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1、,Responding to challenges of population aging: experience from the worldApril 17, 2014Session 2: health and cognitionRobert J Wills cognition and economics in an aging population Life cycle earning by education and ability Investment=F(ability, income, education, financial knowledge) Measuring Gc (c
2、rystalized intelligence, being the direct result of experience, learning, and education, and was relatively free from the influence of biological and neurological factors) and Gf ( fluid intelligence, related to biological and neurological factors and is exemplified by inductive and deductive reason
3、ing) Data: CogUSA Survey & CogEcon Survey about financial knowledge How fluid intelligence is related to psychometric or IQ Number series good measure of Gf, best correlated with economic knowledge and outcomes Empirical age patterns of number series(Gf) and financial knowledge(Gc) Fluid knowledge a
4、nd crystalized knowledge strong predictors of stockholding and investment strategy How malleable is intelligence-mental retirement effect The Flynn effect-IQ may be explained by growth in human capital Data: HRS, ELSA, SHARE pooled data Challenge of dementia- age patterns of normal cognitive decline
5、 and dementia Conclusion: cognition measured in surveys like HRS and CHARLS play an important role in the lives of old peopleJinkook Lee health and cognition of older adults in India Introduction: why study C-reactive protein(CRP) and hemoglobin(Hb)-epidemiological transition-from OECD health data,
6、high morbidity and mortality rate Data: LASI, longitudinal survey biomarker collection, age 45+, DBS(dried blood spot testing) sample, pilot study, structure-community, household, individual Policy background: difference female-male life-expectancy, gender gap, rural and urban(CVD-a problem of urban
7、 rich) Significant state variations exist in India- economic development(significant), education, health care utilization, male preference(indicated by child sex ratio and school attendance) Gap between diagnosed and measured hypertension varies across state Regress CRP on age groups and on state- S
8、ES(social economic status) gradient exist in CRP & Hb; rural- higher risk, state variation- explained by factors, female- higher risk CVD is not only health problem for high SES, but as important for ill-nutrition and poverty Differences between gender , Female disadvantages in cognition because edu
9、cation discrimination. Gender gap in education accounts for gender differences in late-life condition. Education benefits sexual generations. Gender gap in schooling rate and years led to cognition gap.Xiaoyan Lei health outcomes and socio-economic status among the mid-age and elderly in China We wi
10、tness good outcomes from health revolution, such as life expectancy, mortality rate, nutrition(overweight and underweight, obese) Aging problem: population size, workers per pensioner Demographic transition calls for transition of health system(the previous one focus on young, infectious, chronic di
11、seases) CHARLS measure both self-reports and biomarkers Difference by gender, hukou, region Health outcomes include self-report, disability(ADL, IADLs), BMI, body pain(moderate and severe), hypertension(prevalence, diagnosis, medication/treatment), rate the possibility of reaching 75 where women hav
12、e poorer expect to reach 75(ask people below 65) Poorer in rural, women, inland. Disability(ADL, IADLS)&body pain(moderate, severe)-femalemale, costalinland, urbanrural, raise fast with age for subgroups, while pains increase not so sharply BMI(underweight, overweight, obesity): distribution of BMI,
13、 shift right for female; over-nutrition is more of problem than under-nutrition, especially for woman, urban, costal people We draw distribution of BMI and see rich people problems. We dont have problem of obese like western but we already face high overweight Hypertension in women and elderly, and
14、the problems of not diagnose or no treatment. Underdiagnose is high for rural elderly; treatment is not high even among who is diagnosed Self-reported health by sex and age, poor health increase with age Our explanatory variables include education(higher education-better self-report, logPCE(use medi
15、an as a cutoff point to do comparison), age, community(play important role), interview month dummy( due to seasonal difference in BMI) SES gradient is sharper within man, urban, and coastal areas We do reorient: pause response, health outcome, rural access to community service, chronic diseases, whi
16、ch is crucial. Conclusion: three important factors: education (positively correlated with almost all health outcomes), gender, area Policy: be sure what type of policy specifically, adapt to the demographic and health transitions, especially chronic diseasesSession 3: Disease Burden, Subjective Well
17、being and Elderly CareGonghuan Yang Disease Burden of Mid-aged and Elderly Chinese GDB global disease burden Death, life cost, disability, disability-adjust life Results: 0.9 to 0.6 percent death rate, 69.3 to 75.7 in life expectancy(only 58% reach 60 at 1990 while 70% reach 60 in 2010), from 1990 t
18、o 2010: significant change, health pattern transition in China, notable peak of cancer in 55-59 China have better performance than G-20 Burden increase in old people Indicators of specific causes of disease and injury-deaths, YLLs, YLDs, DALY Health pattern transition Morbidity in older people, the
19、main health burdens of NCD for older people The biggest killer: cancer, stroke, COPD, The greatest cause of disability: diabetes, visual impairment(21% have visual impairment after 80 years old), prevalence, lung cancer( versus exposure of smoking) High suicide rate in old people Policy suggestion-m
20、eet specific needsAlbert Park Subjective Well-being and Age: Evidence from DRM Panel Data from Rural China Limitation:1, age and cohort effect confounded; 2, specific to SWB measure used (experienced utility and hedonic well-being) Previous work also find U shape disappear, or weak U shape before 60
21、 We assess: positive (enjoyment and happiness), negative (stress, sadness,) And we find averse U shape pattern (PNAS 2010)- a change in peoples forties or fifties DWR survey and ask question on life satisfaction: “not at all”=0, “a little”=0.5, “very”=1 Inverse probability weighting(IPW) Index of ex
22、perienced utility j=1nitijsourceij/j=1nitij j:activity, i:individual Life domain satisfaction DS=(#-3)/2 We run pooled OLS:SWB=0+fageit+Xit+i+t+it Predicted experienced utility & life satisfaction by age groups with 95% CIs, using OLS and two-way fitted-effect We find U shape in OLS, but once we con
23、trol fixed effect the U shape disappears, but there are significant time trend effect(we control it) “relaxed” emotion Negative feeling: worried, busy, irritated, depressed, tense Explanatory: health, income, housing, family relationship, social relationship - income and family relationship is the m
24、ost obvious, while health is obvious at older age Age profiles of experienced utility by gender DRM&SWB We need more research into the mechanism Panel makes sense in controlling for differences in individual charactersXinxin Chen Disability and Elderly Care in China Disability and elderly care Immig
25、ration of children It may change the traditional gender rule. We are interested in the desirable availability of family care resources, current care arrangement, job divisions within family, namely daughter or son provide health care ADL activities if daily living, difficulties of dressing for examp
26、le Help/care availability: 13.7% receive no help! Where male are more difficult to receive. 52% only get care from spouse, and 6% got from their children Care source for the disabled elder who get help by gender-married elder- child which child provide care Subsample- which parent is more likely to
27、get help, use child sample Dependent variable: care categories (care or no care) Independent variables: child, spouse characteristics Results: son are more possible to care their disabled parents, son-in-law is includes to the daughter!April 18, 2014Session 4: Retirement and HealthDavid Wise Retirem
28、ent around the World Three themes:1. Capacity to work, based on mortality (but whether we can have other indicators that can show health quality, not just death rate)2. Trend of working longer3. Who can work longer, where education is the marker, also related to employment, earnings, accumulated ass
29、ets Capacity to work: increase in life expectancy with the decrease of workingBig differences between counties working at 63, Japan over 60%, France just 10%Graph employment by mortality rate, 纵轴是employment rate, 横轴是mortality rateChina and US are more or less the same in employment by mortality Rece
30、nt trend: employment rate 在1990到2000年有一个drop，2000年之后又继续上升中国是1995年开始drop，到2005年开始又升高（分了三个类别看的，50-54,55-60,61-65） Who can work longer?1, education is the things that matterEducation and DI participationHealth, employment, earnings, asset搞清楚是那些人先退休了Limit education places strong limits on working longer
31、.John Giles The Retirement Patterns and Labor Supply of Older Workers in East Asia1. Concerns over early retirement2. Well-being in old age. Is working always a choice?3. Patterns of labor supply across East Asia, we study the role of pension eligibility, health status and family needs, we also stud
32、y the womens exit to perform non-market household work Steep decline of labor force participation with share of population, with claim to pension Gender gaps and urban rural gaps Tend to retire earlier which is driven by the pension system We notice self-employment important for old people, especial
33、ly in rural 城市人口最受到pension的影响，一个明显的剧烈的drop在可以得到pension的年龄点 日本和韩国这个现象没那么明显 In urban: wealthy and pension. In rural: poor and few pension. We build a decision model: need for income, capacity to work, opportunity cost of time, health status of own and spouse Policy:a) Change incentives related to pens
34、ion systemb) Skills and ability to work longerc) Health and ability to work longerd) Womens work and care responsibility, where we find weak evidence, although we find earlier effects of women because they will give birth to babies.e) Joint retirement decisionLisa Berkman The intergenerational trans
35、mission of health in China: Education of Children and Health Benefits for Parents Aging driven by economics growth and education Motivation:1. Parents mortality is influenced by the childs education2. Limit in intergenerational transfer literacy We pay attention to financial, appraisal, emotional su
36、pport from parent to children Method: first we limit to those have child, then we take parents education, child education, hypertension, ADL Analysis: age, marital status, hukou, province, children whether have more education than parents, number of kids Probit model Negative binomial models Results
37、: huge selection, huge demographic transition Future research: child providing social support or SES resources mediatedConclusion by Axel Borsch Supan Does Aging Matter Policy in need:1. Baby boom/bust: pre-funding2. Longevity: adjust working life3. Fertility: improve the quantity and quality(educat
38、ion and health) Policy in labor market:1. Increase retire age, decrease job entry age2. Increase female participation3. Reduction of unemployment to the NAIRU rate4. Reform the pension systemApril 19, 2014Session 1: 养老政策与养老机构运营王振耀中国养老产业的前景与市场机构转型一、中国的老龄化形势与市场潜力 一个隐藏的超老龄化社会 程度VS绝对数量 关于大于80岁的老人，失能老人，贫
39、苦低收入老人，空巢老人，农村留守老人，慢性病老人二、从发达国家的老龄化应对看养老服务业的发展与经济社会结构转型 养老不仅是产业，还是生活方式、生产方式、管理方式 部分国家老龄化速度比较，当时经济发展水平对比，发达国家的产业结构变化与转型，第三产业比重与就业人数中国不是未富先老 日本主要养老政策、老年人保健福利政策的发展趋势三、中国养老产业的现状与前景 推动我国社会的产业升级与转型，转变就业方式，产业结构等等 全国养老服务体系现状：刚起步（依然按城乡身份管理社会，刚刚建立起基本生活保障制度），老年福利&社区和居家养老服务&床位建设 症结在于，缺乏专业的养老护理学校，缺乏合格的护理人员（按照发达国
40、家的比例推算，至少需要1000万护理人员，可是目前注册在岗且持有证书的只有2万！该行业目前就业总量仅为10万），缺乏养老护理工作的适宜管理与开发机制 养老服务的政策走势：专业化 养老存在三个脱节：老年人与社区缺乏连接，机构与养老人口的政策缺乏连接，养老与护理脱节 如何促成养老产业发展？将经济体制改革与社会体制改革结合起来，将产业的升级与转型结合起来（急需建立养老产业发展的专业支持系统，包括咨询教育和培训） 养老需要打破公与私的界限，需要打开社会投资领域肖才伟政府在养老产业发展中的作用发达国家的经验和做法一、政府与市场的关系 政府目标：保障所有公民老有所养 市场目标：利润最大化 养老产业的发展使
41、二者相互促进目标的实现，但发展快慢、速度取决于二者双重作用二、政府应发挥的作用 立法 调节、平衡代际间、群体间利润分配，保障弱势群体 监督市场行为，维护公平竞争三、发达国家做法（美国） 美国老龄方面的主要指标 美国人口老龄化阶段的划分 美国老龄领域的立法（美国老年人法） 老年人营养部分，集体就餐（老年中心），家庭送餐，营养支持服务 标准，运行，政府分级管理 空巢中的老年人：小孩不在身边饮食结构可能改变对话&问答 养老机构需求很大，有效市场中Demand大，为何Supply不足缺乏专业支撑系统，没有生产养老服务的技术（养老培训问题，现在中国没有一个学校开设养老护理专业） 思考：养老业是否存在组织
42、障碍，价格人为扭曲，政府有没有管制太多使供给不足 养老要解决精神层面的问题 养老大的市场在未来20年以后 公办民营，民办公助社会化养老，政府兜底（国家提供低保、福利院），市场化整体运营 社区养老市场很大但重视不足，国家对整个系统床位补贴，但很多社区不需要床位因而拿不到补贴 业界观点：要找到养老产业的商业模式，建老龄社区（地产商面临转型）只能满足高端市场 例子：爱晚工程，居家养老（把房子卖给老年人，用有产权的住宅用地，见医院、老年中心、引入大学的护理学院）因为现在有钱人也养不了老（不缺资金的情况下买不到产品）希望从高端市场做起（这部分市场商业模式最明显，类似于先富带动后富） 学界观点：但真正需要
43、服务的是底层的人（由11年基线调查的数据，大于60岁的失能老人有38%，需要帮助的占22.7%，农村占27%，城市19%。大部分除家庭以外，没钱支付他人照料，大部分有子女且在居住地附近，配偶提供照料，家庭以外照料保姆仅有0.7%）对于一个市场，先拿willingness to pay 最高的一部分人，但这部分拿完之后，建老龄社区这种对高端市场的商业模式就行不通了。养老社会不一定是最好的，社区养老适合，赫兰模式。希望从中层市场做起，这部分需求最大 子女能否提供照料是问题(退休年龄延迟)，养老产业起帮助子女照料的作用，子女最好在社区附近能够参与，利润空间看家庭竞争能力 竞争对手：保姆市场Sessi
44、on 2：涉及养老的医改与金融创新刘国恩中国医改与长期护理市场一、疾病与医疗 人类疾病的转型 人口期望寿命增长曲线（小孩出生从0岁开始算的&从50岁开始算的）看变化水平与期望斜率前50年：婴儿死亡率显著下降，后50年：科技、医疗手段 慢性疾病与养老体系二、养老、老龄与医疗的关系三、健康与医疗 身体本身的问题（比如cancer）VS外来骚扰，避免战争与赢得战争 病有所医重大制度安排出现方向性问题，重点应放在防止疾病发生上王和我国养老资源的保险解决 我国养老资源的供给现状：人：家庭成员，抚养比5变成3或2（人口政策问题）&专业护理财：社会保险，商业保险，家庭储蓄（替代率，名义与实际状况的差异）物：
45、养老机构，社区设施（顶层设计重视不足），家庭养老（因为抚养比高，压力大） 热点话题：反向抵押贷款，如住房抵押贷款，能解决的问题有限（买不起房，未来房价估不准） 热点话题：企业年金，职业年金 商业养老保险三种给付方式：货币-居家养老-通胀风险制约其发展（资助存在缺口，即使不存在缺口，替代率也有限）半实物-社区养老-需统筹规划-保险公司自建养老社区难以满足demand（物联网和人工智能将促进其发展）实物-机构养老-供给不足（信用和资金是制约发展的关键） 实物模式：供给模式创新探索，中国养老保险公司&中国养老机构联盟互为产业链，养老资源证券化对话&问答： 长期照顾市场可以减轻医疗通胀的压力 长期照顾属于社保体系那一层有待商榷，（是否应该纳入基本保障） 长期照顾市场符合保险经营原则，可精算测算定价，问题在于供给和货币支付方式，能否买到 大目光应放在社区养老上，机构能覆盖的范围太小 机构养老三种模式：英国、美国、日本模式，中国与日本最类似 医患纠纷：宁波解法，医疗责任保险制，医疗事故纠纷解决处理中心。基于信息不对称产生的双方利益冲突往往通过引入第三方来解决。从市场角度看保险是一个很好的选择