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.

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.

 

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