China Demonstration Project: Setting a National Benchmark in Eldercare
I traveled to the Chinese city of Shijiazhuang in late February. Shijiazhuang is nearly two hours southwest of Beijing. ACCESS Health Sweden and ACCESS Health China have partnered with several organizations in Sweden and China to conduct a feasibility study on health and eldercare. Our Swedish partner is the Swecare Foundation. The Swecare Foundation is a semi-governmental organization under the Swedish Ministry of Health. The City Government of Shijiazhuang and the China Development Bank Capital are our Chinese partners. The purpose of the feasibility study is to examine whether Shijiazhuang can adopt certain primary and elder care services. These primary and elder care services are based on Swedish practice. On the twenty fourth of February, the municipal government and administrators in Shijiazhuang City received us. We were shown around what will be the future healthcare city. The purpose of this blog is to explain this project and our initial findings.
Population Aging and Urbanization in China
The largest senior population in the world lives in China. Over two hundred million people are over the age of sixty in China. This is nearly fifteen percent of the total population in the country. This figure is expected to increase to over four hundred million by 2050. The Chinese population has the highest chronic disease burden in the world. This has resulted in an increasing number of chronic disease patients who require constant and lifelong care. China will need to improve rehabilitative, palliative, home, community, and primary care services. There is also a shortage of medical professionals. Medical professionals from a great range of healthcare services will need to be educated. Healthcare costs will need to be contained in the coming years by restructuring the entire system.
There is simultaneously a strong trend of urbanization in China. China has yet to urbanize around fifty percent of its population. There is already pollution in many cities and few communities are prepared for residents who are older and require different transportation services.
Dr. William Haseltine is the founder and president of ACCESS Health International. In Dr. Haseltine’s forthcoming book, Singapore: A City for All Ages, he says that health can be the organizing principle for city planning. Dr. Haseltine expands on this by saying that city planners should organize streets, infrastructure, and housing according to health and wellness aspects. City planners should make it easier for people of all ages to move around between different parts of the city. Transportation should be accessible to everyone. City planning and healthcare should be conceived as two interlinked concepts.
Sweden and China
There is a history of collaboration between Sweden and China in healthcare. This is now being extended into elder and primary care. This year marks the ten year anniversary of the memorandum of understanding of close cooperation between Sweden and China in the field of healthcare. In 2016, China plans to send the Chinese Minister of Health to Sweden. Sweden will return this visit by sending the Swedish Minister of Eldercare to China in fall 2016. In May 2016, a delegation from the city of Shijiazhuang will visit Stockholm to learn more about Swedish primary care.
Launching a Pilot Project in Shijazhuang
Vinnova is a Swedish public state innovation agency. The agency has provided a grant to Swecare and to ACCESS Health International to conduct a feasibility study into the possibility of introducing primary and eldercare services in China based on Swedish practices. During my first trip to China, the partners of this project met with the Chinese counter parties to the project to gather initial data, understand local health and eldercare needs, and to initiate the feasibility study. All parties were enthusiastic and showed a great interest in launching a pilot project in the city of Shijiazhuang planned for the China healthcare city. The officials from Shijiazhuang City included Mr. Zhang Zefeng and Mrs. Li Zhihong. Mr. Zefang is the executive vice mayor of Shijiazhuang and Mrs. Zhihong is the director of the Shijiazhuang healthcare city. They were interested in establishing a primary care clinic based on the Swedish primary care model. Currently, there is no widespread primary care model in China. The Chinese government has recently allowed regions to start introducing different types of community care and primary care. The provinces are free to look around the world for inspiration and launch pilot projects.
In April 2016, we traveled back to Shijiazhuang city and met with representatives from the government, China Development Bank Capitol, and other relevant partners. These partners included the local health bureau and the local community hospital in the Shijiazhuang city center. The Shijiazhuang Community Hospital could be a suitable site to start the introduction of primary care in China. ACCESS Health and Swecare were joined by a delegation of Swedish primary care consultants. The Swedish experts looked around at the local community hospital and realized that the community hospital has some similarities to the Swedish primary care center that was a model in Sweden. The local community hospital has around thirty thousand patients listed. Doctors and nurses work in teams and each doctor sees around sixteen patients each day. This is comparable to the number of patients Swedish doctors see everyday. Doctors and nurses provide care programs for hypertension and diabetes. These care programs are similar to care programs in Swedish primary care.
It will be decided later on in the year if the local community hospital will be a collaborator to the project on primary care in China. The alternative is to construct a new facility in the new healthcare demonstration zone and establish a primary care center there. There are advantages and disadvantages with the two strategies. If you start anew, you will have the opportunity to introduce new work processes, management information systems, and design the facilities according to what primary care services you want to deliver. If you introduce primary care at an existing community hospital, you can work through existing structures and processes.
There are around ten million inhabitants in Shijiazhuang. We were shown the new area where the government plans to build the primary care clinic , a couple of large hospitals, and new residential districts. The government plans to house around one million inhabitants by building a new part of the city. There are currently over two hundred community health stations in Shijiazhuang. A local community health station offers basic healthcare services and medication to individuals who are covered by basic health insurance. The services are free for those who are ensured. Individuals who are uninsured pay out of pocket for basic healthcare services. A small health station with four doctors can receive over one hundred patients in one day. A small health station can receive around two hundred individuals on a busy day. Each patient meets with a doctor for a couple of minutes and often leaves with one or more prescriptions.
There are currently one hundred ninety elderly care facilities in Shijiazhuang with fifty one thousand beds. Traditionally, government officials in China have focused largely on the number of beds in hospitals and in nursing homes when thinking about elder care and healthcare policies. During our discussions with the government, we also explained the concepts of home based eldercare, ambulatory care, and primary care as the founding principles of the Swedish healthcare system.
The government officials showed us around in the new Zhengding area. This large area is over one hundred thirty five square kilometers. The new municipal government building is a large building in the middle of empty land. This empty land will be transformed into the new healthcare city and the surrounding residential areas. I was surprised at how quickly the government built the new municipal government, how determined the government is to introduce best practices from abroad, and their efforts to attract national attention to this project.
Setting a National Benchmark in Eldercare
Government officials want to provide basic healthcare services to everyone before 2020. The municipal government also wants the attention of the national government. They want to set a national example. The government plans to provide preferential incentives to attract membership companies of Swecare to set up their operations with Chinese partners. These partnerships can be either independent or joint. Shijiazhuang is located in the Hebei province. The government would love Hebei to be a pioneer and set the national benchmark for eldercare in the China. The overall plan for the new city is to incorporate more resources in politics, industry, academy, research, and practice.
Swecare is a semi governmental foundation that receives funding from the Swedish Ministry of Health Social Affairs. Swecare is also a membership company that receives funding from healthcare, medical technology, and biotechnology companies in Sweden. These companies are interested in exporting their products and services. Swecare can work as a network and as a facilitator for the project in China. ACCESS Health International spreads knowledge about best practices in healthcare and eldercare in different countries. We want to see best practices in Europe introduced in China. We also want to enable exchanges in the areas of primary care and in service delivery systems between Sweden and China. As such, the different partners in the project have overlapping and similar objectives. The China Development Bank Capital is a for profit entity with the outspoken objective of supporting and lending money to projects that concern urbanization, clean technologies, and healthcare. The China Development Bank Capital is actively looking for involvement in projects that further the development of China as a country. Their thinking is in line with the vision of ACCESS Health International. They are interested in the resources and companies that Swecare can attract to the city.
This initial blog post is an introduction to the China healthcare city project. ACCESS Health International is continuing to engage Swedish primary and eldercare experts. We are also continuing to conduct the feasibility study. I will keep you updated and informed of the progress.