Situation, Challenges, and Countermeasures of Home-Based Healthcare Service Supply and Demand in China

According to the Seventh National Census of China, the population of adults aged 65 and above will be 190 million in 2020 (13.5% of the total population).As the "post-60s" group born at the second childbirth peak reaches retirement age, the growth rate of the population of older adults will accelerate significantly.By 2030, the proportion of older population (aged 65 and above) will reach about 17%, and the growth rate of the population aged 80 and above will be even more pronounced.Greater age is associated with more comorbidities and chronic diseases.It is estimated that 46% of older adults in China suffer from multiple diseases and 38% suffer from functional impairment (1-2).With a rapidly aging population and longer life expectancy, the incidence of chronic diseases, disabilities, and functional impairment are increasing dramatically, posing new challenges to our society's healthcare system and healthcare expenditures. THE CURRENT SITUATION OF HOME-BASED HEALTHCARE SERVICE IN CHINAHome-based healthcare is a response to the need for healthcare services for the special groups (e.g., the oldest-old population or older adults with disabilities, with chronic diseases, or with needs of follow-up healthcare services after being discharged from the hospitals).Studies have shown that home-based healthcare in Japan and the United States can effectively alleviate the shortage of inpatient beds in hospitals, save medical insurance funds, and reduce the cost of seeking medical treatment for patients living in remote areas (3-4).In China, home-based healthcare services have been provided in Beijing, Shanghai, Shenzhen, Jinan and other places, including three types of services -home visits, home care, and home sickbeds * provided by community health service centers, public hospitals, and private medical institutions (5).These medical institutions differ in their service delivery, service recipients, and payment methods.According to the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2018 data, 34.3% of older adults (aged 65 and above) were able to access home visiting services, while as many as 81.8% of older adults desired home visiting services that their communities provided.As shown in Table 1, such significant gaps of unmet needs existed across genders, age groups, types of household registration (hukou), living arrangements, daily living functioning, health insurance coverage, and residential area.In 2020, the National Health Commission and the National Administration of Traditional Chinese Medicine issued the Notice on Strengthening Home-Based Healthcare Services for The Older Adults, which called for further increasing the supply of home-based healthcare services for the older adults and precisely matching the diverse urgent medical service needs of the older adults.However, compared with the countries in Europe, the United States, Japan, and many other countries, China's home healthcare services are still in their exploratory stage, and face a series of challenges.The rest of this paper will explicitly discuss the challenges from both the demand and the supply sides, and in the end provide some recommendations for future policymaking in China.China CDC Weekly * Notes: Home sickbed is a bed designed to help patients recover according to the treatment needs and living habits of patients and uses the family and home as the treatment and nursing place, which can meet various treatment, rehabilitation, and nursing needs.