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和长期护理的关键问题，填补这一领域的研究空白，并提出政策建议。60岁以上的人口占中国农村人口的15%以上。预计这一比例在未来几十年内还会增加。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，期望家庭成员能够为农村老年人提供照顾变得不切实际。在中国，长期护理机构通常很昂贵，尽管政府通过社会医疗保险计划或其他机制部分报销费用，但服务使用者仍然需要承担大量的自付费用。这些费用对于生活贫困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长期护理方面的不公平现象。本研究将首先探讨农村老年人的社会经济地位是否与其健康状况相关。然后，它将评估非传染性疾病预防和控制方案对不同社会经济背景的农村老年人的影响，并审查农村老年人口的需求是否可以通过家庭护理支持得到充分满足。本研究将模拟未来几十年中国农村的人口结构，并预测新型合作医疗计划（NCMS）（农村老年人唯一可用的财政支持，以资助他们的LTC）是否将在长期可持续发展。它将从其他发达国家的长期培训融资中吸取经验教训，并为决策者提出潜在的政策建议。研究结果将惠及多个持份者，包括正在制定中国老龄相关政策的政策制定者、专门从事居家长期护理服务的机构、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目前的健康状况和医疗保健模式以及LTC使用的差异。其目的是为政策制定过程提供信息，并鼓励政策制定者重新审查现有的卫生和长期护理政策。专责提供家居长期护理服务的机构亦会受惠于这项研究，因为这项研究旨在确定现时的家庭照顾服务是否能满足长者的需要，以及找出有机会发展正式家居长期护理服务的范畴。最后，这项研究将使农村老年人及其家庭成员受益，使他们参与各种宣传活动，并与决策者和其他有关方面进行对话。这项研究将采用复杂的计量经济学方法，如集中指数，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（例如集中指数和面板数据回归）中开发的健康不平等研究的初始定量技能的基础上，并通过未来研究领导者计划提供的培训机会（例如高级定量课程和各种知识交流研讨会）进行补充。该计划将使我能够提供强有力的基于证据的政策研究，可以影响政策。

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.