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Worry about eldercare in China

decade of the 21 Century? (2) Do the improving socio-economic resources and availability of community services play
st
a positive role in reducing older adults’ worry about eldercare? and (3) In such a backdrop, is the role of family relations
still important in older adults’ worry about eldercare?

1.2. Population Aging and Changes in Family Structure in China
Population aging in China results from both low fertility rate and rising life expectancy. The one-child policy in the
past few decades since 1979 has contributed to a declining portion of the young in the general population. Meanwhile,
rising life expectancy allows more people to live to old ages. There are currently more than 200 million older adults in
China aged 60 or older, more than 20 million of whom were oldest old, or over the age of 80. In 2019, one in 11 people
worldwide was aged 65 or over. It is projected to grow to one in six by 2050, and at the same time, the number of those
aged 80 or above will reach 426 million (United Nations, 2019). In the past few decades, China’s fertility rate has been on
a downward track. It has started declining since the 1960s, when total fertility rate was around 6.0. It had dropped from
5.8 in 1970 to 2.8 in 1979 before the implementation of the one-child policy (Jiang and Liu, 2016). With the one-child
policy in full swing, fertility fell below replacement in the early 1990s and was around 1.5 by 2010 (Cai, 2013). As a
result, the average number of children per family is lower and the average size of the family is shrinking. The average
number of family members declined from 3.96 in 1990, to 3.46 in 2000, and to 3.09 in 2010 (Hu and Peng, 2015).
Meanwhile, decades of social and demographic changes have gradually eroded the traditional ideal of having multiple
generations living under the same roof. More Chinese older adults are increasingly living alone or with a spouse only.
Using Chinese Census data, Hu and Peng (2015) documented that the percentage of parents living with married or
unmarried children in two- or three-generation households has steadily declined from 74.2% in 1990 to 65.3% in 2000
and 53.0% in 2010. They found 40% of older adults living in empty-nested households, i.e. living alone or with spouse
only. Such a change can be attributed to the growing number of one-child families that makes the multi-generation living
arrangement demographically difficult, and rising incomes for both the young and old and housing availability that make
living independently possible (Du, 2013; Meng and Luo, 2008).

1.3. Expanding Older Adults Welfare Programs
As population aging places an ever-growing constraint on family’s ability to provide eldercare, the state has launched a
series of social programs to address such a challenge. The National Committee on Aging was established in 1999, and
the state has made substantial progress in establishing a social safety net for the elderly population (Feng et al., 2012). In
1997, the State Council passed a decree to set up a uniform old age security system for urban employees, who contribute to
their personal account, which is managed by the local government. By the end of 2012, 304 million urban employees had
participated in this program. Monthly benefit for the pensioners has been on the rise in the past decade (Zhang, 2017). In
rural areas, China initiated the New Rural Pension Program (NRPP) in 2009, aiming at covering all the rural older adults.
The new program is funded by contributions from individuals and subsidies from local and central governments. By the
end of 2011, about 200 million rural residents had participated in the program (Du, 2013). In addition, the minimum
security program is set up for those with low or no income. It had provided coverage for 74 million urban/rural residents
by 2012, among whom 3.4 million were older adults in the cities and 20.2 million older adults in rural areas, which
accounted for 15.7% and 37.8% of older adult population, respectively (Yang, 2013).
China’s network of medical care currently covered both urban and rural areas, with more than 1.3 billion beneficiaries
(Wu and Luo, 2013). While urban residents are covered by the Urban Employee Basic Medical Insurance (UEBMI),
which provides insurance to urban employees and retirees, and Urban Resident Basic Medical Insurance (URBMI), which
covers self-employees, employees in informal sectors, and the unemployed. Rural residents are covered by the New
Cooperative Medical Scheme (NCMS). Under this coverage, part of the patient’s medical expenses is reimbursed. The
treatment for some major diseases, such as lung cancer and stomach cancer, is covered by up to 90%. The personal share
of all medical expenses had gone down from 58% in 2002 to 35% in 2011 (Wu and Luo, 2013).
Meanwhile, the state steps into promoting community-based services aiming to supplement family care and help older
adults remaining in the community (Xu and Chou, 2011). These services, both formal and informal supports available
to older adults within the community provided by people other than family members (Shen and Yeatts, 2013), include
household chores, health care at home, and meal services (Du, 2013). Various pilot projects and experiments have been
conducted in both urban and rural areas since the 1990s (Lee and Kwok, 2006), from government-operated services to
private enterprises. While some of the services are wholly funded or partially subsidized by the local government, some
are paid out of pocket by individual customers (Lin, 2017).

2 International Journal of Population Studies | 2019, Volume 5, Issue 2