Who will care for you when you get old? A study of inequities in health and long-term care among the elderly in rural China

本研究旨在解决中国农村老年人健康与长期寿命寿命相关的关键问题，弥补这一领域的研究空白，并提出政策建议。60岁以上人口占中国农村人口的15%以上。这一比例预计在未来几十年还会增加。在中国农村，老年人依靠家庭成员提供照顾。然而，随着越来越多的年轻人迁移到大城市，有家庭成员来照顾农村老人的期望变得不现实了。在中国，机构LTC护理通常很昂贵，尽管政府通过社会健康保险计划或其他机制报销部分费用，但服务使用者仍然要承担大量的共同支付费用。这些费用对于生活在贫困中的农村老年人来说可能过于昂贵，从而加剧了获得护理机会不平等的问题。本研究旨在探讨中国农村老年人在健康和LTC方面的不平等。本研究将首先考察农村老年人的社会经济地位是否与他们的健康状况相关。然后，它将评估非传染性疾病预防和控制方案对具有不同社会经济背景的农村老年人的影响，并审查是否可以通过家庭护理支助充分满足农村老年人的需求。本研究将模拟未来几十年中国农村人口结构，并预测新合作医疗（农村老年人长期医疗的唯一财政支持）是否能够长期持续。它将从其他发达国家吸取长期债务融资的经验教训，并为决策者提出潜在的政策建议。研究结果将使许多利益相关者受益，包括在中国设计老龄化相关政策的政策制定者、专门从事家庭LTC服务的组织、农村老年人及其家庭照顾者。研究结果将揭示不同社会经济群体的农村老年人的健康状况和卫生保健模式以及LTC使用的差异。其目的是为决策过程提供信息，并鼓励决策者重新审查现有的卫生和长期保健政策。专门从事居家养老服务的机构也将从这项研究中受益，因为这项研究旨在确定目前的家庭养老服务是否能够满足老年人的需求，并确定在哪些领域可能有机会发展正式的居家养老服务。最后，这项研究将使农村老年人及其家庭成员受益，让他们参与各种传播活动，并与政策制定者和其他相关方进行对话。本研究将采用复杂的计量经济学方法，如浓度指数、工具变量（IV）和各种其他模拟模型。数据来自中国健康与退休纵向研究（CHARLS）。这项研究建立在我从以前的工作（例如浓度指数和面板数据回归）中发展起来的卫生不平等研究的初步定量技能的基础上，并辅以未来研究领袖计划提供的培训机会（例如高级定量课程和各种知识交流讲习班）。该计划将使我能够提供强有力的基于证据的政策研究，从而影响政策。

The proposed study seeks to address key questions concerning the health and LTC among rural elderly in China, bridging the research gap in this area, and offering policy suggestions. People above the age of 60 account for more than 15% of the Chinese rural population. This percentage is expected to increase in the next few decades. In rural China, elderly people are relying on family members to provide care. However, as more and more young people are migrating to big cities, the expectation that family members will be available to provide care for rural elderly is becoming unrealistic. Institutional LTC care is usually expensive in China, and although the government partially reimburses the costs through a social health insurance scheme or other mechanisms, service users are still responsible for a substantial amount of co-payments. These costs may be too expensive for the rural elderly living in poverty to afford, which exacerbates the issue of unequal access to care. The proposed study seeks to examine inequities in health and LTC among rural elderly in China. This study will first examine whether the socioeconomic status of the rural elderly is associated with their health status. It will then assess the impact of a non-communicable disease prevention and control programme on rural elderly with different socioeconomic backgrounds, and also examine whether the needs of the rural elderly population can be sufficiently addressed with home-based care support. The study will simulate the population structure of the rural Chinese in the next few decades, and predict whether the New Cooperative Medical Scheme (NCMS) (the only financial support available to the rural elderly to finance their LTC) will be sustainable in the long term. It will draw lessons on LTC financing from other developed countries, and propose potential policy recommendations for decision makers. The study results will benefit a number of stakeholders including policy makers who are designing ageing-related policies in China, organisations specialising in home-based LTC services, the rural elderly and their family carers. The study results will reveal how the current health status and patterns of health care and LTC use among the rural elderly differ across different socioeconomic groups. The intention is to inform the policy making process and encourage policy makers to re-examine existing health and LTC policies. Organisations specialising in home-based LTC will also benefit from this study, because this study aims to identify whether the current family care is able to meet the needs of the elderly and identify areas where there may be opportunities to develop formal home-based LTC care. Finally, this study will benefit rural elderly and their family members by engaging them in various dissemination activities and dialogues with policy makers and other relevant parties. This study will employ sophisticated econometrics methods, such as the Concentration Index, Instrumental Variables (IV), and various other simulation models. Data will be drawn from the China Health and Retirement Longitudinal Study (CHARLS). This study builds on initial quantitative skills in health inequity research I have developed from my previous work (e.g. the Concentration Index and Panel Data Regressions), and is complemented by training opportunities that the Future Research Leaders Scheme provides (e.g. advanced quantitative courses and various knowledge exchange workshops). The scheme will put me in a position to deliver strong evidence-based policy research that can influence policies.