial support to seniors in accessing care services, as well as private sector and civil actors, such as ICT companies that offer technical support for remote monitoring of patients and telehealth services, community volunteers that lead exercise groups, and training institutions and nursing associations that can help professionalize elderly care among front-line workers. A goal of the PPP structure would be to keep families at the core of any changes or additions to support seniors.

Communicating to Stakeholders
Organizing these various stakeholders around a common objective of improving access to care requires a highly flexible management and communication style. This summer, I discovered just how challenging this can be, and at the same time, how crucial these skills are to successful PPP work. When pitching collaboration ideas to a government agency, for example, I found an audience that was sympathetic to the need for better data and open to collaboration with the private sector on research projects, but wary of aggressively launching into projects that would require new policy and financial commitments. At the same time, when discussing the PPP proposal with private actors, I had to explain why investing in this area was a worthwhile use of resources and talents despite limited profitability in the near term. In addition to employing the analytical, management, and communication skills honed at HKS, I also had to personally build relationships of trust and credibility with these stakeholders.

Learning Process
Another very helpful benefit of my participation in the PPP Study Group was weekly calls with Professor Alan Trager, chair of the PPP Study Group, and Samuel Ang (MPA 2005), a former Study Group member who now works in Abbott’s Global Market Access Team. During these calls, key questions would be raised that helped me to piece together the different forms of evidence I was encountering and sort through the motivations and incentives associated with the different stakeholders. These conversations also helped me maintain a sense of balance in understanding the public policy aspects of the project and the private sector’s need to produce some form of concrete result. Learning to recognize how and when to visualize and act to achieve this balance was a key lesson from my internship experience.

There remains more follow up work to be done. Abbott Laboratories is pursuing a three-year research partnership with the Chinese government in the area of long-term-care insurance and elderly care, and we are seeking interns to contribute to the second phase of the PPP project. In addition, the PPP study group is seeking additional student internship proposals for research projects in China and other countries.

Shannon Ding is a 2012 MPA/ID graduate of Harvard Kennedy School and a past Public-Private Partnership Study Group participant.

[1] Uhlenberg, Peter (ed), (2009). International Handbook of Population Aging, Springer Science and Business Media Press.

[2] China Research Center on Aging (2000). Sample Survey on Aged Population in Urban/Rural China (SSAPUR).