Xinxin Chen, John Giles, Yafeng Wang, and Yaohui Zhao
With rapid population aging, China faces unprecedented challenges in providing care to elders. Coupled with sharp declines in fertility, massive out-migration of children, and lower relative wealth of the older generation, the traditional model of relying on the family for eldercare may fail and leave many at greater risk for lacking care and support when needed. To better understand the challenges posed by likely unmet care needs for future elderly, Xinxin Chen, John Giles, Yafeng Wang, and Yaohui Zhao examine determinants of access to care among current elderly, with special attention to gender differences.
Methodology. Chen et al. use the baseline wave of the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011–12, a nationally representative survey of people ages 45 and above to describe patterns of eldercare needs and care provision in China. They analyze factors associated with unmet care needs, examine which family members provide care, and show how patterns in care provision may explain the deficit in elderly women’s receipt of care.
Main findings. Chen et al. show that a significant number of China’s elderly (ages 60 and above) do not receive instrumental care when needed. Specifically, while 23.8 percent of the older population (ages 60 and above) required care in at least one type of daily function defined by activities of daily living (ADLs) or instrumental activities of daily living (IADLs), women are 39.9 percent more likely to have care needs than men. Among those with needs, 11.6 percent have at least one type of unmet need, and women are 29.3 percent more likely than men to have unmet needs. Given that older women are also more likely to be poor, lack of care is likely to compound the difficulty of poverty.
Chen et al. find that most of the gender gap in unmet needs is explained by marital status and the health status of the spouse. Having a spouse increases the likelihood of receiving care for both men and women, increases the likelihood of receiving care solely from their spouse, and decreases the likelihood of receiving care solely from their child. The effect of spouse’s health status also matters. Compared to those having a spouse that requires care, elderly are more likely to receive care from spouses without disabilities. And the effect of having a spouse differs for men and women. Among those who are married, if the wife requires care and the husband does not, then the wife’s probability of receiving care is lower than when the husband requires care and the wife does not.
The authors also reveal a sharp gender division in patterns of family care provision. While men tend to be cared for by a wife, women receive care from their children. That is, a wife is the dominant care provider for men – 53.8 percent of men requiring help are cared for by their wives alone. Among women requiring care, only 28 percent receive care exclusively from husbands. Instead, children provide care to 42.7 percent of women who require care, making them the dominant source of care for women.
Policy implications. Chen et al.’s study has important implications for designing gender sensitive policies in eldercare. As population aging deepens, the scale of unmet needs in China is likely to grow. The Chinese government is setting up community care centers with the aim of helping families provide care to elders. As women are disproportionately represented among those not supported by the family-based system of care, special efforts should be made to reach out to elderly women, not only widows but also those whose husbands appear to be healthy but are either unable or unwilling to provide assistance to their wives.