Update on Aging Statistics and Geriatrics Development in China

To the Editor: We read with interest the article by Li and colleagues, in which they provided an overview of the demographic characteristics of the older population, the current care system and healthcare reform pertinent to the health of older adults, and geriatrics development in China. We appreciate the authors and this journal for their interest and effort in introducing this aging tsunami and ongoing and rapid senior healthcare development in China to the geriatrics community around the world. In addition to congratulating the authors’ accomplishment, we have the following comments: According to the latest demographic statistics from the Chinese government, the number of older adults (aged ≥60) reached 241 million at the end of 2017, an increase of 11 million (almost 5%) in 1 year. This rate of increase is much higher than the 3.3% annual rate in the 2000s. Such accelerated rate of increase of an already large older adult population suggests an even greater challenge to the Chinese healthcare system and the ongoing need to develop qualified geriatric healthcare in China. As Li and colleagues describe, the “inverted pyramid” family structure secondary to the 1-child policy has significantly weakened traditional family support for older adults. Two years ago, the Chinese government introduced a 2-child policy, but a recent report indicates that the birth rate and number of newborns remain low. It is anticipated that China may abolish any birth restriction policy as soon as this year. Moreover, the phrase “family planning” has been removed from the National Health and Family Planning Commission. A new National Health Commission (NHC) was established instead this year. China continues to move forward rapidly on healthcare reform, initiating a number of exciting healthcare reforms: 1) In addition to the collaborative and referral relationships between Level 3A hospitals and their local community hospitals that Li and colleagues describe, the NHC has recently ordered that Level 3A hospitals focus on complex or rare diseases and biomedical research while community hospitals provide care for common and chronic conditions. Level 3A hospitals are required to reduce their outpatient clinic volume for routine care so that patients more frequently seek such care at their local community hospitals. 2) To develop a primary care network, local governments request that residents establish health services contracts with family doctors in their communities. For example, in Jiading District, in Shanghai, family doctor health services contracts have been completed for 241,500 residents, 17.4% of residents. This contract rate is 84.2% for older adults (n = 162,400). It is likely that these two measures, if successful, will lead to fundamental reform of the Chinese healthcare system, in favor of better care for seniors. 3) In an attempt to introduce foreign healthcare expertise and advanced medical technology, China has opened Boao, Hainan Province, as a special zone for healthcare development. In this special zone, physicians with a valid medical license in other specified countries can practice medicine without having a Chinese medical license. Drugs and medical devices that have been approved in other specified countries can be used without approval from Chinese government authorities. This is considered to be a significant step, indicating that China is opening its healthcare sector to direct exchange with foreign medical professional entities without going through an often-cumbersome government approval process. Academic geriatric medicine itself has also experienced several exciting developments in 2018. For example, the National Center on Geriatrics was officially established at Beijing Hospital in May. Aging Medicine, an official publication of Chinese Medical Association Geriatrics Branch, was also launched in May as China’s first Englishlanguage professional journal on aging and geriatrics. This is accomplished in collaboration with Wiley, which is also the publisher of the Journal of the American Geriatrics Society. In May, the Chinese Academy of Medical Sciences and Peking Union Medical College organized the Nanshan Summit in Sanya, Hainan Province, an international symposium with an ambitious agenda on China’s strategy for healthy aging and senior healthcare development. In summary, although Li and colleagues provided an excellent overview based on the information collected at the time their article was developed, China’s population statistics, government policy, and reform of geriatrics health care and academic geriatric medicine are moving forward at an unprecedented speed in the complex and evolving healthcare system. The geriatrics community around the world needs frequent updates to keep up with rapid geriatrics healthcare development in this fast-moving society.