How to enhance the connotation of health management services for the elderly has become an important issue in the current construction of the elderly care service system and the reform of the medical and health system.

On an afternoon in July, Dr. Huang Jianqin, a general practitioner at Huashan Town Health Center in Huadu District, Guangzhou, accompanied by a nurse, visited the residence of a home-based family doctor patient to provide on-site medical services. Currently, nationwide, the health management services for the elderly are still being implemented through the promotion of the "National Basic Public Health Services Specification," which clearly outlines the service procedures and content. This is achieved through the signing of family doctor contracts, which provide health management services, including lifestyle and health condition assessments, physical examinations, auxiliary examinations, and health guidance, to individuals aged 65 and above annually.

Luo Xianfei, Director of the General Practitioner Department at Huashan Town Health Center, stated that the family doctor signing service for the elderly mainly focuses on chronic disease management. As age increases, most elderly individuals suffer from conditions such as hypertension and diabetes, requiring long-term chronic disease follow-up, medication treatment, and scientific dietary management and physical exercise. Therefore, daily professional medical guidance becomes crucial.

In China, elderly care services and medical services are not well integrated, and the elderly population is the main focus of healthcare services, with a stronger reliance on medical care. Many elderly people in grassroots areas face unmet needs for medical rehabilitation and elderly care. Against the backdrop of China's "aging before being prepared," the overall health situation of the elderly population is not optimistic.

As a general practitioner, Huang Jianqin is extremely busy every day. In addition to daily outpatient duties, she also needs to set aside a day and a half each week to provide "home hospital beds" services for the elderly living in her jurisdiction. Currently, the common elderly care methods mainly include home-based care and institutional care. When facing health issues, the practical needs of both are the same.

Huang Jianqin's home visit service targets "family doctor" signed patients who have beds set up in elderly care institutions and households in villages (residences). According to the Huashan Town Health Center, the center has multiple family doctor teams composed of general practitioners who provide regular home bed services to elderly residents in the area.

There is a lot of preparation before each service outing. After determining which elderly households to visit the next day, Huang Jianqin needs to review their medical records, understand their conditions, and identify the medications and medical equipment required.

A few minutes later, the first financial reporter arrived at the Huashan Town Nursing Home with Dr. Huang Jianqin. The facility houses around many elderly residents, most of whom are local urban and rural five-guarantee recipients or solitary elderly individuals. The nursing home's director told the reporter that many of the elderly here suffer from chronic diseases, and about a dozen are bedridden due to mobility issues.

That afternoon, Granny Cheng, who was in her seventies, was sitting on a bench in the corridor chatting with other residents. She had been suffering from diabetes for over a decade, and due to poor management of her daily diet, her legs had developed red spots, posing a risk of developing diabetic foot. Huang Jianqin crouched down, lifted her trouser legs with both hands, and gently wiped and disinfected the red spots with cotton swabs, reminding Granny Cheng to pay attention to her diet control.

Another elderly man, due to a stroke, suffered from hemiplegia, making it difficult for him to move, even unable to adjust his body while sitting on a stool. To facilitate the examination for this man, Huang Jianqin, along with a nurse and another caregiver from the elderly care institution, spent several minutes adjusting his body and legs. Afterward, Huang Jianqin crouched down to perform leg massages and other treatments for the man.

That afternoon, Huang Jianqin spent over an hour at the nursing home, conducting vital sign monitoring, consultations, physical examinations, inquiries about daily activities and medication for elderly individuals. She carefully understood and recorded their physical conditions, developed personalized self-care guidance and recommendations, established personal files, and facilitated follow-up visits.

Subsequently, Huang Jianqin quickly drove to the home of a resident several kilometers away for a house call. At half past three in the afternoon, upon returning to the hospital, Huang Jianqin swiftly returned to the office, promptly recording the conditions of elderly patients who received home visits, completing the medical records, and handling the relevant registration tasks.

According to the Huashan Town Health Center, as of now, this year the center has provided contracted services to over-aged elderly individuals, and long-term prescription services to elderly patients with chronic diseases. Additionally, it has established home beds for over-aged elderly individuals, conducted home bed visits, and made house calls to over-aged elderly individuals.

In many grassroots rural areas within the country, a significant number of elderly individuals, due to factors such as being alone, illness, or economic constraints, do not seek medical attention promptly, which places a burden on their health and daily lives of their families. In the view of Huang Jianqin, it is essential for patient families and medical institutions to communicate and cooperate with each other, mutually promoting the care of the elderly.

Recently, Huang Jianqin once again visited a family sickbed in the village to provide medical services. Huang Apo, who is over a hundred years old and resides in a village in Huashan Town, has been bedridden for a long time due to a stroke, resulting in paralysis and loss of sensation in her limbs. By the time Huang Jianqin arrived, her husband, Mr. Luo, had already completed some daily care tasks.

Huang Jianqin came to Huang Apo's side, skillfully turning her over to check her back and other areas for bedsores. "The care is handled very well, there are basically no bedsores," Huang Jianqin said, praising the family for their excellent care, which also made the doctor's job much easier.

Luo Xianfei told the First Financial Daily reporter that on one hand, family members need to understand daily care work, and on the other hand, they need to receive scientific guidance. "The cooperation between doctors, patients, and family members is very important. Even for home hospital beds, we visit for care about once a week, while the majority of daily care is still primarily provided by the family."

Currently, policies are encouraging the construction of home hospital beds. "At present, the settlement method for home hospital beds follows 'payment for specific diseases'. The settlement standard for Guangzhou residents' medical insurance is yuan/person, and for employee medical insurance, it is yuan/person. The reimbursement rate exceeds ninety percent, with a very small proportion of out-of-pocket expenses for individuals." Wang Yongliang, the director of Huashan Town Health Center, told the First Financial Daily.

However, from the perspective of the currently interviewed family doctors, the family's understanding and normal perception of home care services have also become a significant factor affecting the establishment of home care beds. "Previously, when communicating with disabled patients over the phone, several disabled patients were concerned about whether the promised home care services could actually be delivered. Initially, they had reservations and were unwilling to accept home care services. A few days ago, Dr. Huang and I went door-to-door to visit these families. After our patient explanation, these elderly individuals eventually dispelled their doubts," said Luo Xianfei.

National basic public health services have been implemented for many years, with requirements for the health management of the elderly, including providing regular physical examinations for seniors aged one year and above. Currently, this work is still being carried out in various regions, such as Huadu District, which offers free health check-ups for elderly residents aged one year and above every year. However, there are still residents who are unwilling to participate.

On a certain date, according to the "National Aging Development Report for the Year" released by the Ministry of Civil Affairs and the National Committee on Aging, as of the end of the year, the population of people aged 60 and above nationwide was 264 million, accounting for 18.70% of the total population. The health status of the elderly requires high attention from all sectors of society. Issues such as cognitive, motor, sensory function decline, as well as nutrition, mental health problems, which accompany aging, are becoming increasingly prominent. Over 85% of the elderly suffer from at least one chronic disease, and the number of disabled elderly people continues to rise.

Rural medical and health resources are scarce, and community elderly health management exhibits fragmented and weak supply characteristics. The above-mentioned author's research indicates that rural elderly people have a low evaluation of the health management services provided by township medical and health institutions. The evaluation results reflect the elderly's trust in medical institutions, which will affect their further utilization of services. Therefore, the health management services for rural elderly people face significant pressure and challenges.

In recent years, efforts have been made across various regions to promote the integration of medical and elderly care services, but a true "one-stop" service entity has yet to be realized. The realms of "medical care" and "elderly care" remain distinct. Multiple interviewees have informed the First Financial Daily that the content of medical services for the elderly population still needs improvement in many areas.

Elderly health management is the essential path to achieving healthy aging in rural areas, and sufficient, widely-reaching service provision is the foundation for effective health management. In terms of "service provision," according to the Health Bureau of Huadu District, in recent years, relying on family doctors and home beds, innovative explorations have been made in the "Accompanying Care" elderly medical work, setting up temporary medical service points in villages and communities, and moving the elderly medical service windows forward.

In fact, there are still policies that need to be improved in expanding the content of health management services for the elderly. Previously, two deputies to the National People's Congress proposed the implementation of a policy in Wuhan that would provide free Traditional Chinese Medicine (TCM) consultations and partial reduction for Western Medicine consultations for elderly individuals aged 60 and above. In January, the Wuhan Municipal Health Commission's official website disclosed a "Reply to the Proposal" stating that the Municipal Medical Insurance Bureau indicated that considering the basic national conditions of China's long-term presence in the primary stage of socialism, the level of medical insurance funding is not high, and the fund's support capability is insufficient. Implementing a policy of free TCM consultations and partial reduction for Western Medicine consultations for individuals aged 60 and above would not only reduce the level of benefits but could also lead to unnecessary medical waste.