Countermeasures Study against Aging Problem in Shanghai Shanghai Academy of Development & Reform Ruan Qing

In 1979, aging people in Shanghai over 60 years old initially occupied over 10% of total Shanghai population, which made Shanghai become the first aging city in China. Time goes on, currently “Elders Living Alone” families are growing faster, which brings huge challenges for the Social Security System in Shanghai

Current Situations and Tendencies Practices and Countermeasures Catalogue 1 2 3 Current Situations and Tendencies Challenges Practices and Countermeasures

Current Situations and Tendencies 上海市发展改革研究院

Currently Situation of Aging Problem in Shanghai 1.4% 0.8% 19.6% of Shanghai Population in 2015 30.2% of Shanghai Population in 2015 Increased (2014) Increased (2014) Aging People over 65 Aging People over 60

The Construction Map of Shanghai Aging People over 60 60-64 70-79 65-69 The Construction Map of Shanghai Aging People over 60

Aging Population Change in Shanghai in Last Decade Unit:10K Over 60 Over 65 Year

Aging Population Proportion Change in Shanghai in Last Decade Over 60 Over 65 Year

Life Expectancy Change in Shanghai Unit: Years old Years Life Expectancy Male Female 2015 82.75 80.47 85.09 2014 82.29 80.04 84.59 2013 82.47 80.19 84.79 2012 82.41 80.18 84.67 2011 82.51 80.23 84.80 2010 82.13 79.82 84.44 2005 80.13 77.89 82.36 2000 78.77 76.71 80.81 1990 75.46 73.16 77.74

Tendencies During 2015 and 2020, Aging people over 60 years old will increase 0.21M in Shanghai By 2018, totally over 5M By 2020, totally over 5.31M Touch the peak value during 2045-2050

Unit:10K Year

Challenges 上海市发展改革研究院

Heavier Old-Age Burden Higher Medical Cost Pressures Far More Nursing Needs

Heavier Old-Age Burden Age Dependency Ration Increase Sharply （Age Dependency Ratio=Aging population/Working Age Population×100%） 26.1%（2000） 50.2%（2015）

Support Ration Change of Staff Endowment Insurance in Shanghai during 2006-2015 (Unit: 10K) Year Individual Numbers of Payment Individual Numbers of Pensioner Support Ratio 2006 477.7 294.7 1.62:1 2007 483.8 310.0 1.56:1 2008 495.3 324.4 1.53:1 2009 506.9 338.9 1.50:1 2010 542.9 352.0 1.54:1 2011 926.9 364.0 2.55:1 2012 948.0 378.4 2.51:1 2013 952.4 390.6 2.44:1 2014 969.3 404.1 2.40:1 2015 995.6 415.8 2.39:1

Higher Medical Cost Pressures Serious Aging Problems More Chronic Disease Attack More Medical Insurance Cost During 2007-2015, the Staff Medical Insurance Expenditure of Shanghai averagely increased 13.5% every year. In 2014 and 2015, the disbursement of medical insurance for retired people is 6.2 and 6.3 times as much as the value of working people respectively.

Far More Nursing Needs 5.4％ of total Population in Shanghai 17.9％ of Aging people over 60 Aging People over 80 in Shanghai：0.78M（2015） During the “Twelfth Five-year Plan”, aging people over 80 years old averagely increased 5.5% every year By the end of 2015, over 0.98M aging people live alone without their children In the near future, over 80% aging people are the parents who have only one child There are about 13% aging people over 80 years old who cannot take care of themselves It is extremely urgent to establish a long-term care insurance system for ageing people

Practices and Countermeasures 上海市发展改革研究院

√ Promote Reformation of Staff Endowment Insurance Recent Works Promote Reformation of Staff Endowment Insurance Optimize Reformation of Medical &Medical Insurance Perfect the Geriatric Nursing System √

Enlarge the System Institution Coverage Delay the Age Apply for Pension Flexibly Reformation for Endowment Insurance in Agencies and Institutions Reformation of Staff Endowment Insurance

Support Ratio Decreased More Deficit in Endowment Insurance Fund More Aging People Support Ratio Decreased More Deficit in Endowment Insurance Fund Endowment Insurance In 1999, deficit in endowment insurance was 0.59B RMB. By the end of 2010, the value increased to 10.3B RMB In order to optimize the deficit, Shanghai begin to promote the reformation of Staff Endowment Insurance System

Enlarge the System Institution Coverage 2011 Migrant Workers Company Staff who have joined in social security for small town The number of insured increased 4M,which made up the deficit in 2011 Staff Endowment Insurance +

Delay the Age Apply for Pension Flexibly 2010 People possess professional skills People who holding the certificate of technician or senior technician Other talents required by companies Can delay apply for pension when allowed to retire （Male ＜65，Female ＜60）

In 2012, institutions also implemented the policy above Reformation for Endowment Insurance in Agencies and Institutions In 2007, government finance made up the lost of retired people in agencies In 2012, institutions also implemented the policy above In 2015,agencies and institutions implemented consistent calculation methodology for pension as enterprises In 2015, established occupation pension system for agencies and institutions - Lighten the pressures from staff endowment insurance fund disbursement - A fair environment for fund disbursement purpose

√ Promote Reformation of Staff Endowment Insurance Recent Works Promote Reformation of Staff Endowment Insurance Optimize Reformation of Medical & Medical Insurance Perfect the Geriatric Nursing System √

Reformation of Medical & Medical Insurance Medical Insurance Fund Pre-disbursement Control and pre-disburse the fund of medical insurance for medical institutions Promote “Family Doctor” Mechanism From 2011, established contracts between family doctors and community residents By the end of 2015, signing rate is 44% Enhance the Management of Chronic Diseases Regularly provide physical examination for aging people over 65 years old

√ Promote Reformation of Staff Endowment Insurance Recent Works Promote Reformation of Staff Endowment Insurance Optimize Reformation of Medical & Medical Insurance Perfect the Geriatric Nursing System √

Perfect the Geriatric Nursing System Pension Service System Service System Geriatric Nursing System Geriatric Nursing Medical Insurance Fund Financing System Government Finance Fund

“9073”Pension Service “9073”means 90% aging people take care of themselves at home, 7% aging people accept pension service in community, and 3% aging people accept pension services in agencies By the end of 2015, there were 699 pension agencies established in Shanghai , including 0.12M beds provided

Beds Numbers in Pension Agencies of Shanghai during Last Decade 4.31 5.24 6.41 7.24 8.47 8.99 9.36 9.65 10.21 10.75 12.6 2 4 6 8 10 12 14 万 年份 Unit:10K Year

Establish Medical & Nursing Beds By the end of 2015, there were 27.3K Nursing Beds provided for aging people which were established in health centers, nursing agencies and hospitals both public and private

Pilot for Old-aged People Nursing & Medical Guarantee Plan Target Groups：Shanghainese whose age over 70 and have joined in staff medical insurance… Evaluation：Evaluate the self-care capability, health status ,etc., of aging people by professional institutions 3 levels in medical & nursing service Service agencies：Geriatric Nursing service agencies which managed by medical insurance Service Staff：Professional nurses and trained care associates Services：Basic Nursing, clinical nursing and home nursing ,etc. Service Standard：3-7 times every week according to different nursing levels. Every time, 1 hour Payment Allocation：90% disbursed by medical insurance fund，10% payed by individual

Treatment & Maintenance Combination of Treatment & Maintenance Increase the medical institution in nursing agencies and settle the expenses by medical insurance fund Sign the service contract between nursing agencies and health centers Encourage “Home Doctors” provide more basic health services Implement Old-aged People Nursing & Medical Guarantee Plan

Countermeasures and Suggestions 上海市发展改革研究院

Perfect Staff Endowment Insurance System Introduce relevant policies to extend retirement age Extend the retirement age for five years for both male and female Extend pension insurance payment year appropriately Extend pension insurance payment year from 15 years to 20 years progressively Search for different mechanisms to finance the pension insurance Establish the reserve fund for Shanghai pension insurance, the fund could financed by government, national assets and land leasing Develop Supplementary Pension Insurance To support supplementary pension from policy level, especial from tax and etc.

Expend the Functions of Individual Medical Insurance Account Optimize Staff Medical Insurance System Expend the Functions of Individual Medical Insurance Account Reform the Medical Disbursement System Promote the Development of Commercial Health Insurance

Establish a Long-term Care Insurance System The purpose for Shanghai to launce the “Old-aged People Nursing & Medical Guarantee Plan” in 2013 is to discover a feasible way to establish “Long-term Care Insurance System” The “Long-term Care Insurance System” could be treated as an independent Insurance Target Groups：All working and retired staff who has payed staff medical insurance Financing from: Government, enterprises and individuals. At the initial phase, could be financed by staff medical insurance fund Payment ways：Consider the care target with different status

Questions? 上海市发展改革研究院