A/HRC/45/14/Add.1 40. The current social pension scheme provides for a basic income support from the age of 60, while it also calls for contributions allowing for augmentation of the basic payouts. 47 However, many lower income individuals who are close to the age of 60 cannot meet the criterion of 15 years of contributions to augment future payouts or afford a lump sum contribution.48 41. China maintains relatively young statutory retirement ages, 49 which imperil the sustainability of the system as the proportion of the workforce continues to decline.50 In addition, adequacy of pension benefits and portability of pension rights is an issue of concern. F. Care 42. China has achieved palpable progress in improving access to health and care services. Through a series of health sector reforms starting in 2003, the Government established a medical insurance system covering all rural and urban residents and invested significantly in the health infrastructure. 51 Remaining challenges include access to affordable health-care services, quality care and adequate coverage for health-related expenditure, especially in primary care service at the local level, in particular in rural areas. 52 The health sector has a rather segmented institutional design, with disjointed responsibilities that are dispersed over various State organs and ministries, which predictably leads to insufficient coordination and interdepartmental competition for resources.53 43. It is projected that, from 2015 to 2050, total spending on older persons with respect to care, medical care, nursing, welfare and facilities will rise by around 19 percentage points, from about 7 per cent to 26 per cent of the gross domestic product, imposing a heavy burden on families and the government. The challenge for China as its society ages is how to address problems of care and geriatric-medical care associated with the ageing phenomenon, especially the financial challenges related to pension system funding and the unbalanced supply-and-demand structure of care resources for older persons.54 44. The thirteenth Five-Year Plan (2016–2020) puts clear emphasis on private provision and private payment funded by the individual going forward, whereas the government will continue to allocate funding to cover services for selected low-income and vulnerable groups. 55 In line with this, local governments have a vested interest in encouraging the establishment of older persons’ care institutions in both rural and urban areas by simplifying procedures such as registration, licensing and standardization. 56 45. China’s old-age care system is based on family home care, supported according to the principle of subsidiarity by the community and supplemented by institutions, combined with geriatric medical care. 57 Changing family and household structures and rural-urban migration, with a large proportion of older persons now living separately from their 47 48 49 50 51 52 53 54 55 56 57 10 Ibid., p. 5. See European Union-China Social Protection Reform Project, “Chinese situation and prospects”. Of note, older persons who reach the statutory retirement ages but fail to contribute to the scheme for 15 years are allowed to continue their contribution until meeting the requirement of 15 years or to transfer to the Basic Pension Scheme for Urban and Rural Residents at the locality of their Hukou and claim benefit therewith. ILO, “What drives old age work in China?”, p. 1. UNDP, China National Human Development Report Special Edition, p. 215. A/HRC/35/26/Add.2, para. 56. WHO, China Country Assessment Report on Ageing and Health, p. 23. A/HRC/35/26/Add.2, para. 59. UNDP, China National Human Development Report Special Edition, pp. 211–212. Glinskaya and Feng, eds., Options for Aged Care in China, pp. 13–14. Ibid., p. 15. Government submission on the protection of rights and interests of older persons in China, p. 17.