I have gotten a little behind in my reading of Ben Shobert’s recent excellent articles in Asia Healthcare Blog on senior care in China. Here are the last four:
- ‘Ambassador Locke’s China Green Hospital & Senior Living Trade Mission’
- ‘Start at the Beginning: A Conversation with Dr. Sean Leng’
- ‘Another Perspective on Geriatric Care in China’
- ‘Getting Your Senior Care Facility Licensed in China’
And, here they are again, with a snippet from each.
This week, the U.S. Department of Commerce together with Ambassador Locke, led one of five trade delegations that the Ambassador has committed to conducting in 2012. This one, focused on China’s burgeoning need to build green hospitals and senior care facilities, conducted meetings in Xian and Beijing. Relative to senior housing, roughly twelve companies exhibited in Beijing (yours trulyincluded). The other 11 present in Wednesday’s Beijing meetings were UA Design Group, Victory Star Architecture Design Group, Holabird & Root,Perkins & Will, Beijing Sun City Group, Zhangtian Haikang Investment Group, Cascade Investment, Belmont Village, Cornerstone Affiliates, Hanson Bridgett, and Merrill Gardens. This was a lot of top-shelf experience from the United States, a commentary both on the quality of this trade mission as well as the level of interest building around the senior care market in China.
Geriatrics remain a field that is in need of extensive development in China, a point that simply cannot be over-stated as Western operators begin to more aggressively expand in the country. Dr. Leng shared “The problem there is no standard training curriculum for geriatricians.” As a discipline, geriatrics in China is not well organized. A doctor in China would have the opportunity to specialize in a particular field that would be identified as a geriatric area; the example Dr. Leng offered was cardiology. The problem with this is that most cardiologists see older patients anyway, so while the Chinese medical system may think it is educating people in the field of geriatrics, the sub-specialty of cardiology actually predominates. Consequently, as Dr. Leng said “the functional aspects of falls, dementia, frailty and other age-related specific syndromes are not really addressed.”
Dr. Wang pointed out that while the West has what she calls “two legs” for addressing elderly care issues – a medical model and a community model – China really only has a family model. As she put it, “all services related in the long-term care for the elderly have only depended on family.” Because the family has acted as the caregiver, China has not prioritized clinical geriatric training like it needs to. She added, “Regarding the government officers in China, physicians and nurses, most of them have not had an opportunity to get a better education and training to update their professional knowledge and skills related to the gerontological / psychosocial and geriatric care because the Chinese traditional family care model has been [the] only access or resource … There has been no need for them to update their knowledge and skills … due to a ‘blank area’ in the programs of long-term care for the elderly in in China.”
With this in mind, I was very eager to speak with Michael (Qin) Qu, a Shanghai based lawyer with the Co-Effort Law Firm. For those not familiar with Michael’s work, he publishes a regular newsletter on China’s senior housing and care industry. What I wanted to explore with Michael were the specific regulations and procedures that guide approvals of foreign owned and operated senior care facilities.
The first point that Michael made is that China’s approval process is different between for-profit and not-for-profit institutions (that has proven to be an important distinction for those in the industry who are familiar with the back story to Cherish Yearn). A not-for-profit must obtain the approval of the Ministry of Civil Affairs and the local government; however, because few (if any) foreign investors in China’s senior care market are not-for-profit, this is less interesting than an understanding of the for-profit regulations.
Michael shared that as of today a for-profit senior care institution must secure the approval of the Ministry of Civil Affairs, the Ministry of Health, the Administration of Industry and Commerce and the Ministry of Commerce (MOFCOM). The Ministry of Health will want to explore the nature of the healthcare services being provided in your facility: if they determine your services are most similar to those offered by a hospital, you will be held to higher standards and the qualification process will be longer and more difficult. In contrast to this, if you are offering what Michael called “in-house healthcare” then the qualification process for approval of an internal clinic is more straight–forward. Michael was quick to add that in China, distinctions between nursing homes, independent living, assisted living and CCRC do not yet exist, so foreign operators should be careful in assuming those same classifications will guide the Ministry of Health’s view of what you are offering and what standards you will be held to. Again, this question of how your facility will be classified is a great example of how regulations can – and will – be widely interpreted on a very regional basis. Michael said that a foreign operator should plan on 6 months of back-and-forth with the relevant government agencies prior to receiving the necessary approvals. As the market heats up, whether this time frame will contract or get drawn out is something western companies will want to pay attention to.