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China's aging population can't afford health care

C. Cindy Fan is associate dean of the Social Sciences Division, a professor in the departments of Geography and Asian American Studies, and the author of "China on the Move: Migration, the State, and the Household" (Routledge Studies in Human Geography, 2008). This op-ed originally appeared on Nov. 1 in "Is China Facing a Health Care Crisis?," a New York Times online debate among China experts.
Some say that the Chinese are increasingly wealthy. But are they also increasingly healthy? Life expectancy in China has improved from under 60 years in the 1950s to 74 today, just four years less than that of the United States. Such speedy improvement was possible thanks to the Communist Party's early commitment to spreading basic health knowledge and vaccinations — via "barefoot doctors" and others — across the countryside where the vast majority of the Chinese lived. 
Going forward, health care in China faces multiple challenges. People who are 65 and older account for 9 percent of the population, a proportion still much lower than that of aging societies such as Germany (21 percent) and Japan (23 percent). But a steady improvement in life expectancy combined with the shrinking of the young age groups is accelerating the aging process. The current legal retirement age of 55 for women and 60 for men is fast becoming obsolete. The growing number of retirees — many of whom are not protected by a social safety net or sufficient nest eggs — is problematic. As the Chinese age, the demand for care of degenerative diseases such as heart disease and diabetes — due in part to rising consumption — will increase relative to basic health care. 
Despite the promise of egalitarianism attributable to Mao, services such as education and health care are not free and can in fact be costly in China. Moreover, the job market marginalizes the sick and the old. Left to fend for themselves, the Chinese are motivated to save diligently. Savings are often what makes it possible to treat an illness, finance a wedding or a child's college education, or pay for a down payment for an apartment. 
Access to and affordability of health care is especially problematic in rural China. A sick family member is a main reason that rural Chinese pursue migrant work to augment household income. But a large number of migrant workers also means that the elderly are left behind and not being cared for by their children. Urban Chinese have better access to health care. Still, the sick and the disabled are among the poorest segments of urban society.
Another challenge to health care — lack of physicians — has a socialist root. Unlike medical personnel in Western societies, Chinese doctors are not among the highest paid. And most hospitals are run by the government. To address the mounting pressure on health care and improve delivery of care to a larger spectrum of society, a rethinking of how to manage medicine and motivate the next generation of health care providers seems imperative.
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