Management of human`s resources life quality improvement in China

Abstract

The need of transition to a model of sustainable development, caused by modern economic reality, is related to the direct improvement of the quality of life of all segments of the population (especially the vulnerable) and the development of human resources. This requires a long-term strategy of organizational, instrumental, and economic support for the implementation of the appropriate state policy with the simultaneous modernization of scientific approaches. That is, ensuring the functioning of the chain "increasing the quality of life" - "increasing needs" - "growing the economy" is vitally necessary in modern conditions. The dissertation work is devoted to the study of managing the development of human resources by methods of long-term improvement of the quality of life. By studying the experience and using the lessons of developed countries such as the United States of America, Germany and Japan, a basis was built for choosing a model and developing a system for the introduction of long-term care insurance (geriatric insurance) in China as one of the methods of improving the quality of life, taking into account the characteristics of local social security and increasing the safety of life for the elderly. In the theoretical part of the dissertation were systematized the theoretical foundations, were deepened concepts and was formed a methodological approach to ensure the management and evaluation of the effectiveness of the implementation of long-term care insurance as one of the methods of improving human resources life quality in China. Based on the study of the experience of commercial geriatric insurance in foreign developed countries, are proposed the content, subsidization system, financing mechanism of long-term care insurance in China and the willingness of Chinese citizens to participate in insurance. Thus, it was found that with the development of the economy and the progress of medical technologies, the life expectancy of the population increases. At the same time, the share of elderly people in the total population is increasing due to a decrease in the birth rate: China's population is aging at an accelerated pace. Thus, in 2010, the population aged 60 and over was more than 10%, and China received the status of an "aging society". By the end of 2021, the number of people aged 60 and over reached 270 million, accounting for 19% of the total population, a 9% increase from 2010. According to the World Bank, the aging of Chinese society will accelerate in the next 20 years. By 2040, the number of elderly people aged 60 and over will reach about 420 million, accounting for more than 30% of the population. As China's elderly population continues to grow, so does the number of people requiring long-term care. At the same time, the traditional Chinese family model has changed, families are usually smaller, young people do not want to live with the elderly, and small families of 2-3 people have become the main type of family formations. Thus, the Chinese government found itself in a kind of "scissors": as a result of a significant technological leap and undeniable successes of the medical system, the number of elderly people has increased significantly, which, on the other hand, leads to a redistribution of funds from investments to social security. Due to the weakening of the function of family care for the elderly, the problem of caring for the elderly Chinese is transferred to the society, but the provision of social institutions for the elderly is not sufficient. Current elderly care services provided by Chinese health facilities and geriatric nursing homes are mainly devoted to physical and daily care of the elderly. But no attention is paid to such services as psychological assistance, social interaction and awareness of one's own dignity, which are important and sometimes vital for the elderly. In addition, elderly care facilities in China generally have many problems, such as low service level, few types of services, low cost efficiency, professional quality of staff providing elderly care services, high bureaucratic access procedure before receiving services, etc. As the problem of aging continues to worsen in China, the dissertation research emphasizes the need to reform and improve the existing elderly care facilities on the one hand, and establish a unique long-term care insurance system to ensure an adequate supply of care services on the other. This will be the key to improving the quality of life of the elderly in China. However, the costs related to medical and social care for the elderly will already become the largest item of public expenditure in China in the medium term. Therefore, the state monetary resource will inevitably be forced to redirect from investments to the social sphere. If appropriate measures are not taken, the social costs associated with the life of the elderly in China will significantly destabilize the country's economic growth. This peculiar paradox must be articulated as clearly as possible before the population and find its solution through new social agreements regarding the rules of pension and health insurance. Society must clearly understand: the rules of the game in the social sphere must be changed due to a number of objective and subjective reasons, otherwise the system will come to a dead end. But for now, we cannot fail to note that the broad discussion of social problems at all levels, from expert to everyday, usually does not end with more or less real recommendations from any side of this multifaceted problem, including care for the elderly. Long-term care insurance as a method of improving people's living standards in the United States, Japan, and Germany has achieved some success, with China as a case study. The history of the introduction of long-term care insurance in the United States, Germany, and Japan was found to have many common features, such as a high proportion of elderly people in the general population and a low birth rate, a weakened function of family unity. The successes and problems of each country developing long-term care service systems can become useful sources for the establishment and development of quality-of-life improvement systems in China, which have great theoretical and practical significance. However, China has its own national conditions and characteristics, so it is not possible to just copy the successful experience of the three countries, but to develop a management model for the development of long-term care insurance in accordance with the actual conditions of China, which will ensure an increase in the economic potential of the population under conditions of sustainable development. In the author's survey, more than 65% of respondents expressed a desire to participate in long-term care insurance in Henan Province, China. Among the forms of care, respondents chose the home form of care (68%) compared to special geriatric facilities (32%), and the cash form of payment (57%) for professional payment of services prevailed. In addition, the study revealed that the population's willingness to introduce long-term care depends on the location of the household ("hukou"), the age of the respondent (r=0.833), the presence of people with physical or mental disabilities in the family (r=0.846) , income (r=0.711), number of children (r=0.698) and other factors. For example, people with urban "hukou" are more willing to support long-term care insurance (r=0.676) than people from rural areas. Also, in the course of the study, it was found through regression analysis that concern about the quality of life of the elderly population and confidence that the government can create an ideal long-term care insurance system to some extent increases the demand for long-term care insurance (r=0.792). After analyzing four typical Chinese cities - Shanghai, Qingdao, Nantong, Changchun, which are planned to be made typical when introducing the long-term care insurance model, certain differences and contradictions in the implementation of the proposed methods of improving the life of the population were revealed. Thus, due to the difference in the application of the principles of sustainable development in the everyday understanding of a person, there is a lack of perception of the triad of the socio-ecological-economic complex, due to which the respondents put economic priorities first, relegating the ecological component to the last place. This was especially felt under the influence of the COVID-19 pandemic, when a large number of elderly people were left without proper care. To date, only Hainan Province has introduced a system of private life and health insurance. This is caused by the location of the province (sea resort), so due to the high number of tourists in the region, sustainable development is a priority. It was found that the demographic trends of the development of the urban and rural population of the province differ from the general trends in the country. With the introduction of the private life and health insurance system, a significant direct correlation was established between the dynamics of population density growth, the growth of the total birth rate, the growth of the demographic burden and indicators of social satisfaction with the quality of life. It is expected that the implementation of the long-term care insurance system in each pilot region will provide a solution to a number of socio-economic issues: the economic "burden" from the elderly will decrease; the social function in the management of the processes of development of the province's economy will be activated; the efficiency of distribution of medical and pension resources will increase. During the development of the pilot stage of long-term care insurance, many problems were also identified, such as incomplete coverage of rural "hukou" residents, inconsistent and incomplete criteria for assessing disability and forming criteria for the need for care, excessive dependence of health insurance funds on the decision of local authorities to collect funds, a significant gap between the offer of professional assistance services and the actual demand. In order to minimize the negative consequences of demographic changes, the dissertation work, based on analytical studies, expert opinions and research on the scientific basis, proved the need to rethink the goals and tools of policy in the field of improving the quality of life and developing human resources. Taking into account foreign experience and the recommendations of international organizations, one of the options for a comprehensive solution was the adoption of the National Action Plan on Aging in the form of a targeted state program. This document, even in a declarative form, would be a confirmation of the understanding of the complexity of this issue and attention to the situation of the elderly, which would allow setting the task in a qualitatively new format, including with the involvement of public assistance and donor funds. Thus, long-term care insurance for the elderly (retiree medical and social needs insurance) is aimed at meeting needs by ensuring access to medical and medical care and the need for outside care. In this study, it was proposed to consider geriatric insurance as a symbiosis of health insurance with social care and even sometimes with social integration. In China's domestic realities, when the number of elderly people will only increase over time, the development of long-term care insurance will become more and more relevant. Geriatric insurance will allow prudent individuals to take care of their own old age and the old age of their relatives or loved ones in advance with generous monthly contributions that will guarantee care in case of need. The system of long-term geriatric insurance proposed in the study is based on the principle of broad benefit, which is provided by the strategy of person-oriented development of human resources; introduction of diversified and differentiated financing, which forms a tripartite risk distribution mechanism between individuals, the state and the market; replacement of a one-time cash payment with a comprehensive service that extends to the entire lifetime of the insured person; reliance on commercial insurance companies that carry out professional management and operation of the market. Summarizing the above, it can be noted that with such problems of long-term care insurance implementation as: lack of legal framework; chaotic funding; inconsistency in the standards and criteria for assessing the need for care; the lack of proper competence of professional personnel for long-term care, etc., can be combated by the following methods: - to promote simultaneous full coverage of urban and rural residents by the system of commercial geriatric insurance; - to improve the legislative level of long-term care insurance; - expand funding channels (for example, allow distant relatives to pay for long-term care); - master scientific and technical means and create uniform standards for assessing the needs of human resources; - optimize aids and create professional teams of nurses. At the same time, the essential content must satisfy both the interests of society as a whole and the individual subject of insurance protection. Of course, the list of problems raised in the dissertation is far from exhaustive. The author is aware that some of theses at the stage of breaking the issue of geriatric insurance are (or may seem) quite controversial. However, the main goal of the study was to actualize public interest in this issue. Therefore, the practical significance of this research lies in the involvement of specialized experts from all types of insurance, in particular medical, social service providers in the development of a mechanism for implementing the best examples of world experience in geriatric insurance as a method of improving the standard of living of the Chinese population. ssment and weighting of indices and, therefore, the objectivity of the overall process of assessing sustainable development. This made it possible to improve the methodological approach to forming a scientifically based and "intelligent" system of evaluation and monitoring urban territories' development through entropy and TOPSIS methods. This approach makes it possible to assess the level of sustainable development of urban territories and the key factors influencing this process quantitatively and objectively through an assessment of the significance and fluctuations of each parameter. The entropy method estimates the weight of individual second-level indices in the proposed approach. The TOPSIS method measures the performance of sustainable development of particular researched objects. To assess the level of sustainability of regions, a scale is offered, which allows, based on the measurement results, to conclude about the territory's weak, average, good, and high-quality level of sustainable development. The formed judgement scale was laid as the basis of an improved methodical approach to determining the main priorities of strategic management of sustainable development of regions. This approach is based on specific values of parameters and assessments of the level of sustainable development of territorial entities. It contributes to the formalisation of the decision-making process (which reduces the influence of the human factor and subjectivity when decision-making). Due to the substantive and structural-process aspects of strategic management of territories development, a scheme (algorithm) of actions based on measuring regions' level of sustainable development was proposed. According to the proposed scheme of the strategic decision-making process, the use of the developed measurement and evaluation system makes it possible to establish the main factors (drivers) of the territory's sustainable development and further assess the performance of individual regions. The identified drivers should be the main focus in developing sustainable development policies and strategies and, differentiated by region, allow for the formulation of measures that are a priority for one or regional territorial community. An assessment of the factor’s influence in the general indicator of sustainable development for the entire general sample (31 provinces in the territory under the control of the Central Government of the People's Republic of China) showed that the component "science and technology" has the most significant impact (55.4%). The influence of economic growth (17.6%), social well-being (16.4%), and the environmental component (11.23%), on the other hand, is insignificant. Therefore, science and technology is the driving force of the sustainable development of territories in the PRC, and the role of this factor is increasing year by year: from 54.07% in 2016 to 54.56% in 2019. The analysis of the second-level indices showed that the most significant aspects of sustainable development are those belonging to the "Science and Technology" group (technology market turnover, the R&D involvement of the personnel of industrial enterprises, the number of patents, R&D funds of industrial enterprises, financial expenditures for science and technology). The least significant is the residential building area per capita (social group), electricity consumption per unit of GDP (economic component), level of centralised wastewater treatment and harmless level of waste processing technologies (environmental component), and water consumption per unit of GDP (economic part). The total impact of these indicators together is only about 5%. The obtained results reveal the fundamental factors of promoting the sustainable development of cities in the People's Republic of China: the development of talents, science and technology, capital and policy. At the same time, the obtained results also indicate that the sustainable development of cities is more related to the activity of business circles, while the government can significantly contribute to such action. Therefore, the quantitative results from the proposed strategic decision-making algorithm made it possible to formulate the general principles of the strategy of the PRC in the direction of sustainable development. To improve the scientific and technological component of sustainable development, it is proposed to strengthen scientific and technical publicity, create a favourable environment for scientific and technological progress and independent innovation, and promote training and the introduction of talents. Regarding the economic subsystem, the primary efforts should be aimed at changing the regime of extensive economic growth, developing the tertiary industry, and establishing the industrial system in backward areas. When making strategic decisions on social issues, it is advisable to focus on the factors that affect the social stability of the community (infrastructure, access to public facilities, equality and justice) and to implement proper planning and leadership. From the point of view of environmental aspects of regional sustainable development, the most critical issues to be resolved are the effective use of land resources and the strengthening of the role and functions of environmental management. Using the TOPSIS model, the sustainability performance of each of the studied 31 provinces was assessed, and their ranking was carried out. The territorial distribution pattern of the sustainability performance of the provinces grouped into four regions (coastal east, central, west and the urbanised agglomeration of Beijing-Tianjin-Hebei) is determined. In general, the level of development of provinces and territories is uneven, and the overall grade is relatively low. According to the results, the sustainable development of various regions of China is characterised by a weakening trend from the eastern coastal areas to the western inland parts. Considering this, the features of community development (economic structure, resource availability, socio-demographic situation, and development of science and technology) were characterised in detail. There were investigated reasons that restrict sustainable development and formulated strategic proposals for strengthening the potential of sustainable development for each regional territorial community. The obtained results testify to the practical significance and feasibility of using the provisions developed during this research in managing the regional territorial communities’ sustainable development in the People's Republic of China.