How to fill the shortage of nursing staff in China? Is it feasible to learn from Japan to bring in foreign workers?

Text/Li Dan

"The Japanese Experience".

Some insiders pointed out that at present, China's aging stage is equivalent to the situation in Japan in the mid-1990s. In the future, as China ages faster, it may catch up with Japan by around 2050.

Considering that China and Japan are both East Asian countries, the two have similarities in terms of pension concepts and cultural values, and Japan's accumulated experience in coping with the aging of the population (including the construction of the old-age security system, the development of the aging industry, the promotion of old-age services, the promotion of old-age care, and the cultivation of talents) has also been studied and borrowed by Chinese scholars.

Image source: Visual China

In the future, how should China and Japan continue to improve the old-age security system? In the face of the problems faced by the two countries, such as the shortage of elderly care personnel and the introduction of foreign populations, will they be effective? On April 14, at the "China-Japan International Forum on Social Governance of Aging: Prospects and Responses" jointly sponsored by China (Shenzhen) Comprehensive Development Research Institute and Pangu Think Tank, experts from the two countries expressed their views on topics such as the severity of old-age care and policy adaptation.

Pension gap, how to make up?

The aging of China and Japan has one thing in common: the baby boom will make the aging degree of the future more intense, and the pension gap will continue to increase.

According to Katsuyu Kojima, director of the Research Department of Japan's National Institute of Social Security and Population Issues, Japan's 2021 census data shows that the country's elderly population aged 65 and above has reached 36 million, accounting for 28.6% of the total population.

Kitao Hayami, a senior researcher at the Japan Research Institute of Economy, Trade and Industry, added that by 2025, the population born of Japan's first post-World War II baby boom will exceed 75 years old and become super elderly. In addition, between 2035 and 2040, the number of people born on the second baby boom will also exceed 65 years old. "The next 10 to 20 years will be a very tough time for Japan."

Similarly, China's aging is also related to the three baby booms of the past.

Data show that between 1962 and 1975, about 360 million people were born on the mainland. This means that in 60 years, from 2022 to 2035, this group of 360 million people born in the "second baby boom" will join the army of old age. The data of the seventh census just released shows that the number of people over the age of 60 on the mainland has exceeded 264 million.

On the one hand, the number of elderly people is increasing, life expectancy is increasing, on the other hand, the birth rate of newborns is declining, and the same dilemma facing China and Japan is that the pension gap will increase.

In order to cope with the dilemma, from April 2022, the Japanese government will raise the starting age for the elderly to receive pensions at the latest from the original 70 years old to 75 years old, and if they choose to receive it in advance, the monthly amount will be reduced, and vice versa. According to the latest regulations, if the elderly start to receive pensions from the age of 75, the amount will increase by 84% compared with the elderly who began to receive them at the age of 65.

Looking at China in contrast, according to Lin Bao, director of the Research Office of Pension and Security of the Chinese Academy of Social Sciences, since 2014, although China has made great efforts in pension reform, such as the integration of the pension insurance system for urban and rural residents, personnel within the system and enterprise employees, emphasizing the establishment of a multi-level and multi-pillar pension system, it is still affected by the huge impact of population aging.

"In addition, there are some problems in the design of the pension system itself, such as the minimum number of years of payment is only 15 years, and the payment standard is 60% to 300% of the average wage, the former causes many people to pay for 15 years and does not pay, and the latter causes many high-income earners to not pay according to the actual income." Lin Bao pointed out that from the statistical yearbook, pension income in 2020 has been lower than expenditure, in other words, there has been an annual funding gap.

In order to solve the gap problem, the state pointed out the direction from the top-level design: delaying retirement, developing a strategic reserve fund, raising the basic pension standard, and developing a multi-level pension insurance system. In addition, Lin Bao believes that it can also be improved from the two aspects of system convergence and revenue and expenditure side reform.

According to Lin Bao's concept, on the one hand, the basic pension of urban and rural residents can be changed to a national pension, or a citizen pension, similar to Japan's current initiatives. On the other hand, in the case of a payment standard of 60% to 300%, the payment range can be increased and the payment obligation of high-income earners can be increased. At the same time, when reforming the retirement age, the opportunity can be taken into account in actuarial fairness, reform the relationship between treatment and contribution linkage, and incentivize delayed retirement.

Fiscal pressure, how to solve?

As the aging of China and Japan deepens, the reality of government financial pressure is becoming increasingly prominent.

How much does Japan's social security system spend on the elderly? Kojima Katsujiu introduced that for the elderly, in addition to medical insurance in Japan, there is also a medical system for the super elderly, widow pensions, disabled pensions and so on. In addition, long-term care insurance is basically for the elderly over the age of 65.

In 2019, Japan's social security expenditure was about 123 trillion yen. At the same time, Yasuhei Komamura, a senior adviser to the Ministry of Health, Labor and Welfare and vice president of the Japan Economic Policy Institute, added that japan's social security expenditure is expected to reach 125 trillion yen by 2025, accounting for about 24% of the country's GDP.

In Japan, about 50% of social security spending is spent on pensions, about 30% on medical care, and the elderly are the main beneficiaries, "it is said that more than 60% of medical insurance is spent by the elderly." To some extent, Japan's social security system is centered on the elderly.

In the face of fiscal pressure, where should the government go? In the view of the North Tail Morning Mist, the most important thing is to consider how to support social development, that is, to promote the development of social labor force by increasing resources.

"At this point, the issue of women's employment in Particular should be of particular concern." According to Kitao Hayami, there is a phenomenon in Japan where there are fewer women working, and even if women do, they cannot get the same salary as men.

To this end, Kitao Hayashi pointed out through research that from the current point of view, the overall female participation rate in Japan is about 30%, and if you want to achieve a balance of pensions, you must increase the female work participation rate to about 66% to 75%.

In China, considering the special situation of its aging, Liang Chunxiao, director of the Research Center for Aging Society of Pangu Think Tank, believes that the social security system, including pensions, is based on the structure of the young population in the past, and the core task facing the mainland in the future is how to adapt the entire social system to the aging society.

To this end, Liang Chunxiao suggested that, first of all, it is necessary to release 300 million elderly labor force and increase total factor productivity, so as to cope with the shortage of young labor and weak economic growth. Second, it is necessary to deal with the challenge of insufficient pension income in a full-factor, multi-pillar and step-by-step manner. Third, it is necessary to promote reproductive freedom, equal birth rights and fertility welfare, and cope with the severe challenge of the trend of low birthrate.

Is it feasible to bring in migrant workers to fill the shortage of nursing staff?

The shortage of elderly care workers is another common point in the aging process of China and Japan.

According to Qipu data, China's population aged 60 and over accounts for 18.7%, according to which it is estimated that there is a gap of about 7.2 million elderly care workers in China.

Since 2013, mainland universities and colleges have successively opened majors such as elderly services, in an effort to deliver young blood to the industry. But low salaries, heavy burdens, contradictions are difficult to reconcile... Many graduates of related majors have fled the pension industry after completing the three-year course, and even more have graduated and changed careers before entering the industry.

Similarly, in Japan, how to solve the shortage of manpower and how to protect layoffs are also common topics around the long-term care insurance system. In order to alleviate the shortage of personnel, Japan once imported nursing staff from Indonesia, Vietnam, the Philippines, Myanmar and other countries.

How effective is the introduction of foreign population? Can China learn from that?

According to Yin Ting, a special researcher at the Institute of Industrial Economics in Japan, from the perspective of increasing the number of services, the introduction of foreign workers is a way, but the services provided by foreign workers and the services provided by natives will be very different, and the elderly who receive services will also have a sense of distance from foreigners. "How to make up for this difference is a problem to be considered in the future."

Professors Anri and Akira, chair of the Department of Sociology at Kyoto University in Japan, tried to analyze the entire introduction system. In Anri's view, at present, Japan's system for the introduction of foreign nursing staff is very complicated, in addition to the use of cooperative methods to introduce technicians, the identity label of foreign personnel may also be trainees, personnel learning special skills, and foreign workers, "which makes the whole system not very efficient."

Eventually, Japan formed a pyramidal system of providing a foreign labor force: the top certified nursing staff, who became the most senior talents in the long-term care system, mainly composed of Japanese; the middle layer was the middle level of personnel who received certain training and had certain skills, and some of them were borne by foreign personnel; the lowest level, which was also the largest number of people, was mainly borne by foreigners.

In addition, Anri and Ko also pointed out that the labor force imported from each country, the channels through which they are used, and the purpose of use are different. For example, for the Thai labor force, the Japanese government generally does not provide labor insurance, and it is mainly used for long-term family care. The labor force introduced from Singapore and Taiwan is mainly used to take care of the elderly as a family unit.

"Whether Japan's long-term care delivery method is suitable for China must be analyzed according to the actual situation in China, but one way to learn from Japan's experience is to cooperate from the three aspects of family, society and institutions, which is the best way." Anri and Akira added.

(Editor: Xun Shilin Proofreader: Yan Jingning)