China Daily Weekly - 09.08.2019

ByZHANGJIN

C

hina has seen its aging

population growing rap-

idly. This trend is expected

to last for a long time. In

2018, the number of people over the

age of 65 inChina reached 166 mil-

lion, accounting for 11.9 percent of

the total population. It is projected

that the number of elderly people

aged 65 and over in the country

will exceed 400 million by 2050.

There is therefore anurgent need

to establish a comprehensive elder-

care system combining pensions

and medical care and nursing care.

To cope with its growing elderly

population, Japan has established

a community-based integrated care

system for the elderly that provides

long-term nursing care, medical

care services and social care, pro-

viding experience thatChina can

draw from.

The sophisticated community-

based integrated care system

of Japan provides nursing care,

medical care, preventive care and

in-home care for patients in acute,

recovery and chronic phases.Based

on the long-term care insurance

system, the nursing system allows

elderly people to enjoy services

in their homes, elderly care orga-

nizations and communities. The

preventive care system provides life

assistance and preventive care for

the elderly. Japan has also estab-

lished community general support

centers to meet the demand for

services for the elderly. With the

medical care, nursing care, preven-

tive care and in-home care systems

linked, the elderly who need medi-

cal and nursing care services can

get them within 30 minutes, while

still enjoying their later life in an

environment they are familiar with.

AsChina’s population is rapidly

aging, demand for elderly care

is rising. However, suppliesof

medical and nursing care services

are inadequate. First, domestic

hospitals offer no nursing care

services for the elderly and fail to

conduct effective management of

healthcare workers, as patients

paying high fees may still receive

low-quality services. Second, the

division of the pension for medi-

cal care and nursing care is still

unclear.Medical care insurance

has beenutilized for nursing care,

leading to long stays for some

patients that cause a shortage of

hospital beds.

Third, adding more rehabilita-

tion medicine intoChina’s medical

insurance system would signifi-

cantly ease the medical expen-

diture burden on families while

the proportion of rehabilitation

medicines in the system is still low

and rehabilitation and medical care

organizations across the country

are inadequate. Fourth, the current

supplies of medical care for those

elderly that are disabled or have

dementia cannot meet the actual

demand.

Fifth, hospice and palliative care

services and death education need

to be further promoted inChina.

Sixth, community-based integrated

service centers are not in place. Sev-

enth, the long-term care insurance

system is incomplete.

Meanwhile, it is not yet a good

time for across-the-board imple-

mentation of a nationwide pilot

program as it remains fragmented.

Therefore,China shou draw onld

Japan’s experience and improve

its community-based integrated

care system to cope with its aging

population.

First,China needs to establish a

community-based integrated care

system consisting of nursing care,

medical care, preventive care and

in-home care. The government

can establish service centers in

communities to provide medical

care, rehabilitation and nursing

care services for the elderly.A

“community+internet” platform for

integrated care services should also

be established.

Second, a long-term care insur-

ance system should be established.

As an independent social insurance

system, it is a fundraising mecha-

nism that clarifies the responsibili-

ties of government, enterprises and

individuals.China needs to settle

payment standards in line with its

financial capacity, improve rating

systems for nursing care services

and make procedures for the ser-

vices more standardized. Individu-

als and households inChina should

be financially prepared for elderly

care.

The scope of medical insur-

ance and long-term care insur-

ance should be clearly separated.

In Japan, the insurances are

clearly distinguished, as acute

medical care is covered by medi-

cal insurance and long-term care

focuses on the needs of people

whose physical functions fail to

fully recover after rehabilitation

periods.Long-term daily care

requires healthcare workers who

are equipped with professional

knowledge.

In addition,China needs to

improve the supply of care for dis-

abled and partly disabled elderly

people, increase the support for rel-

evant organizations, and promote

the idea of self-reliance among the

elderly to reduce the care burden

on health workers.

It can also establish service

centers for the elderly with

dementia. The government needs

to introduce supporting policies

to encourage communities to

build care centers for such elderly

people, provide them with a safe

environment, set standards for the

environment and healthcare ser-

vices, and improve governmental

subsidies for professional elderly

care organizations. Subsidies can

be provided according to the per-

formances of the organizations.

Meanwhile, professional training

for the care of elderly people with

dementia needs to be organized

to help ease the pressure on their

families.

Efforts are also needed to pro-

mote hospice and palliative care

services inChina. Related depart-

ments should build hospice and

palliative care service frameworks,

develop complete assessment

standards and medical guarantees,

and establish transfer mechanisms

between care service organizations

and terminal care hospitals.

More focus needs to be laid on

death education by incorporating

death-related courses intoChina’s

currenteducation system, promot-

ing the public to live and die well,

and guiding them to face death.

Theauthorisaresearcherwith

theChinaCenterforInternational

EconomicExchanges.Theauthor

contributedthisarticletoChina

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necessarilyreflectthoseofChina

Daily.

CountrycandrawlessonsfromJapan’scommunity-basedintegratedcarefortheelderly

ByDENNISPAMLIN

A

n experience that is

becoming increas-

ingly common around

the world is the sorting

of waste.

It may seem like a trivial activity,

but it has slowly moved into the

center of conversation on the future

of business and sustainable devel-

opment.

Waste sorting is a complex phe-

nomenon that can be an impor-

tant step toward a global circular

economy.Maybe it even will be

something we will look back on as

one of the first steps toward an eco-

logical society.

But sorting of waste could also

mean participating in an activity

thatundermines sustainable devel-

opment by allowingunsustainable

companies touse recycling as a way

to pretend they are sustainable.

When Royal Dutch Shell, a

British-Dutch oil and gas company,

wanted to dump an oil rig in the

ocean in 1995, many people in

Europe had just started to separate

glass bottles and newspapers. The

company’s plan was viewed as a

sign of arrogance. The incident

led to an important meeting, after

which many companies started

including environmental factors in

their risk assessment.

The situationisdifferenttoday.

It is no longer clear if the kind of

waste sorting done in Western

nations is part of the problem or the

solution. There are areas where the

sorting of waste is working reason-

ably well, for example, in the glass

and metal industries.Butatatime

when we are looking at a transfor-

mative system change and global

sustainability, there is a need to fun-

damentallyrethink waste sorting.

In the coming decades, the world

needs to eliminate theuse of fos-

sil fuels, become more resource-

efficient, lift billions out of poverty

and ensure greater equity. In order

to ensure this, we need a resource-

efficient circular economy, and

waste sorting can play a key role.

But that would be a very different

kind of waste sorting.

People around the world have

begun to realize that much of the

waste they sort is not integrated

in sustainable material flows, but

instead shipped to poor countries,

where it is not handled in an appro-

priate manner.

Asmorecountries refuse to

become dumping grounds for the

unsustainable lifestyles of rich

countries, a healthy discussion

about global sustainability has

begun to emerge.

Out of the waste that is recycled,

much of it is turned into low-value

goods in a way that does not result

in a radically reduceduse of natural

resou rces.Instead, recycling initia-

tives areused by companies sell-

ing low-quality goods that are not

made to last.

Awaste sorting system for the

21st century should build on the

opportunities that digitalization

provides, and allow citizens to track

what is happening to the waste they

are sorting. It should also provide

information about the companies

they have purchased products from.

It should require companies to

show how resource-efficient their

solutions are, allowing consumers

to compare options.

It is time tounderstand that

Western recycling systems, to a

large extent, areused byunsus-

tainable companies that produce

everything from fast fashion to

unhealthy fast food.

China could initiate the next

generation of waste sorting systems

— those that support hyper-trans-

parency and move away from the

systems in the West that are con-

tributing to reduced transparency.

Such a waste sorting system

would be a driver for innovation

and extreme resource efficiency

andatrue step toward ecological

civilization.

Theauthor,whoco ntributedthis

articletoChinaWatch,isasenior

adviserattheResearchInstitutes

ofSweden,seniorassociateat

theChineseAcademyofSocial

SciencesandfellowattheResearch

CenterofJournalismandSocial

DevelopmentatRenminUniversity.

Theviewsdonotnecessarilyreflect

thoseofChinaDaily.

Chinacouldinitiateatransparentrecyclingsystemthatdrivesinnovation,resourceefficiency

Time torethinkwaste sorting

Ensuringgood olddaysinChina

22 COMMENT August 9-15, 2019 CHINA DAILY GLOBAL WEEKLY