1. Countermeasures Study against Aging Problem in Shanghai
Shanghai Academy of Development & Reform
Ruan Qing

2. In 1979, aging people in Shanghai over 60 years old initially occupied over 10% of total Shanghai population, which made Shanghai become the first aging city in China.
Time goes on, currently “Elders Living Alone” families are growing faster, which brings huge challenges for the Social Security System in Shanghai

3. Current Situations and Tendencies Practices and Countermeasures
Catalogue 1 2 3
Current Situations and Tendencies
Challenges
Practices and Countermeasures

4. Current Situations and Tendencies
上海市发展改革研究院

5. Currently Situation of Aging Problem in Shanghai
1.4%
0.8%
19.6% of Shanghai
Population in 2015
30.2% of Shanghai
Population in 2015
Increased (2014)
Increased (2014)
Aging People over 65
Aging People over 60

6. The Construction Map of Shanghai Aging People over 60
60-64
70-79
65-69
The Construction Map of Shanghai Aging People over 60

7. Aging Population Change in Shanghai in Last Decade
Unit:10K
Over 60
Over 65
Year

8. Aging Population Proportion Change in Shanghai in Last Decade
Over 60
Over 65
Year

9. Life Expectancy Change in Shanghai
Unit: Years old
Years
Life Expectancy
Male
Female
2015
82.75
80.47
85.09
2014
82.29
80.04
84.59
2013
82.47
80.19
84.79
2012
82.41
80.18
84.67
2011
82.51
80.23
84.80
2010
82.13
79.82
84.44
2005
80.13
77.89
82.36
2000
78.77
76.71
80.81
1990
75.46
73.16
77.74

10. Tendencies
During 2015 and 2020, Aging people over 60 years old will increase 0.21M in Shanghai
By 2018, totally over 5M
By 2020, totally over 5.31M
Touch the peak value during

11. Unit:10K
Year

12. Challenges
上海市发展改革研究院

13. Heavier Old-Age Burden Higher Medical Cost Pressures
Far More Nursing Needs

14. Heavier Old-Age Burden
Age Dependency Ration Increase Sharply
（Age Dependency Ratio=Aging population/Working Age Population×100%）
26.1%（2000）
50.2%（2015）

15. Support Ration Change of Staff Endowment Insurance in Shanghai during 2006-2015 (Unit: 10K)
Year
Individual Numbers of Payment
Individual Numbers of Pensioner
Support Ratio
2006
477.7
294.7
1.62:1
2007
483.8
310.0
1.56:1
2008
495.3
324.4
1.53:1
2009
506.9
338.9
1.50:1
2010
542.9
352.0
1.54:1
2011
926.9
364.0
2.55:1
2012
948.0
378.4
2.51:1
2013
952.4
390.6
2.44:1
2014
969.3
404.1
2.40:1
2015
995.6
415.8
2.39:1

16. Higher Medical Cost Pressures
Serious Aging Problems
More Chronic Disease Attack
More Medical Insurance Cost
During , the Staff Medical Insurance Expenditure of Shanghai averagely increased 13.5% every year.
In 2014 and 2015, the disbursement of medical insurance for retired people is 6.2 and 6.3 times as much as the value of working people respectively.

17. Far More Nursing Needs
5.4％ of total Population in Shanghai
17.9％ of Aging people over 60
Aging People over 80 in Shanghai：0.78M（2015）
During the “Twelfth Five-year Plan”, aging people over 80 years old averagely increased 5.5% every year
By the end of 2015, over 0.98M aging people live alone without their children
In the near future, over 80% aging people are the parents who have only one child
There are about 13% aging people over 80 years old who cannot take care of themselves
It is extremely urgent to establish a long-term care insurance system for ageing people

18. Practices and Countermeasures
上海市发展改革研究院

19. √ Promote Reformation of Staff Endowment Insurance
Recent Works
Promote Reformation of Staff Endowment Insurance
Optimize Reformation of Medical &Medical Insurance
Perfect the Geriatric Nursing System √

20. Enlarge the System Institution Coverage
Delay the Age Apply for Pension Flexibly
Reformation for Endowment Insurance in Agencies and Institutions
Reformation of Staff Endowment Insurance

21. Support Ratio Decreased More Deficit in Endowment Insurance Fund
More Aging People
Support Ratio Decreased
More Deficit in Endowment Insurance Fund
Endowment Insurance
In 1999, deficit in endowment insurance was 0.59B RMB. By the end of 2010, the value increased to 10.3B RMB
In order to optimize the deficit, Shanghai begin to promote the reformation of Staff Endowment Insurance System

22. Enlarge the System Institution Coverage
2011
Migrant Workers
Company Staff who have joined in social security for small town
The number of insured increased 4M,which made up the deficit in 2011
Staff Endowment Insurance +

23. Delay the Age Apply for Pension Flexibly
2010
People possess professional skills
People who holding the certificate of technician or senior technician
Other talents required by companies
Can delay apply for pension when allowed to retire
（Male ＜65，Female ＜60）

24. In 2012, institutions also implemented the policy above
Reformation for Endowment Insurance in Agencies and Institutions
In 2007, government finance made up the lost of retired people in agencies
In 2012, institutions also implemented the policy above
In 2015,agencies and institutions implemented consistent calculation methodology for pension as enterprises
In 2015, established occupation pension system for agencies and institutions
- Lighten the pressures from staff endowment insurance fund disbursement
- A fair environment for fund disbursement
purpose

25. √ Promote Reformation of Staff Endowment Insurance
Recent Works
Promote Reformation of Staff Endowment Insurance
Optimize Reformation of Medical & Medical Insurance
Perfect the Geriatric Nursing System √

26. Reformation of Medical & Medical Insurance
Medical Insurance Fund Pre-disbursement
Control and pre-disburse the fund of medical insurance for medical institutions
Promote “Family Doctor” Mechanism
From 2011, established contracts between family doctors and community residents
By the end of 2015, signing rate is 44%
Enhance the Management of Chronic Diseases
Regularly provide physical examination for aging people over 65 years old

27. √ Promote Reformation of Staff Endowment Insurance
Recent Works
Promote Reformation of Staff Endowment Insurance
Optimize Reformation of Medical & Medical Insurance
Perfect the Geriatric Nursing System √

28. Perfect the Geriatric Nursing System
Pension Service System
Service System
Geriatric Nursing System
Geriatric Nursing
Medical Insurance Fund
Financing System
Government Finance Fund

29. “9073”Pension Service
“9073”means 90% aging people take care of themselves at home, 7% aging people accept pension service in community, and 3% aging people accept pension services in agencies
By the end of 2015, there were 699 pension agencies established in Shanghai , including 0.12M beds provided

30. Beds Numbers in Pension Agencies of Shanghai during Last Decade
4.31
5.24
6.41
7.24
8.47
8.99
9.36
9.65
10.21
10.75
12.6 2 4 6 8 10 12 14 万 年份
Unit:10K
Year

31. Establish Medical & Nursing Beds
By the end of 2015, there were 27.3K Nursing Beds provided for aging people
which were established in health centers, nursing agencies and hospitals both public and private

32. Pilot for Old-aged People Nursing & Medical Guarantee Plan
Target Groups：Shanghainese whose age over 70 and have joined in staff medical insurance…
Evaluation：Evaluate the self-care capability, health status ,etc., of aging people by professional institutions
3 levels in medical & nursing service
Service agencies：Geriatric Nursing service agencies which managed by medical insurance
Service Staff：Professional nurses and trained care associates
Services：Basic Nursing, clinical nursing and home nursing ,etc.
Service Standard：3-7 times every week according to different nursing levels.
Every time, 1 hour
Payment Allocation：90% disbursed by medical insurance fund，10% payed by individual

33. Treatment & Maintenance
Combination of
Treatment & Maintenance
Increase the medical institution in nursing agencies and settle the expenses by medical insurance fund
Sign the service contract between nursing agencies and health centers
Encourage “Home Doctors” provide more basic health services
Implement Old-aged People Nursing & Medical Guarantee Plan

34. Countermeasures and Suggestions
上海市发展改革研究院

35. Perfect Staff Endowment Insurance System
Introduce relevant policies to extend retirement age
Extend the retirement age for five years for both male and female
Extend pension insurance payment year appropriately
Extend pension insurance payment year from 15 years to 20 years progressively
Search for different mechanisms to finance the pension insurance
Establish the reserve fund for Shanghai pension insurance, the fund could financed by government, national assets and land leasing
Develop Supplementary Pension Insurance
To support supplementary pension from policy level, especial from tax and etc.

36. Expend the Functions of Individual Medical Insurance Account
Optimize Staff Medical
Insurance System
Expend the Functions of Individual Medical Insurance Account
Reform the Medical Disbursement System
Promote the Development of Commercial Health Insurance

37. Establish a Long-term Care Insurance System
The purpose for Shanghai to launce the “Old-aged People Nursing & Medical Guarantee Plan” in 2013 is to discover a feasible way to establish “Long-term Care Insurance System”
The “Long-term Care Insurance System” could be treated as an independent Insurance
Target Groups：All working and retired staff who has payed staff medical insurance
Financing from: Government, enterprises and individuals. At the initial phase, could be financed by staff medical insurance fund
Payment ways：Consider the care target with different status

38. Questions?
上海市发展改革研究院