共享与合作 - 养老产业的个性化体验（2015年11月） (2).pdf

November Connected and coordinated:Personalised service delivery for the elderly1|Connected and coordinated:Personalised service delivery for the elderlyAbout this reportWe are entering a new era of health new health.Health matters.It matters to each of us as individuals and to society it connects us all like no other.It lies at the heart of our economic,political,social and environmental prosperity and is one of the largest industries in the world.Two assumptions underpin the traditional approach to healthcare:that its about the treatment of disease;and that its the domain of a particular professional group.We need a different approach to cope with the ageing curve and increasing incidence of chronic conditions an approach that expands the focus from care and cure to vitality and wellbeing,and from episodic intervention to personalised integrated services.We must also bring care closer to the citizen and manage health collectively.New entrants from outside industries are already blazing a trail,but preserving the health of the populace will ultimately become a shared endeavour.This PwC global paper focuses on the need to shift our mind-set to reform and create more innovative and effective ways to deliver services in ageing societies.We believe those that quickly respond and make sense of the changing landscape will be the winners in the new paradigm.In addition to the global cases and views,I am also keen to share with you a few facts and figures from the China market.The transformation of health is upon us.A new era of healthcare is emerging.Will you be ready?Mark GilbraithChina Leader,Health1|Connected and coordinated:Personalised service delivery for the elderlyConnected and coordinated:Personalised service delivery for the elderly|2Table of contentsElderly care service in China 3The price of progress 9Why the current way of caring for the elderly is neither cost effective nor sustainable 10A new service delivery model for the elderly 12Addressing needs in a personalised way 13Bringing everything together 20The road to a new care model 21A shared endeavour 29Connected and coordinated:Personalised service delivery for the elderly|23|Connected and coordinated:Personalised service delivery for the elderlyElderly care service in ChinaConnected and coordinated:Personalised service delivery for the elderly|4Chinas demographic changes over the past decades have been influenced by policyKey factors contributing to the growth of Chinas populationKey factors slowing down the growth of Chinas population195519651974198820051970198119951950196019701980199020002010Post-war baby boom(1950-1957)The second baby boom:when the first baby boomers became parents（(1980-1990)（Great Leap Forward and Three Years of Natural Disaster(1958-1961)Family planning policy launched(1971)Family planning policy continued(1990-)（=1 million peopleSource:National Bureau of Statistics,PwC analysts A declining birth rate and extending average life span has led to an aging population spanning from 2010 to 2050Source:China Statistical Yearbook1950AgeAbove 65million2020404060608080001020304050607080901001980Agemillion20204040606080800Above 650102030405060708090100million20204040606080800Above 65Above 650102030405060708090100010203040506070809010020102050Fmillion20204040606080800FamaleMaleAgeAge14.4 million,5.4%of female population62.4 million,8.0%of female population10.4 million,3.7%of male population56.4 million,7.4%of male population28.5 million,6.0%of female population178.9 million,26%of female population22.2 million,4.4%of male population151.5 million,21.4%of male population5|Connected and coordinated:Personalised service delivery for the elderlyElderly citizens prefer to stay at home,however;higher incomes,smaller families and social shifts have led to a rise in senior citizens selecting nursing homesHigher disposable income is resulting in higher payment capacity in elderly carePer capita disposable income（RMBSmaller family scale results in heavier burden for young generation in elderly careFamily scale（person/familyNursing homes are increasingly popular as social ideals shift Reason for staying in nursing homes has shifted from lacking family care to seeking a preferred form of retirementProportion of Chinese seniors staying in nursing homes%Population of Chinese seniors staying in nursing homesUnit:10,000Per capita disposable income：RMBUnit:million%Family scale：person/family200520103.363.10200520101.2%2.2%UrbanRuralUrbanRural200520103,23510,4935,91019,109Per capita disposable income：RMBUnit:million%Family scale：person/family200520103.363.10200520101.2%2.2%UrbanRuralUrbanRural200520103,23510,4935,91019,109200520101.2%2.2%20052010Unit:10,000Annual growth rate 16%116243Per capita disposable income：RMBUnit:million%Family scale：person/family200520103.363.10200520101.2%2.2%UrbanRuralUrbanRural200520103,23510,4935,91019,109200520101.2%2.2%20052010Unit:10,000Annual growth rate 16%116243Chinese population above 65Unit:millionPer capita disposable income：RMBUnit:million%Family scale：person/family200520103.363.10200520101.2%2.2%UrbanRuralUrbanRural200520103,23510,4935,91019,109200520101.2%2.2%Per capita disposable income：RMBUnit:million%Family scale：person/family200520103.363.10200520101.2%2.2%UrbanRuralUrbanRural200520103,23510,4935,91019,109200520101.2%2.2%20052010Annual growth rate 16%116243A declining birth rate and extending average life span has led to an aging population spanning from 2010 to 2050CharacteristicsCare ProviderQuotes Living in senior living institutions Provided to people who prefer to stay with people of own age Senior living facilities“I feel more and more difficult to communicate with the young generation.And in senior living,I can have more same aged people to stay.”-Hangzhou The elderly live at home Mainly designed for the elderly who need care but fail to receive family care Serve as support to home care Community senior care in day time,and self or family members at nights The healthcare is mainly provided by community hospitals and thus mainly focuses on day care or home help“From my experience,taking care of old people requires a lot of time,and my son is very busy,so I will choose senior living”-Shanghai Living in own home The elderly are traditional,and prefer to stay with family Self or family members“I still prefer to stay in my home,as I dont think the staff in senior living will treat me like my children”-ChengduSource:China Civil Affairs Statistical Yearbook,China Statistical YearbookSource:PwC report;Literature research;Strategy&analysis Per capita disposable income：RMBUnit:million%Family scale：person/family200520103.363.10200520101.2%2.2%UrbanRuralUrbanRural200520103,23510,4935,91019,109200520101.2%2.2%20052010Unit:10,000Annual growth rate 16%116243Connected and coordinated:Personalised service delivery for the elderly|6Demand for beds in nursing homes predicted to increase rapidlyAge60-6464-6970-7475-7980-8485-8990-9490-94Divided by age groupPredictionPotential demand of elderly care bedsPreferenceDivided by the number of those willing to use nursing homesProportion of seniors who are willing to stay in nursing homesHealth ConditionDivided by health conditionSelf-careIncapableOthersSemi self-carePrediction of demand for elderly care beds,2015F-2025F14,00012,00010,0008,0006,0006,5907,1007,6228,1588,7129,2889,94510,62311,32712,06812,8524,0002,000Unit:1,000 bedsRises in the number of Chinas elderly care institutions,and value of private investments are underpinned by government support and market demandSource:Literature research;Strategy&analysisNumber of elderly care institutions in China went up by 3,400 in the 11th Five-Year Plan period,and the compound annual growth rate of beds reached 16.2%.1.48 1.70 2.32 2.63 2.87 3.14 34.7 34.4 36.0 37.5 38.5 38.1-5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 0.00.51.01.52.02.53.03.54.04.5200520062007200820092010Number of bedsNumber of institutionsNumber of beds:millionNumber of elderly care institutions:thousand2005-2010Number of elderly care institutions and beds in ChinaNumber of beds in private elderly care institutions went up from 2%in 1999 to 13%in 2010,while the average bed number of private institutions is higher than public institutions.Number of beds in private/public elderly care institutions98%87%2%13%0%10%20%30%40%50%60%70%80%100%199920101.02 million3.14 million90%Average number of beds in institutionsPrivate 91Public 88Source（China Statistics Bureau（PwC Analysts7|Connected and coordinated:Personalised service delivery for the elderlyIncreasing income and social shifts since 2001 have seen demand for high-end elderly care in China grow,resulting in more high-end senior communities GrowingDefiningBeginningBefore 2001Features Almost no middle and high-end senior communities in China;Few companies in elderly care property industry The first high-end senior community,though few new entrants followed More enterprises spring up in the elderly care property industry,with more high-end senior communities and different property operation models Strong potential in senior community attracts many investors Government supportPractices None Beijing Sun City Qinheyuan Huichen Senior Apartment China Insurance Regulatory Commission allows insurance fund to invest in elderly care property200120052010Source:Document retrieval A mature elderly care industry attracts customers with professional care and promotes investment in related areasMedical serviceEducational institutesEntertainmentOther facilitiesInvestment opportunitiesProducts for the elderlyHousehold carePropertyInsuranceSelf-careAssisted self-careSpecial careElderly care institutionsGovernment policiesFund of investorsService providerMotivationSupporting facilitiesSource:Document retrieval,PwC AnalystsConnected and coordinated:Personalised service delivery for the elderly|8Opportunities in Chinas elderly care market are wide spread,particularly in the high-end marketSource:Document retrieval,PwC AnalystsOpportunitiesHospitalCurrent Chinese elderly care marketSelf-careLiving assistSpecial careAcute careAlthough Chinas elderly care market is still growing,and not as mature as developed countries,there are strong business opportunities.High-end elderly care currently makes up less than 1%of the whole market,which indicates great potential for future expansion.PositioningLevel of care service9|Connected and coordinated:Personalised service delivery for the elderlyThe price of progressTwo related and remarkable changes have taken place in the last century.Thanks to sanitation,safe water,improved nutrition,modern medicine and better housing,we have triumphed over many of the maladies from which our ancestors died.And the average human lifespan has more than doubled.In 1900,infectious diseases were the leading cause of death,even in developed countries like the United States.Today,the big killers are heart disease and cancer.1 Global life expectancy at birth has soared from about 30 years to 70 years over the same period.2Yet this huge improvement in human longevity carries a price.Whereas infectious diseases strike down young and old alike,chronic diseases become more prevalent with age.So within current health systems,elderly people consume more healthcare.In the United States,for example,older citizens account for 14.7%of the population but 33.9%of the healthcare bill.3 A similar pattern prevails in the EU15,with per capita expenditure on healthcare roughly doubling between the ages of 66 and86.4Moreover,declining fertility rates have created a demographic double-whammy:as the number of older people is rising,so the number of workers available to provide,and pay for,their care is falling(see Figure 1).And changing lifestyles mean that fewer elderly individuals will be able to rely on their relatives for help.Nearly a quarter of all North Americans and Western Europeans now live alone.In Australia,if current trends continue,there will be a 90%rise in 65+single person households from 1996 to 2021.5 Solo living is also on the rise in many emerging countries.Indeed,research firm Euromonitor International predicts that there will be 288 million single-person households by 2020up from 240 million in 2010.6In addition,the quality of the care individuals of every generation seek is increasing.Widespread access to digital information due to new technology and greater personal expenditure on healthcare(in the form of higher insurance premiums,deductibles and prescription fees)have both raised peoples expectations.So have their experiences as consumers,where having a voice,choice and convenience are the norm.As a result,people want more options and information about the care they receive,more input into decisions about their care and higher standards of treatment.Increasingly people want to receive services in their own homes.One Australian study found that almost 60%of Australians aged 70 years or over would prefer to receive formal care at home in the event that they are unable to care for themselves,compared to 28%who would prefer to receive residential care.The remainder would prefer to receive care fromfamily.7The question is:how can we deliver this care?If the number of people aged 65-plus swells by some 60%in the next 15 years,and the care they require mounts with age,yet there are fewer workers to support them,how can we look after them all?Figure 1:The ratio of retirees to workers is risingThe number of people aged 65 or older per 100 people of working age(1564)AfricaAsiaAustralia&New ZealandEuropeLatin America&the CaribbeanNorthernAmerica7.017.131.235.918.133.56.311.022.725.911.522.4Source:United Nations,World Population Prospects:The 2012 Revision(2012).2015 2030Connected and coordinated:Personalised service delivery for the elderly|10Why the current way of caring for the elderly is neither cost effective nor sustainableThe current way of caring for the elderly is economically unsustainable because it is based on a costly,hospital-centred health system.If we are to devise a better alternative,we need to start by understanding the real needs of the elderly and why we currently spend so much on theircare.Culture is one key factor.Health is usually defined in terms of disease,and older people have more diseases than younger people do.Hence,seen from a clinical perspective,the elderly suffer more illness and the solution is more healthcare.But older people themselves often view things differently.In one survey of 650 elderly citizens in the Netherlands,for example,two-thirds of the respondents irrespective of agesaid their general state of health was good or very good.8 In other words,they enjoyed life,didnt see themselves as sick and didnt want to be medicalised.Research by British gerontologist Ian Philp reinforces these findings.When you actually ask older people what they need,he notes,their top three priorities are pain management,companionship and financial advicein that order.9 So healthcare providers are focusing on the w