Modern Aging China: What Can We Learn From Sweden and the Netherlands?

We recently organized our second Modern Aging lecture in Beijing. The event, which focused on entrepreneurship in the aging industry in Scandinavia, was held at China Social Worker Association. We invited two Swedish experts to share their expertise on innovations in elder care in Sweden and the Netherlands.

Rui Hu, our program manager for ACCESS Health China, introduced ACCESS Health International and the Modern Aging program. She spoke about our Modern Aging Sweden and Singapore programs and explained how these programs served as models for the Modern Aging China program in Beijing and Shanghai. She highlighted the progress that ACCESS Health China has made over the past seven months since we first launched in China. She called on the audience to join the entrepreneur community to participate actively in our Modern Aging program.

Following Ms. Hu’s introduction, Anna Riby, project manager and vice president of Swecare, gave a presentation titled, “The Swedish Healthcare System and Innovations in the Private Sector.” Swecare is a semigovernmental foundation that promotes international cooperation and exports from the Swedish healthcare sector. Swecare is a collaboration between the private sector, the public sector, and academia. Ms. Riby offered an overview of the Swedish healthcare system, outlined the development of Swedish elder care and healthcare, and provided some examples of innovative solutions from Swedish companies, such as devices and eHealth applications.

The Swedish Healthcare and Elder Care Systems

Swedish healthcare and elder care are organized around several important values, Ms. Riby explained. Healthcare in Sweden is for everyone, based on need and not the ability to pay. Healthcare is publicly funded, but service delivery is provided by both public and private sectors. To fulfill the ambition of universal coverage and high quality care, the system needs to work cost efficiently. Care must be evidence and knowledge based, so that we know what we are doing and why, explained Ms. Riby. A focus on patients will ensure that care is based on the needs of the individual patient and of the highest quality. The Swedish healthcare system is decentralized into three levels: the national level, the regional level, and local authorities. All three levels in the political system share responsibility for healthcare. Each level has its own taxes. Each level covers the cost of its activities.

At the regional level, healthcare is further divided into three levels: Primary care is the first point of consultation for all patients within the healthcare system, usually a primary care physician or a nurse at a primary healthcare center. Primary care is the foundation of the Swedish healthcare system. Secondary care is healthcare services provided by medical specialists, but within a limited number of specialties, and other health professionals who generally do not have first contact with patients, often at a general hospital. Tertiary care is specialized hospital care, including inpatients and care based on referral from a primary or secondary health professional. Tertiary care is provided in a facility that has personnel and facilities for advanced medical investigation and treatment.

After her brief introduction to Swedish healthcare, Ms. Riby turned to elder care. Around twenty percent of the Swedish population is above the age of sixty five, the official retirement age in Sweden. By 2060, that figure is estimated to reach twenty five percent. The numbers of people age eighty and over and one hundred and older are also increasing sharply. The longer lifespan is a positive development, but also a huge challenge for society and care providers. Efficiency, especially cost efficiency, is a necessary focus area for Swedish healthcare and elder care.

Living at home turns out to be an ideal solution to improve cost efficiency in Sweden. More than ninety percent of people over sixty continue living in their own homes. Sweden has become a leader in enabling senior citizens to keep living in their own homes for as long as possible, even when they require extensive care and social services. This approach offers many benefits. It is more effective, more economical, and, most importantly, preferred by the elderly themselves.

To prevent falls and injuries, subsidized homecare services, such as gardening, changing light bulbs, and changing curtains, are available in many municipalities. If an individual needs more assistance, the person is assessed and can qualify for additional homecare support, including personal care, household services, security alarms, transportation, companion services, or food delivery. If someone requires long term care, it is also possible to receive advanced healthcare in the home, including palliative care. The team that visits the patient in the home may come from the primary care center or from the hospital.

If a person is no longer able to live independently in his or her own home, a place in special housing can be arranged. The main cause for a move to special housing is dementia. In some cases, short term care housing is needed, for rehabilitation and recovery after a stay in hospital. Short term care housing helps patients who are too frail and need too much care to live at home.

The growing proportion of elderly in the population poses certain challenges, explained Ms. Riby. To maintain quality and increase efficiency, we need to take advantage of the opportunities that eHealth and similar solutions offer. We need to cooperate with several industries, such as medical technology, information technology, and private caregivers. We need more professionals focused on the needs of the elderly. We need to attract more personnel to the elder care sector. For the most fragile elderly with multiple illnesses, we must ensure that they receive care that takes their entire health picture into consideration in an environment that maintains as much of their independence and quality of life as possible. We also need more coordination of care among caregivers, between primary and tertiary care, homecare, and home healthcare. The quality of care in Sweden varies from region to region. The Swedish healthcare system must also ensure that it is possible to receive the best care, even in remote areas. Prevention, security, mental health, safety, and social factors are all important to supporting the well being of the elderly.

Innovation in Sweden

Ms. Riby explained how the Swedish innovation system is addressing these challenges. In Sweden, ideas for innovation can come from three sources: healthcare itself, research settings, and companies or private individuals. Innovation often involves collaboration between and among these different groups. Innovation is thriving in places like the Swedish innovation agency Vinnova, the Swedish Agency for Economic and Regional Growth, science parks at universities, incubators and accelerators, test beds, academic primary care centers, and in elderly housing.

Ms. Riby also shared innovative policy solutions. Various financial mechanisms can influence the behavior of caregivers in a desired direction. In Sweden, there are around one hundred different quality registries. The primary aim of these registries is to support follow up, analysis, continuous improvement, and evidence based care. Senior Alert is a register used to prevent malnutrition, fall injuries, oral problems, and pressure ulcers. The National Board of Health and Welfare and representatives from municipalities and county councils work together to develop open comparisons and public performance reports on healthcare and social services.

Many innovative solutions are being introduced in caregiving, including new technologies, to make care more patient centered and evidence based. Swedish companies are an important source of innovative solutions and constant improvement in assistive devices, training and education, fall prevention, ulcer treatment, safety alarms, quality register systems, eHealth and information technology solutions, well being, and other areas. Remote Contact is a communication tool connected to a television that allows the user to receive and send images and text and voice messages. Mobile security alarms often have bracelets for alarm calls and can be used with other accessories in the home. JustoCat is a tool to improve interaction between a person with dementia and his or her caregiver.

After Ms. Riby’s presentation, Sofia Widén, the ACCESS Health Sweden country manager, discussed innovation she discovered on her recent trip to learn about elder care in the Netherlands.

A Focus on FocusCura and the Netherlands

Ms. Widén briefly introduced Dutch elder care and recent trends. Healthcare insurance in the Netherlands provides universal coverage for seventeen million citizens, sixteen percent of which are over age sixty five. The life expectancy in the Netherlands is eighty one years. Healthcare spending represents fifteen percent of gross domestic product. Healthcare insurance costs between 130 and 190 dollars per person per month. Separate long term care insurance is available as well. Recently, the Dutch government introduced reforms to the elder care system.

Ms. Widén presented a case study of FocusCura. FocusCura is an eHealth company that creates solutions to support elderly living at home independently. The founder, Dr. Daan Dohmen, is a former elder care nurse assistant who combined his interest in elder care with his passion for technology. One tool his company developed is called the VideoCareApp. This application (app) connects users to the Medical Service Center, which enables users to book appointments and to communicate with healthcare professionals online. Another tool developed by FocusCura is a health monitoring app that can help people manage their conditions. The software uploads its collected data to electronic health records to help medical professionals make better treatment plans.

The elder care system in the Netherlands has accumulated a lot of experience after many years of development. The system has evolved to become quite complex, Ms. Widén explained. An older person can receive care from hospitals, family doctors, community nurses, family caregivers, family members, and others. The VideoCareApp is a remote video system that enables all of the elder care service providers to communicate online. The medical staff can monitor the updated status of users through this system. Users receive better care via the system.

As in China and Sweden, the Dutch government encourages the elderly to live at home. The health monitoring application monitors chronic diseases. This app can remind users to measure their health indicators on a regular basis. The app instantly sends the data to the user’s doctors. For consultations, users can choose either online or in person services. There is no difference in content and quality between these two kinds of services.

The monitoring system connects the electronic health record to the self reported data from the users. If there is abnormal data, the system issues an orange alert to the medical center. The community hospital sends someone to the user’s home to double check. If the situation is severe, the system will upgrade to a red alert, prompting the hospital to act immediately. This prevention system ensures good management of the health of the elderly. If you want to know more about FocusCura, please see this blog post by Sofia Widén.

After presenting the two applications developed by FocusCura, Ms. Widén expressed her interest in learning more about innovative elder care in China. China has its own unique qualities and advantages in elder care. We can learn from each other’s experience, which will result in mutual improvement and benefit.

The elder care systems in Sweden and the Netherlands are well designed and highly effective, with low cost and high quality. These systems serve as models for the rest of the world. In China, we are facing the same aging challenge, but we aare at different stage of development and have different processes to meet the challenge.

How Do We Compare?

Sweden and the Netherlands are both developed countries with a large nationwide welfare system. According to Ms. Riby, the population of has been aging for a long time. The recent trend really began in the 1960s. Sweden has had time to adjust to this change. Sweden has established a system of high quality and reasonably cost efficient care. “In Sweden, most elder care is funded by municipal taxes and government grants. In 2014, the total cost of elder care in Sweden was 109.2 billion Swedish kronor (about 12.7 billion US dollars), but only four percent of the cost was financed by patient charges. Healthcare costs paid by the elderly themselves are subsidized and based on specified rate schedules.”[ref]Elderly Care In Sweden.[/ref]

As the largest developing country, China is likely to grow old before it grows rich. “China is aging so fast that a process that took up to a century in the West will happen in the coming thirty years here.”[ref]China’s Ageing families under pressure, BBC News, posted on September 21, 2012.[/ref] China’s pension and medical systems are so flawed that there is no publicly funded long term care insurance in China or a mature referral system in hospitals. “According to Dai Xianglong, chief of the National Council for Social Security Fund, pension reserves account for only two percent of China’s gross domestic product, compared to eighty three percent in Norway, twenty five percent in Japan, and fifteen percent in the United States. As a result of the low reserves, the benefit level is very low, especially in the countryside, where the pension fund only covers approximately one third of the elderly people, who each receive a monthly payment of only twelve US dollars.”[ref]Population Aging in China: A Mixed Blessing, The Diplomat, posted on November 10, 2013.[/ref]

Recently, the Chinese government has introduced new healthcare reforms to address aging issues more effectively. China is setting up a hierarchical medical system to improve efficiency at lower cost. The Chinese government is also encouraging the private sector to establish a long term care insurance system.

It is important to learn from the successful and highly effective systems and innovations in countries like Sweden and the Netherlands. We must also take into account the different local institutions and specific national characteristics when learning from and applying the experiences from other countries. It is a step by step process to set up a well functioning elder care system in China. We still have a long way to go.

Modern Aging China plans to hold events on a monthly basis, in both Beijing and Shanghai. The format of the events will range from small group discussions to large forums. Modern Aging China will recruit members into our community of entrepreneurs, cultivate and support innovative business plans, and encourage the entrepreneurship of the younger generation in the aging industry. Stay tuned for upcoming opportunities to join the Modern Aging China community! For updated event information, please follow our official WeChat account: AccessHealth.