Rodenberry never thought that Speaking Trek would mean speaking Chinese and Hindi
While browsing the excellent HaoHao Report I was drawn to a story by Ian Sample of UK's The Guardian. The USA's retreat from space exploration last week, Ian writes, marks a new era in China and India led space exploration.
China has lifted astronauts into orbit and sent its first robotic missions to the moon. India found water on the surface with its first lunar mission last year, and plans to launch astronauts into Earth orbit in 2016. Japan, too, has sent a satellite to the moon, returning extraordinary HDTV video of the surface.
With the US space agency out of the running, the leading contender for a return to the moon is China. In 2004, government officials announced an unmanned lunar exploration programme that would put satellites in lunar orbit, touch down on the surface and finally bring home up to two kilograms of rock samples before 2020.
Sample goes on to point out how a mission to the moon in 2016 would be a different beast from a mission in 1960.
A crewed mission to the moon in the 21st century will be a different beast from the Apollo programme. The blurred images would be replaced by colour HDTV footage. The communications would be clear and frequent. From a permanent base, astronauts would truly explore the moon instead of only scratching the surface. The venture could be commercial and scientific in ways that were not possible 40 years ago.
Ken Pounds, professor of science at Leicester University is also cited several times waxing poetic about what this means politically for the United States.
Pounds said: "The Americans are the only ones who can say 'we've been there, done that,' but the point is they are not there now.
"The moon is very visible and any proposition by another country to set up a permanent presence there would be unacceptable to the Americans."
Pounds basically argues that concerns over a China-led space race would become a sustained political issue. I disagree. I could fathom it being a story for a few weeks leading up to the launch maybe, but I doubt attention spans in 2020, focused as they are on more pressing concerns (like the, by that point, out of control health spending) will be long enough to put up with a story that's any longer than that. It's more believable that the landing would mark a cultural shift: it could become a way that China definitively brands itself as the country of the moment. The Olympics didn't quite do that; they were more a lead in chapter. The article gets into this a little bit with pictures from a future mission trumping anything that Apollo brought back, but doesn't go far enough. (disclaimer: this is all assuming that the mission is not pre-empted by a giant real estate bubble burst in China).
The article also mentions but fails to expound on what I believe to be the most interesting point. With NASA officially out of the picture in the foreseeable (due to mismanagement, financial and program wise, they were unofficially out of the picture long before Obama pulled the plug) countries like China and India are going to reap the benefits of the ongoing technological tidal wave. If they go to the moon in 2020, there is a good chance that building technological momentum could take them even farther, much sooner than we think.
When the Vulcans arrive, they might very well be speaking Chinese of Hindi.
Is Chinese Hospital Reform lagging because the Chinese don’t know any better?
On China HB Adam Daniel Mezei was prompted by China's recent passage of Hospital Reform Guidelines to ask whether "That the PRC’s citizens tolerate the rampant graft in the provision of prescription drugs is due to a lack of awareness of a better model of doing so? Knowledgeable Chinese that have studied abroad or who read articles by climbing the Wall know that there is a better way to receive health care in other parts of the world, do they not? What are your thoughts?"
First off, the summary of the guidelines is this;
- The management system of public hospitals should also be reformed so that operation and supervision of the hospitals are conducted separately, it said.
- The quality of public hospitals’ medical services should be improved, whereas their incentive mechanism of income distribution should be perfected, the statement said.
- Public hospitals should also gradually quit profiting from drugs and rely on medical service charges and government subsidies.
- The guideline also encourages non-governmental sectors to invest in and set up non-profit hospitals.
Next, my response to Adam;
The Chinese are fully aware that there are better ways to do things. For that matter, so are Americans. Unfortunately for both, actually bringing about change is difficult. The reason that graft in the provision of prescription medications is tolerated has to do with compensation mechanisms for doctors. The PRC statement did a marvelous job of understating this huge issue, only saying that compensation mechanisms for doctors had to be “perfected”.
Doctors in China are underpaid relative to the amount of time they put into school and work. Their status in society is, therefore, artificially low since status in China is largely conferred by the amount of money one earns. They know this to be true. The government knows it to be true. So, on the surface it might seem like doctors are at the mercy of the government, and one might be prompted to ask "so why doesn't the government just clamp down?"
It's hard to clamp down because the number of doctors in China is very small. So, politically, the doctors have a lot of leverage to do what they want to since a strike or something to that effect would cripple an already hobbling healthcare system.
The political compromise is that doctors are de facto allowed to take in funds through grey channels. The government makes a big show out of condemning the practice, but can’t actually take any actions to stop it until they 1) Up salaries, or 2) give doctors full freedom to go private.
The Chinese do have to be given a lot of credit for actively working to change their health system. What has to be understood is that they have made unprecedented strides in health system improvement since the early 1980s when the term “healthcare professional” was most widely associated with barefoot doctors or TCM practitioners. They are on their way, and unhindered by the state-level political considerations that are so prevalent in other nations. The political compromises they have to make with interest groups like doctors are much easier to deal with.
Pfizer’s China Strategy shows why they are still alive in the Big Pharma Consolidation Wars
About a year ago I made a post about how Pfizer had really become a veteran Chinese hand, after it had agreed to conduct a study on the needs of China's rural poor. This was seven years after Pfizer had lost a series of trademark and patent cases since 2002.
I thought that Pfizer had learned an important lesson about doing big, SOE-sized business in China - it's important to cooperate before you operate.
Pfizer has been on both the winning and the losing sides of China patent and trademark laws since 2002. If anything, it has learned just how different a playing field China is than the rest of the world, and that access to this potentially rich pharma market has to be earned. That's why the announcement by Pfizer and PlaNet finance, "to conduct an in-depth research project on the health care needs of the working poor in China," should be amusing new to many experienced China watchers for the sheer fact that it is a testament to just how 'Chinese' Pfizer has become.
At this point Pfizer would fit right in with local and provincial level Chinese officials soberly putting padded red envelope donations in boxes for the Sichuan relief efforts on live television, and staring intently into cameras for a few seconds before making the drop, so as to make sure that their faces were clearly caught by the upper level cadres watching the proceedings. Even the mission statement present in the article screams "I get it. We gotta co-operate to get some state level love."
Today the WSJ Health Blog reports that China came up several times in Pfizer's call with analysts early in the afternoon. The call mainly talked about the approach that Pfizer was planning to take in the Chinese market.
In some ways, the approach sounds like pharma’s strategy in the U.S. a few years back, when the industry was swimming with sales reps and companies were aggressively wooing “key opinion leaders” — top physicians who could influence other docs.
Here’s how Ian Read, president of Pfizer’s drugs business, framed the Chinese market and Pfizer’s strategy in the country, according to a transcript from Thomson Reuters:
… in large part it is an out-of-pocket market, so brand loyalty and quality is really important. … our total portfolio is growing, and it is not as impacted as the United States or Europe is by [generic competition]. So this requires what I would call a traditional investment thesis, feet on the street, field force, relationships with physicians … invest with key opinion leaders
Last month, Pfizer said it planned to increase its sales force in China to 3,200, from about 2,300 now. That comes as the company makes some significant cuts to its total global workforce.
The phrase "we need feet on the street" jumps out at me here. It tells me that Pfizer continues to have an impressive understanding of the Chinese market.
Source: Asia Healthcare Blog
Unlike physicians in the US, Chinese physicians have long gotten used to depending on drug sales for the majority of their pay check. State provided salaries are small, and hospital oversight is opaque enough to make under the table payments from drug sales reps easy, and widespread. With the new Essential Drug List that was finalized this past summer, under the table payments are going to be much hard to make because and overwhelming percentage of the most profitable drugs are going to be sold exclusively at rural hospitals for a flat fee. Hospital controlled pharmacies, too, are on the way out. Moreover, exclusive drug distribution contracts will be granted to companies for each drug. This means that competition between distributors will decrease, and the need for under the table payments will be substantially decreased.
The new reality will involve a lot more 'feet on the ground' because of where the most drugs are being sold (rural pharmacies) and because it will now take more time to persuade doctors that a particular product is the best product (harder in the sense that if will not be necessary to actually make a case for the product as opposed to forking over a red envelope with red 100 Yuan bills inside).
There is a reason that Pfizer is still alive in the Big Pharma Wars.
Healthcare in Asia won’t be that cheap for long, and neither will business (probably)
The global pharmaceutical landscape is changing. Big pharma companies are merging and getting bigger in order to expand their pipelines, and they are getting leaner, shedding jobs in the most expensive markets. The future of big pharma, everyone seems to think, is in low-cost Asia.
I recently talked to a big pharma exec who seems to think otherwise. While he acknowledges that the industry is undergoing changes and increasingly moving East, he also talks of it being a process that is much more akin to an equilibrium than a one way plane route.
Asia has some innate advantages over other markets due to its population size. It is easier to find target patient populations for clinical trials simply because the number of people in countries like India and China is so great. Doctors and drug monitors are also comparatively less expensive in some Asian economies than in the West.
But, the pharma executive points out, a lot of places in Asia are already some of the most expensive in the world. Singapore and Hong Kong medical and PhD talents, for example, demand a market price that comes close to what one finds in the West.
The issue is one of perception. It is easy to see the job shift as permanent if one thinks of the developed West's (America, strongest EU members) position in the world as static, and sees Asia as playing catch up. In fact, the executive says, if the current mergers and job cuts in America prove anything it's that Asia is not the sole mover. America and the developed West, too, are moving. Moving down.
As little as ten years ago, doing a drug trial in Eastern and Central Europe was a good way for pharma companies to make money. Now, according to the executive, it costs the same to conduct a trial in Poland as it does to conduct one in Germany. The same sort of trend, he says, could likely happen in Asia. The result is that America may once again become a cheap option for doing healthcare business. At that time, salaries in the US should be lower relative to what they are now since the value of goods and services across the world will be somewhat more uniform. If America and the West can keep building on their current experience advantage, then there is the additional possibility of America and the West, ironically, being the place where companies go to get more for less.
I have heard the argument for equilibrium before. I buy it.
The best example I have seen is by Dr. Hans Rosling (His bio has this to say; "A professor of global health at Sweden's Karolinska Institute, his current work focuses on dispelling common myths about the so-called developing world) one of the world's foremost Western experts on India and Asia's developing regions.
Dr. Rosling's central dispute is that the developed world is too willing to see the relationship with its developing neighbors as being governed by a static construct rather than by a dynamic equilibrium. This is reflected in policies which serve to propagate the status quo. The truth, he seems to claim, is that the developing world is stronger than anyone gives it credit for, and the developed world's powers are much more fragile than they seem.
Depending on how you see the world, Dr. Rosling is either a maverick hero who dares to break through the Orwellian veil of media spin, a weaver of fairy tales that allow people in developing countries to sleep soundly at night knowing that their future hopes will soon be realized, or just a very educated person who is using what he has learned through a lifetime of looking at the world from several unique perspectives to give the rest of us a glimpse into the possible future that awaits.
Whether equilibrium happens or not, Americans and others in the developed West working in corporate healthcare fields have a dynamic future to look forward to. The floodgates letting high-paying jobs leave from the West to the East will eventually close, and some jobs may even come back to the United States. Until that happens, the pharma executive says, the industry will continue to merge and shed jobs. But, equally important, the markets will continue to expand and new opportunities will continue to open up. More than ever, a premium will be put on education. The jobs of the past decade that required a masters or X years of work experience will not return, and will increasingly be given to PhDs or MDs on top of their other duties.
This may sound like a harsh reality, but it is also an inevitable one. High paying jobs in the future will exist, but they will take more work to maintain simply because the competition will be that much higher. It's important to swallow this bitter pill, convince yourself it tastes good, and move forward. Good luck to everyone.
China. The walls have ears there, and probably everywhere else.
This is in reply to Dan Harris' post on the dangers of not being careful with information when doing business abroad - China. Do The Walls Have Ears?. Mr. Harris makes his paranoia when going abroad to "China and many other countries," and then goes on to illustrate why it is justified.
"I am convinced about 99.9% of all emails go through. But the way I interpret that is that at least one email I send per day will not reach its destination. If I do not hear back from someone rather quickly, I just assume they did not get my email and so I send it again. In other words, I assume the worst.
I have a similar attitude regarding my privacy when in China and many other countries. I assume my hotel room is bugged and my internet is monitored. I assume the worst and I take every measure I can to be careful. I know people will (and have) laugh at my "paranoia" but I have plenty of stories to tell involving people who were not careful about their data."
I agree that it is, indeed, justified, but I actually feel that he hasn't taken his paranoia far enough. It is important to be careful with information everywhere and all the time - not just when doing business, or when doing business abroad. Maybe I'm paranoid, but I prefer that over the things that might happen if I was not.
The caution one exhibits in China, Korea, Russia, or any other country not waving an American or EU game should not be any different from what one does everywhere else.
Identity theft and surveillance is a reality no matter where you go: and identity theft is currently the fastest growing crime, in the developed world. There are certainly differences in the level of surveillance one can expect from nation to nation, but these are not as great as differences in perception.
China has the CCP, the PLA and it's special units, America has the Patriot Act, the DHS, the FBI, CIA, and it's special units, Europe has Interpol and its special units...depending on who you are and what national/ideological interests you represent, the level of paranoia you feel in each of these countries is sure to vary significantly. Perhaps, in the past, this sort of relative fear was justified since global affairs of policy and economy were much more fragmented. Today, countries' interests have been blurred together by the whirlwind of a computer driven, hyperpaced, 24/7 economy. Paradoxically, in this environment, the perceived need for surveillance has increased because now even slight advantages in negotiations can lead to lucrative gains in the fast paced trading world. So it is no longer just enough to have selective information surveillance; it is important to have omnipresent information surveillance since one never knows what could be important.
Given that having as much information as possible is now more important to everyone, it is not enough to be vigilant with one's information when traveling abroad to a region of the world that has traditionally been a rival of one's home country. It is obvious, perhaps, but not enough.
Who is more likely to trap the fly with honey? Someone that the fly is already cautious of? Or someone that the fly is perfectly comfortable with?
Why long term care market in China will open up only after today’s real estate bubble pops
By 2020, 17% or 248 million of Chinese citizens will be over 60 years of age (For Samuel Green's excellent four part series on this subject, go here, here, here, and here). Any businessman who looks at this number will tell you that it represents a huge market opportunity. Of course, there is a catch. You have to know when it's time to enter the market.
Right now, is definitely NOT that time. But, there likely IS a right time.
Unfortunately, waiting until the bubble pops is already too late for many people.
Currently, the Chinese government is over-incentivising the real estate market in order to produce jobs. SOEs, flush with cash and blessed with leaders who have limited term limits and so care little for the long term consequences of expensive real estate purchases, are pushing the price of real estate ever higher through bid wars at record setting real estate auctions. This means that non-SOE players, even real estate giants like SOHO, are getting shut out of real estate purchases. If you are a foreign investor wishing to enter the Long Term Care market by building a private retirement home or something similar, you can't do it by purchasing a plot of land and building something on top, unless you want to set up shop in the middle of some abandoned country side (in which case, you can't ever really hope to build a high end facility). It's just too expensive.
(If you don't believe that there is a real estate bubble, read this article (highlighted by Dan Harris and China Law Blog) and see if you come away unconvinced.)
So what does this mean? It means that the time to invest in long term care is right after the bubble bursts and real estate prices collapse. With a little luck (relative to the long term care facility tycoon's position) the bubble will collapse close to 2020, when China's elderly population starts to peak.
At that point two things might happen. 1) The government will be glad to offer assistance to those wishing to relieve some of the burden from retirement homes already running at over capacity (today, there is a 5.5 million deficit in the number of beds needed for ailing seniors), and 2) Couples of working age will be able to buy previously unbuyable apartments, and decide they have money left over to send their parents to a really nice retirement home.
If those two factors don't make an ideal investment period for long term care facility entrepreneurs then I don't know what will.
Sinosplice sees hospitals in train Stations and vice versa
Sinosplice had what I thought this was a great piece of insight on Chinese hospitals:
"...Chinese train stations and Chinese hospitals are very similar.
- Both serve huge numbers of people
- Both contain a wide cross-section of society
- Both involve a lot of helpless waiting and nerve-wracking purchases
- Both offer VIP options which offer English-language services and a quieter, more private atmosphere
- Both leave you with a sense of wonder and hopelessness at the magnitude of the problems heaped on a government which has to provide for 1.3 billion people.
(I can also totally understand why many of the doctors and nurses had attitudes scarcely better than train station ticket vendors.)"
As some in the comments pointed out, it's not just that hospitals look like train stations, but also like bus stations and any other understaffed high demand public services. Of course, health reform has kicked off, and releasing some of this pressure on hospitals is a primary focus of that effort.
Still, there is something to be said for the ultimate inefficiency of a system that funds all public services from a single budget and tries to do so equitably. For some reason, historically, health has been viewed by all revolutionary governments as something that needs to be taken care of only after the 'real' issues of statehood, like economy, political legitimacy, and military build up, are solved, or at least brought to acceptable equilibrium. That's why it is common to see crowded, unsanitary, and corrupt health systems in the middle of bustling world centers like Shanghai, Brazil, New York...etc. Eventually this mistake in policy catches up with you.
If you think I'm overgeneralizing, just name me a country with over 60 million people, which has healthcare outcomes on par with its economic prosperity. In other words, of the most populous countries with 60 million people or more, who's ranking as an economic power (a measure of development) is equal to or lower than their health indicators? Chances are you'll find only two no matter how you measure outcomes - France and Japan. Then again, both of these countries were stable regional and global powers for a combined period of 1000 years who were forced to curtail their ambitions after their economic expansions were thwarted in various military engagements, so they have had a while to focus on health.
Photo essay on the Elderly in Rural China
I thought that this photo series by Italian site Cinnaoggi is a nice complement to Samuel Green's excellent four part series on China's elderly (Part 1 Here, Part 2 Here, Part 3 Here, and Part 4 Here.)
Several of the pictures really give a sense of how much care is required for sick elderly in China's countryside. The pictures are not representative of the countryside as a whole, but our focused on some of the most extreme poverty. In this sense they mirror what one might see anywhere in the world, developed or not. I saw many similar scenes in Eastern North Carolina, where elderly women were living in homes and trailers without running toilets or piping.
But, they give a sense of what Samuel was talking about, especially the first picture of the two women lying in adjunct beds being fed by caregivers.
Source: La condizione degli anziani in Cina: le immagini
This sort of attention requires full time care, and costs a lot of money.
The rural life and time of China’s elderly, Part IV: Limiting Catastrophe
In the previous articles (Part 1 HERE, Part 2 HERE and Part 3 HERE) we highlighted the issues faced by the rural elderly in China and some of the fundamental reasons for the burgeoning healthcare crisis in rural areas. This article will conclude, and offer suggestions which could potentially alleviate some of the pressure.
Biao (2007) concludes in his report that, individually, the ‘left-behind’ are not particularly more disadvantaged than those who are with their families (the differences are marginal). However he does reinforce the argument that rural areas are holistically left behind. Socially and economically, rural areas have been left behind by their urban counterparts.
He states that “Although migration exacerbates the hardship, preventing migration is not a solution. Instead, the institutions that maintain the urban-rural divide should be modified to enable more migrants to settle down in cities with families,” (Biao, 2007).
If one observes the poor level of health care access for the elderly in rural China, perhaps migration is a reaction. The high quantity of rural-urban migrants suggests this is already happening. If a family member can afford to pay for their parents’ care by moving to the city, then it is not migration that caused the problem but migration that is helping to solve it. Perhaps this is why migrant remittances are the primary reason for better psychological outcomes for the elderly left-behind. While a three-generation household was observed to have the best outcomes psychologically, the opportunity cost of having a tight-knit family is the lack of an urban income flow. It is important to understand that migration is not a ‘get-rich-quick’ scheme, it is a necessity caused by resource disparities between rural and urban areas. Curbing migration would only help to exacerbate the rural-urban divide, which is the fundamental problem behind all of these issues.
Biao (2007) suggests that the hukou system must be reformed in order to allow more families to settle in the city. This is not a realistic or desirable solution. Through this article it has been concluded that the problem is not that the 38-61-99 are left behind. The direct effect of being left-behind (at least for the elderly) is marginal. Negative psychological outcomes appear to be overcome by migrant remittances. The fact that an elderly person does not have their child nearby to care for them is not a problem solely caused by migration; it is a problem of resource deficiencies. While there are cultural reasons for children caring for their parents, much of it is born out of necessity (hence why urban areas experience less co-residence). And while the brain drain is caused by migration, the underlying reason for that migration is resource shortages in rural areas (although future research into these motivations is needed). The real issues with being left-behind are access to care and a cycle that constantly reinforces resource disparities between rural and urban areas. Both these issues are examples of resource shortages and any long-term sustainable solution will look into increasing resources in rural areas.
One such solution to shorten the resource gap, is encouraging private investment in eldercare. A baomu system that is regulated and standardised, with subsidies to provide incentives to private industry, would substantially improve access to care (both financially and physically). What a sophisticated baomu system will achieve is an efficient allocation of the scarce resources in rural China. Recalling the figures mentioned in the second article, 50% of chronically ill patients required over 7 hours of care per day. The current informal and unregulated arrangement will undoubtedly be inefficient. Entrepreneurship in this area will potentially find a way to optimise the baomu in rural areas and maximise the amount of care they can give. Obviously the baomu cannot provide the same level of care as doctors, although it could be argued that doctors are not particularly well suited to caring for chronic illness and older demographics.
Another possible avenue is a system which pools migrant remittances into a pseudo-health insurance scheme, supplementing the NCMS as a fund from which community health services (such as baomu) can be paid for.
Ultimately, Premiere Wen and co. will have to do a lot more of this in rural China
Zhang & Goza (2006) believe that the promoting of young couples co-residing with the wife's parents (as opposed to the husband's) would help balance the sex ratio in rural China, although it might not be wise to recommend something which cannot be enforced without removing personal freedoms. However, their main recommendations reinforce those of this article; to address the rural-urban gap through both financial assistance and improving the retention of young, skilled workers.
“The government should work on improving the educational level of the rural population, especially among female children; and extend to rural regions some version of the minimum livelihood system that currently exists in urban areas. Such programs may enable the rural regions to attract additional employers and to retain more of their young.” - Zhang & Goza (2006)
Ultimately the rural-urban divide is a subject that goes above and beyond the content of this article. It is an issue that will likely be addressed in numerous future pieces on China HB. The primary issue of migration is the near-crisis statistic regarding levels of eldercare needed from 2030. Throwing money at the problem will not solve it alone. A sophisticated private investment and rural development programme would result in a sustainable solution that could possibly avert disaster. Although it could be argued that it is too late and the Chinese government should focus on damage limitation.
The Rural Life and Times of China’s Aging Population, Part III: Institutional Problems
By Samuel Green
In the previous articles (Part I is HERE, and Part II is HERE) we introduced the problems an elderly person in rural China will face on an individual level. How migration affects their psychological well-being and how they receive care. In this section we will discuss the more macro-level issues of human healthcare resource disparities and the hukou system. We will also look at the fledgling baomu initiative which may address some of the issues faced by the rural elderly.
Subtle, we know.
One issue that has not been discussed extensively in academic literature is the impact of migration on the ‘brain drain’ experienced in rural China. China is a perfect example of problems faced in every healthcare system. Rural areas find it difficult not only to properly train medical practitioners, but to keep them from migrating to urban areas. As discussed previously, the aging rural population will require more health resources. As the rural population ages it will require more chronic treatment, not covered by the NCMS. However, trained doctors still continue to flock towards urban areas which already have sufficient resources. While the brain drain has been significantly studied and discussed, there has been little research on the attitudes of urban doctors towards working in a rural area. Many articles have suggested that urban doctors should be forced to work in rural areas to alleviate the strain on resources.
This solution would increase the ability of rural services to provide high technological care (Dib et al., 2008). A number of levels of government are attempting to encourage experienced specialists to switch from hospitals to work regularly at community based services, since their skills and expertise valuable towards the improvement of care (Liu, 2006). Incentives need to be created for doctors to move to/stay in rural areas (Anand et al., 2008). But, rural areas are inconvenient, lower paid and lack the prestige and status one achieves when practicing in the city. As the average Chinese youth becomes more and more educated, the average age of certified doctors is likely to decrease. On the other hand, rural areas are populated mainly by the elderly. As young people leave the countryside to head for the city, the social incentives of doctors to practice in a rural area will likely diminish. A city like Shanghai influences a completely different lifestyle to that of Chaohu. Will Shanghainese doctors want to work in Chaohu? Probably not.
Even though the 'barefoot doctor' of the past appears to have disappeared (Zhang & Unschuld, 2008), the benefits gained from expert training and delivery would be much appreciated in this new scheme. Dummer & Cook (2007) also recommend a new barefoot doctor scheme, with a focus on primary preventative care.
It should also be said that if China figures out how to get good doctors to the country side then it will be somewhat of a global hero, since almost all countries have this problem. An additional vital question that needs to be asked, which is more unique to China, is whether the upcoming health care crisis for the elderly in rural China is caused by migration, or if migration just exacerbates underlying problems that already existed.
While one might simply point at the above discussed brain drain the real culprit might be the hukou system. The hukou system is a household registration system which, among other things, is used to calculate health insurance requirements and analyze the needs of the local population. Rural-urban migrants are not registered in the hukou system. Thus they are not included in urban health insurance schemes and are ignored when making resource allocation decisions. Health policy is based solely on the local registered population.
“In many towns along China’s coast and particularly in the Pearl River delta, migrants outnumber the local population by large margins, but they are very rarely mentioned in local government development plans and reports. All social and economic development indicators, such as the school enrolment rate and number of hospitals for every thousand persons, are calculated on the basis of the size of the permanent population." - Biao (2007)
the children of migrant's cannot go to schools in areas where their parents aren't registered
Migrants are left in an extremely vulnerable position, one where social benefits are non-existent and job security is low. This is the primary reason why rural family members are left behind, because dependants would not receive any benefits of migrating. It is much more efficient for the breadwinner to send money back to their home-town (where prices are cheaper and there is some form of social welfare) than to move the whole family to an urban area. However this means there is a need for a caregiver to replace the missing child. This is the fundamental institutional problem behind the lack of caregivers.
The concept of a ‘baomu’ (literally, Protection Mother) is becoming more popular in families that can afford it (600-1000RMB/month). Essentially a live-in maid, a baomu has basic knowledge of eldercare (Cooke, 2006). Of course, a fundamental problem of the baomu system is that the employed maid will have less time to care for their own relatives. There is also a need for quality standards. It is unlikely that the baomu supply on its current trajectory will keep up with the rapid increase in the elderly population, but it is essential that these services are in place to ease the strain on nursing homes. One solution would be to encourage private sector investment in eldercare. It is a growing segment (over 500% projected) and there is considerable need for a baomu system that has standards and can allocate resources efficiently.
This report by the Beijing Review is worthwhile reading; 'Aging City Leads the Way'.although it is difficult to predict whether this sort of system would work in a rural area, as many of the potential baomu would have left for the city. The government is encouraging private initiatives in the nursing home sector but, in Beijing for example, the system currently only serves 0.6% of the senior population (Xinhua News Agency, 2005). This is woefully inadequate, and Zhang (2000) highlights that to increase capacity by just 3% the government would have to invest at least US$200 billion (based on numbers from the Ministry of Civil Affairs).
Holistically this series has discussed the major issues of rural-urban migration on the elderly left behind. In the final part we will suggest ways to improve the system and conclude whether it is too little too late, or if a crisis situation can be averted.
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- Pfizer's China strategy shows why they are still alive in the Big Pharma Consolidation Wars: http://bit.ly/akKGf3
- Why long term care market in China will open up only after today's real estate bubble pops - http://bit.ly/cdGE4w
- @kevnfu that is all too true. I referred to it as the world's largest game of Human Frogger
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- China Law Blog Legal issues for the China entrepreneur
- Conflict Health Daily Opinion and Analysis on Armed Conflict and Public Health
- Dalmatian American Food How to make the most delicious food
- End Poverty in South Asia Excellent World Bank blog dedicated to issues of development
- Free For All Don Taylor, Duke University Professor, writes about health issues in America
- Global Health Ideas PhD students discuss a variety of health issues across the world
- Globalization and Health Latest open source research articles
- Inside-Out China A Literary, Cultural, and News blog with highly skilled writing
- Manage My Practice Health 2.0 and how to use it
- Manage The Dragon A great place to start for people doing China research
- Manish Rathi's Blog An Indian product engineer writes lucidly on healthcare in India
- MSGED Funky fun blog
- My Health Beijing A Beijing doctor shares wellness tips for life in the Chinese capitol
- You Call That Hip Hop Unique and always fun to read blog about hip hop in China’s capital