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Open Journal of Social Sciences, 2015, 3, 150-156
Published Online November 2015 in SciRes. http://www.scirp.org/journal/jss
How to cite this paper: Lu, J.P. (2015) Status Quo, Problems and Countermeasure Research of Home-Based Care Service
Market in China—A Case Study of Sichuan Province. Open Journal of Social Sciences, 3, 150-156.
Status Quo, Problems and Countermeasure
Research of Home-Based Care Service
Market in China—A Case Study of Sichuan
Busin e ss School, Sichuan Normal University, Chengdu, China
Received 28 September 2015; accepted 13 November 2015; published 17 November 2015
Copyright © 2015 by author and Scientific R esea rch Publishing Inc.
This wor k is lic ens ed under the Creati ve Commons Attribution International License (CC B Y).
This paper makes a case study of Sichuan Province whe re a larg e number of agi ng population lives.
By the social investi gatio n meth od , 35 0 aged com munity people are inter viewed to discuss the
conflict be tween supply and d emand in the c u rre nt hom e-b ased c are se rvice m ar ke t and th e
problems a rising out of th e m ark e t-orie nted oper ati on. In addition, th i s paper bri ngs a bout spe-
cific counter measu res and recomm enda tions, with a view to give full play to the role of mar k et-
oriented m ech anism in o ptimized al l oc ati on of res ou rces , and to inspi re par ticipa ncy of v a riou s
force s in to home-ba sed c are se rvice mar ke t, th u s diversifying th e h ome-ba sed car e s ervice pro-
viders and p rov isi on m od es in China, and g re atly im provin g the QOL (qual ity of life) of the elderly.
Home-Based C ar e Ser vice, Demand, Supply, Probl ems, Coun termea sures
As the only country whose aging population exceeds 100 million in the world, China is witnessing more than 3%
growth rate of aging population, representi ng 5 times of the population growth rate for the same period. It is es-
timated that the aging population will reach 438 million by 2050, showing a 28.76% of aging rate . In light of
the economic and social development situation in China, “age before it gets rich”, “no o ffi c i al g uarantee before
aging” are deemed the two fundamental realities of the country. Meanwhile, China’s population aging is ac-
companied with industrializa tion & urbanization process and middle income trap; under this circumsta nce, the
J. P. Lu
problem of aging is e xceptionall y serious across the world. Sichuan Province, ranking the fou r th place in terms
of population size, is challeng e d by the more serious aging situations, presenting several features includ ing large
aging population base (ranking the second place in China), rapid aging gr owth rate, advanced age, large number
of empty-nest elderly, more intensive rural aging phe nomenon, etc. Accord ing to the sixth National Population
Censu s held in 2010, Sichuan Province has 80.4175 million of permanent resid ent population, accounting for
about 6.03% of total populatio n in China. The population exceeding 65 years and above is 8.8055 millio n, mak-
ing up 10.95% of to tal population in Sichuan Province, 2.08% higher than the national a ver age level. Addition-
ally, according to the data ob ta ined fr om the subject research report “Esti matio n on Population Aging in Sichuan
Province for the Future 30 Years Based on the Sixth Natio nal Pop ulatio n Census Results” prep ared by Sichuan
Provincial Aging Population Depart ment, Sichuan will encounter exceptionally serious aging situation in the
forthcoming 30 years. It is estimated that the tota l population up to or exceeding 60 years will make up more
than 25% of total p opulatio ns in Sichuan Province by no later than 2027, and will exceed 33% by no late r than
2036. Population aging imposes profound impact upon economical and social aspects of Sichuan Province, and
the growing demands fo r pens ion, medical treatment and social service are req uired by a large number of aging
population. However, the elderly care service in Sichuan Province, especially the “9073” mainstream care ser-
vice, is not improved. For this, the elderly care service shall be advanced by giving full pla y to the r o le of mar-
ket-or ie nted mechanism provided that the guidance and instruction from competent governmental agencies shall
2. Survey on Demand s f or Home-Based Ca re Service in Sichuan Province
During October 2014 to February 2015, the Author, by question naire survey method, has made survey on the
demands for home-based care service in major communities of Sichuan Province. In this survey, 380 question-
naires are distributed totall y and 350 are collected, including 331 valid ones.
2.1. Basic Information about the Respondents
Among the 331 valid questionnaires, 133 questionnaires are completed by male respondents, accounting fo r
40.20% of the to ta l, and 198 questionnaires completed by female respondents, making up 59.80%. The average
age of all respondents is 72.65 years. A major ity of respondents have married and accompanied with spouses,
totaling 198 perso ns, accounting fo r 59.82% of the total respondents. 95 respondents are widowed, accounting
for 28.7% of the total; 32 respondents are divorced, 9.67%; and 6 respondents are unmarried, making up 1.81%.
Among them, 198 respondents live together with their spouses, accounting for 59.82%, 85 respondents live to-
gether with their children, 25.73%; 48 respondents live alone, 14.45%. A majority of respondents before retire-
ment are peasants, making up 19.94% of the total respondents; followed by the common te c hnic ian s, accou nting
for 15.71%. The respondents who are individual businesse s share 15.11% and handicraft s man make up 10.27%.
The remainders who are engaged in other industries only make up less than 10% of the to tal.
2.2. Economi c an d He alth Status of the Respondents
There are 85 respondents whose monthly income is lower than RMB 1000 accounting for 25.68% of the total
respondents, 90 respondents whose monthly income is between RMB 1000 a nd RMB 2000, 27.19%; 65 res-
pondents who monthly income betwee n RNB 2000 and RMB 3000, 19.64%; 91 respondents whose monthly in-
come exceeds RMB 3000, 27.49%. There are 177 respondents who are capable of taking care of them, account-
ing for 53.47% of the total respondents; 119 respondents who are semi-self-cared, 35.93%; 35 respondents who
are fully incapable to care fo r themselves, 10.57%.
2.3. Demands of the Respon dents for Hom e-Based Care Service
Among the respondents, there are 279 respondents who are eager for househo ld management service (sweeping,
cloth cleaning, fee pa ying agent, repair and maintenance of household app liances), accounting for 84.29% of the
total respondents; 145 respondents who de si re sa fe ty care service (bath help, acco mpanied sho pping, etc.), ac-
counting fo r 43.81%, 90 respondents who wish fo r day-care center service, making up 27.19%, and 105 respon-
dents who desire elder l y meal delivery service, sharing 31.72%. There are 113 respondents who wish for medicine
disp e nsing and buying age nt service, account ing for 3 4.14 % ; 1 18 resp o nde nts wh o hope for accompanied
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medical treatment, accounting for 35.65%; 250 respondents de siring periodic door-to-door physical inspection,
sharing 75.53%; 133 respondents requiring healt h-care consulta tion, making up 40.18%; 110 respondents who
wis h fo r professional health care, 33.23%; 139 respondents expecting healt h-care lecture, 41.99%; 77 respon-
dents who hope for getting recovery instructions, 23.26%; 66 respondents desiring home bed service, 19.94%;
and 13 respondents expecting to get other care service, 3.93%. There are 148 respondents who desire door-to-
door reading and chatting service, accounting fo r 44.71%; 82 respondents desiring professional psychological
consultation service, 24.77%; 218 respondents who wish fo r development of periodic recreational activities,
65.86%; 203 respondents wh o expect to diversify the community activities, 61.33%; 27 respondents desiring
legal consolation service, 8.16%; 18 respondents desiring matchmaking service, 5.44%.
According to the survey and analysis above, it is revealed that the elderly in Sichuan Province has great and
urgent demands fo r home-based care service, especially in the aspects of daily care, med ical treat ment, health
and psychological aid. This is the precondition and basis fo r market-oriented oper ation of home-based care service.
3. Analys is of Current Situation Concerning Supply of Home-Based Care Service in
As shown in Table 1, in recent years, Sichuan Province achieve rapid growth rate in economic and social de-
velopment. The living standard and social security i ndicator s (including the per cap ita disposable income and
consumption expenditure of urban and rural resi dents, number of urban and rural reside n ts maintaining endow-
ment insurance, total beds provided by elderl y service institutions, etc.) present a substantial growth trend. Ac-
cording to the Statistical Communiqué of Sichuan Province on the National Economic and Social Development,
the per capita disposable income of urban and rural residents in Sichuan Province was RMB 15,461 in 2010, up
to RMB 24,381 in 2014, representi ng a growt h rate of 12%; the per capita consumption expenditure of urban
and rural residents across Sichuan Province grew fr om RMB 12,105 in 2010 to RMB 18,027 in 2014, witnessing
an annual growt h ra te of 10.68%; the per capita net income of rural re sid en ts i ncreased fr om RMB 5140 in 2010
to RMB 8803 in 2014, with annual growth rate up to 14.82%; the per capita consumption expendi ture of rural
residents was RMB 3896.7 in 2010 and increased to RMB 6906 in 2014, representing an annual growth r a te of
14.66%. The number of urban and rural residents maintaining endowment insurance witnesses a rapid growth,
increasing from 13.11 million in 2010 to 30.139 million in 2014. In addition, the to tal beds provided by eld er ly
service institutes experience substantial increase: additional 3155 beds are provided by the state-run urban el-
derly social welfare institute s across Sichuan Province in 2010; 152 rural central gerocomiums were newl y built
and expanded, providing 11,000 beds. 8313 kinds of urban community service facilities a re made a vailab le and
781 community service centers were built. In 2011, the total beds of elde r ly care service institutes (excluding
rural gerocomiums) reached 57,096; and 112 rural central gerocomiums were newly built and expanded, pro-
viding 12000 beds. 4819 urban community service centers (station) are established. In 2012, the total beds of
elderly care service institutes in Sichuan Province reached 319,000, and 2937 urban community service ce nters
(station) were established. In 2013, the total beds of elderly care service institutes in Sichuan Province attained
to 336,000, includin g 5525 beds provided by the 73 ne wly-built or expanded rural central gerocomiums, and
Table 1. Resident income, consumption, insurance procurement and care bed in Sichuan Province during 2010-2014.
Urban residents Rural residents
Total beds for
net income Per capita
consumption exp enditure Per capita
net income Per capita
consumption exp enditure
rate (%) Amount
15,461 11.7 12,105 11.5 5140 15.1 3896.7 11.6 1301.1
17,899 15.8 13,696 13.1 6128.6 20.5 4675.5 20.0 1494.0
20,307 13.5 15,050 9.9 7001.4 14.2 5366.7 14.8 1614 31.9
22,368 101 16,343 8.6 7895 12.8 6127 14.2 3001.6 33.6
24,381 9.0 18,027 10.3 8803 11.5 6906 1 2.7 3013.9 36.1
J. P. Lu
2940 urb an community service centers (station) were established. In 2014, the total beds of elderly care service
institutes in Sichuan Province reached 361,000, and 10,276 community service institute s were establis hed , in-
cluding 6806 urban community service organizations.
It is revealed that Sichuan Province, for d eali ng with the population aging dilemma, did efforts to make up the
shortfall in terms of insuf ficient supply of endowment servi ce and made a signific ant progress. However, com-
pared with the increasing population aging rate and the urgent demands of the elderly for house-based care ser-
vice, the efforts are not enough. To solve the problems arising in the house-based care service market in Sichuan
Province, specific counter measures and recommendations shall be given.
4. Problems in the Current House-Based Care Service Ma rket
4.1. Dislocat ion of Governmental Functi on in H ous e-Based Care Service
At pres ent, the governmental agencies assume much house-based care work which sho uld not have been as-
sumed, resulting in “offside” and “defa ul t ” of government functions and unsatisfacto ry situation under which
social resources fail to allocated appropriately through market-oriented mechanism .
Offs id e of government functions means that governmental agencies undertake many functions that should not
have bee n i mple me nted in the process of administrati ve actions. O f fsi d e of government functions in house-based
care service includes both functional offside and relationship o ffs ide. T ypical functio nal offside is manifested by
direct organization and undertaking of cultural or recreational activities in co m munit ie s, volunteer programs,
scientific p o p ular iza tio n, nonprofit nature of charity or contr ibution activitie s, etc. In the short term, active par-
ticipation by government may impose a re markable influence on the rap id development of house-based care ser-
vice. But in the long term, development and growth of non-governmental organizations and volunteer organiza-
tions is the sound strateg y for resolution. The government shall gradually hand over the foregoing house-based
care work to non-governmental organizations, volunteer or ganizations and civil associations. Typical rela tion-
ship offside is reflected by the administrative subordinating r ela tio ns hip b et ween the governmental function de-
partments and non-governmental associations. Such relationship should be the relationship of guidance and
coordination, service and supervision. For example, the social work ser vices in co mmunitie s become the sub-
sidiaries of governmental function departments, and caseworkers are considered as administrative staff serving
governmental agencies. Under this circ umstance, the social associa tio n s can not expressly d e fi ne their responsi-
bilities and duties; in turn, the growth and development of those association s will be affected adversely.
“Default” of government func tio n means the government fails to play its o wn r ole in the home-based care
services by failing to do or not doing wel l its o wn wo rk, which specifically demonstra tes in three fields, namely,
investment, service management as well as social organization fos te r in g and supporting. As fo r investment,
some local governments fai l to list the home-based care services on their financial budgets, therefore, their in-
vestments in the home-based care services are severely insufficient, and related financial investments are ran-
domly used or run off without fu nd supervisio n and restr aint of standards and specifications. As for service
management, the government fails to develop sound plans and management laws and rules, and the present sit u-
ation is, the government is governing something it should not govern and ignoring something it should govern.
And as for social organization fostering and supporting, the government fa ils to formulate related government
policies to support the sustainable and health development of social organizations, meanwhile, social organiza-
tions’ development is greatly restrained due to insu f ficient fund support fro m the govern ment.
4.2. Unsound Operation of Market-Or i ented Mechanism
Excessive intervene of government narrows enterprises’ profit-making space. In the house-based care service
fields, the gover nment shall, as the mana ger or supervisor, be responsible for industry planning, providing i nitial
funds and controlli ng service qualit y, other than direct provision of house-based care service to the elderly. But
in practice, some local governments, influenced by traditio nal mind setting, intend to take care of every single
thing personally; as a consequence, the par tic ip ation by civil associa tions into house-based care service market
is impaired and the profit-making space of relevant enterp rises are narrowed, thus the growth and development
of relevant civil associations and enterprises are suppressed .
Relevant enterprises have no good under st and i ng of the market-oriented mechanis m, a nd the relationship
between market demands and supply is unbalanced seriously. W ith increasing aging speed, the elderly has
J. P. Lu
growing de mands for house-based care service. However, many civil assoc iations and enterprises have no good
knowledge of the emerging industry, and most of enterpr ises seem that the house-based care service industry
represents small profits even loss and are lo ath to partic ip ate into such market. Therefore, the house-based care
service market is at initial exploration phase, and the house-based care service products are single. There is a
gap to be filled between the actual demands of the aged and actual supply. Di ffe r ent care service requirements
fail to be satis fied fo r the elderly at different living levels.
Actual and valid demands of the elderly are insufficient, and scale economies effect can not be achieved. At
present, the mode of providing for the aged in China is in transition fro m house-based care service to social pro-
viding for the aged. The traditional idea of elderly support is quite difficult to be changed and a large number of
old people fail to accept the mode of house-based care service. Therefore, real and valid market demands have
not been generated, thus scale eco no mies effect is impossible. Some house-based care service programs for ming
the initia l market shape fa i l ed to achieve sufficient co verage due to shortage of scientific planning and scatter
industry layout. The number of service objects of such programs range from several hundreds to a dozen. As a
consequence of small industrial scale, the enterprises are bound to increase service pr ice to o ffs et costs and
achieve pr o fits. Ho wever, the economic income of the elderly is at low level and they can not affo rd high-price
service; in this case, the demands of the elderly are not real and valid one, as a result, the market must shrink and
the development of house-based care service industry will be i mpaired.
4.3. Deficient House-Based Care Service Profe s sionals
According to the Survey on Status Quo of Elderly Support Professi onal Tea m prepared by the Department of
Social Welfare and Charity Promotion in June 2013 through developing questionnair e survey and interview in
15 provinces (municipalities, autonomous regions) including Beijing, Shanghai, Sichuan and Yunnan, the fe-
male old-care nursin g members account for 83.5% of the total members; the nur sing members who are 40 - 49
years old make up 51.0%, 50 years old and above, 28.1%; the nursing members whose education degree is pri-
mary school and below account for 21.7%; middle school, 45.2%; and agricultural registered permanent resi-
dences, accounting for 55.8%. The nursing members who s e entire period of actual operation is less than 1 year
account fo r 14.8% of the total, and 1 - 2 years of working e x per ience, 25.9%; 3 - 5 years of working experience,
30.6%. The nursing members in formal e stab lishment account for 25.9% of the total, and nursing member
beyond formal establi shment, 74.1%. The ones who signed labor contract make up 64.9% of the total, t he ones
failing to sign labor contract, 27.8%. Nursing members who are well trained account for 73.5%, the ones failing
to be trained, 26.5%; the ones without qualificatio n certificate, 39.8%; the ones possessing junior certificates,
41.9%; intermediate certificates, 13.3%; senior cer tificates, 4.1%. Nursing members who s e monthly income is
between RMB 1000 - 1499 account for 42.9% of the total, RMB 1500 - 1999, 34.8%. Additionall y, 27.6% of
nursing members feel unsati sfactory to their income. The nursing members who suffe r from serious psychologi-
cal pressure make up 21.9%; moderate psychological pressure, 26.7%. The nursing members who will change
their careers account for 27.7%; uncertain, 35.4%. Other elder ly support staff (including caseworkers, medical
staf f, health recovery staff and elderly-support voluntee rs) wh o is in forma l establishment accounts for 36.1%,
26.6% of the total sta ff intend to change their carriers. The data above veri fies the fact that the c ulti vation of
professional talents lags far behind the establis hment of eld erl y-support or ganizatio n s. Severe shortage of elder-
ly-support professionals is attributed to the following reasons: mobility of elderl y-support service teams, dif fi-
cult recruitment, unreasonable age structure, small occupational de velopment potential, incomplete training
mechanism, absence of mid & long-ter m plan, irregular emplo yment system, weak sense of ide nti ty, low sa lary,
high labor intensity, high risks, etc.
4.4. Low Resource Utilization Rate
Firstly, some government functional departments foc us on their own interests and refuse to break the existin g
boundaries in carrying out the home-based care services, for example, the civil affairs departme nts, wh i ch can
allocate financial fund, welfare lotte ry fund, etc., foc u s on living material guarantee for “three without” people
and low-income elders, the labor department concentrate on reemployment of fe ma l e workers at the age of 40s
to 50s, and the health departments only concern elder s’ he althcare, therefore, the join forces are not developed
for prope lling the susta inab le and health development of the home-based care services. Secondly, elderly care
resources are usually decentralized at separate communities and organizations, which only serve their own elders
J. P. Lu
without sharing wit h others. And third ly, due to insufficien t communications among the government, the society
and the market, the shared mechanism between elderly care facility and service market resources is not actually
established, and elderl y care service requirements at all levels can not be ful filled .
5. Proposals on the Market-Oriented Operation of Home-Based Care Services
5.1. Advocating the Concept of Home-Based Care Services
As an innovative mode, the mode of home-based care services is essentia lly different from traditional family
supporting mode, whic h will not be deeply rooted among the people without actively publicity and advocacy .
The government, as the ad vo cator of such mode, is obliged to public ize the trend of population aging in our
country to the whole societ y, advocate the home-based care service system, encourage the consumption concept
of “paying fo r services”, deepen people’s sen s e of approval for the home-based care services, gradually change
the elders’ tr aditional consumption concept and consumptio n behavior and lay the foundation of a large-scaled
home-based care service mar ket. On the other hand, such active advocacy may also attract social investment for
elderly care services, whi ch will provide more support and increase both demand and supply, and actually bring
the home-based care services a sustainable and health development.
5.2. Widening Development Space of Non-Go v er n mental Capit als in House-B a se d Care
Service Indu st ry
Successful running of market-oriented mec hanism is inspired by economic benefits received by market activity
participa nts. Elderly support industry has obvious external economic feature and is bound to lag behind demands
only by relying on social forces. In addition, the balance point for the loss and profit for the elderly support in-
dustry, as the meager profit industr y, is relatively high and its nature determines hard operation. Participation of
social forces may be considered as “contribution” or sharing of the responsibilities carried by the government.
For the elderly-support service industry, it is bound to shrink if no preferential policy is provided for compensa-
tion, thus adversely influencing the supply of care service to the elder l y. Therefore, all-round supports shall be
provided to facilitate pa r ticipation of more non-governmental capitals into house-based care service. Firstly,
positive measures shall be developed. Access system and program management system shall be established
based on the principle of mutual bene fi t to encourage and support participation of various civil associations, en-
terprises and individuals into house-based care service by the manners of “purchasing service”, “contracting-out”
and “entrustment” . Secondly, the possibility of establishing public financial investment mec hanism shall be
explored to raise social funds in several channels, thus providing more relax surviving and development space to
the civil associations and providers which are engaged in house-based care service. T hirdly, ince ntive mechan-
ism shall be established. Incentives and support shall be grant ed after compre hensive e xa mination is made to the
size, service ite ms and social benefit of private house-based care service organiz ations, so as to provide more
supports in development of house-based care service market.
5.3. Improving Specialization Level of Management and S e r vi c e St af f
Effo r ts shall be made to de velop a set of co mplete management and service staff cultivatio n and management
system with respect to recruitment, training, salar y and benefit, and management. Firstly, appropriate measures
shall be taken to combine tr aining of house-based care service workers and the laid -off workers re-employment
programs. The laid-o ff workers who meet relevant requirements get together to learn profe ssi onal care know-
ledge and go to duty until work p e rmits are obtained. In this way, sound moral acco mplishment and basic skills
can be guaranteed at the beginning of professional team establishment process. Secondly, elderly-support ser-
vice management specialty shall be set. Qualified colleges, universi ties and vocational education insti tut ions
shall be encourage and supported to se t such specialties as elde r ly-support management and service, aged care,
geriatric sociology and development of products for the aged. The competent administra tive authorities shall
grant preferential policies to the foregoing colleges and institutio ns wi th respect to enrollment, charge and infra-
structure construction. Thirdly, nursing member periodic training system shall be maintained. Cooperation shall
be developed together with colleges, universitie s and health professional schools, to offer systematic training to
the nursing members serving existin g elderl y support organizations and co mmunitie s, so as to assist the nursing
members in grasping b asic health, care, recovery knowledge and skills. Forth: elderly support professionals shall
J. P. Lu
be introduced. While improving the quality of exiting nursing members, best efforts shall be done to introduce
talents. Namely, young and excelle nt talents with high education degree shall be introduced to the house-based
care service team through open recruitment, engagement and directed education. Meanwhile, the la id -off work-
ers who possess some skills and business quality should be recruited to serve the institutio nal or community el-
derly support fie l d .
5.4. Increasing the Home-Ba se d Care Service Staff’s Remuneration
Work nature, work meaning, work contents and work requirements of the home-based care service staff shall be
strictly defined to di ffe r fr om those of the ordinary household services. Publicizatio n shall be carried out to im-
prove the society’s recognition and respect to the home-based care service staff. More government sub sid ies and
basic insurances such as endowment insurance, medical insurance, work-related injury insurance, unemploy-
ment insurance, etc. shall be ensured and paid in full fo r the home-based care service staf f based on labor guar-
antee policies. The home-based care service staff shall be, on basis of social worke r’s occupation level evalua-
tion system, given corresponding material treatment. As for qualified home-based case service sta f f, they shall
be entitled to related employment and reemployme nt supporting policie s.
With the acceleration of the aging process in Sichuan, the demand for home care service for elderly people is
urgent, but the current home care service supply seriously lags. Home care service market is a prominent prob-
lem such as the government dislocatio n, the operation of the market mechanism being not perfect, the lack of
talents, the low efficiency of resource utiliza tio n. T here is urgent need to take measures to promote the concept
of home care services, broaden the development of private capital in the home care service industry, improve the
management and service staff of professiona l level, and i mprove the treatment of home care service personnel.
This paper is funded by Sichuan philosophical and social science program (program code: 13S004, Research of
Market-oriented Operatio n of House-based Care Service Market in Sichuan against the Background of Ne w-
type Urb a nizatio n) and general scientific and research initializa tio n program of Sichuan Normal University
(Research of Procurement by the Government to Social Forces—taking Jinjiang District, Chengdu City for in-
stance). I am very grateful to the two funds for the support of this artic le.
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