民办养老机构“低入住率”的原因分析:来自市、县两级的证据
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摘要
近年来,在养老服务社会化提供过程中,民办养老机构"低入住率"现象引发广泛关注。本文利用2016年中国社会科学院经济研究所课题组全国养老机构问卷调查数据,基于理论假说,选择人口特征、服务价格、服务内容、财政补贴和机构特征5个维度共14个变量,包括老龄化率、每百张床位人员配置、是否提供医疗服务、是否提供上门服务、入住老人月收费、有无财政补贴、运营时长、房屋使用来源等作为解释变量,以养老机构入住率作为被解释变量构建多元回归分析模型,试图对民办养老机构的"低入住率"之谜做出解释。实证结果显示,每百张床位人员配置、运营时长、有无财政补贴以及房屋使用来源对民办养老机构入住率影响显著,但并未发现以自理老人收费和不能自理老人收费两个指标来衡量的养老服务价格对入住率产生显著的影响,即"价格决定论"未被证实。进一步分析发现那些之前享受过财政补贴但当前不再享受财政补贴的民办养老机构与无任何财政补贴的民办养老机构在入住率上并无统计学意义上的显著差异,也就是说一旦民办养老机构不享受财政补贴,其入住率存在下降的可能。研究结论表明民办养老机构低入住率主要影响因素有人员配置比例、运营时长和财政补贴的持续性。可见,无论是基于财政补贴政策还是鼓励社会力量提供养老服务的方式都需要进一步建立长效的补偿机制和运营机制。
In recent years,the phenomenon of"low occupancy rate"in private nursing institutions has aroused widespread concern in the process of providing social services for the aged. Based on the data of"Nursing Home Survey"conducted by Economic Institute of CASS and theoretical hypothesis,this paperchooses 14 variables from five dimensions of population characteristics,service price,service content,finan-cial subsidy and institutional characteristics as explanatory variables,and the occupancy rate of pension in-stitutions as explanatory variables,including aging rate,the staffing allocation of each hundred beds,wheth-er to provide medical services,whether to provide door-to-door services,monthly fees for the elderly,whether there is financial subsidy,length of operation,sources of housing use and so on. The multiple re-gression analysis model tries to explain the mystery of"low occupancy rate"of private nursing institutions.The empirical results show that the staffing allocation of each hundred beds,the length of the operation,thefinancial subsidy and the use of the house have significant influence on the occupancy rate of the private in-stitutions,but it is not found that the price of the aged service has a significant impact on the occupancyrate,that is,the"price determinism"has not been confirmed. Further analysis shows that there is no signifi-cant difference in occupancy rate between those private nursing institutions that have previously enjoyed fi-nancial subsidies but no longer enjoyed financial subsidies and those without any financial subsidies. Thatis to say,once private nursing institutions do not enjoy financial subsidies,their occupancy rate may be low-er. The results show that the low occupancy rate of private nursing institutions is mainly due to the low pro-portion of staffing,the length of operation and the sustainability of financial subsidies. Therefore,both thecurrent financial subsidy policy and the way to encourage social forces to provide care services for the aged need to further establish a long-term compensation mechanism and operating mechanism.
In recent years,the phenomenon of"low occupancy rate"in private nursing institutions has aroused widespread concern in the process of providing social services for the aged. Based on the data of"Nursing Home Survey"conducted by Economic Institute of CASS and theoretical hypothesis,this paperchooses 14 variables from five dimensions of population characteristics,service price,service content,finan-cial subsidy and institutional characteristics as explanatory variables,and the occupancy rate of pension in-stitutions as explanatory variables,including aging rate,the staffing allocation of each hundred beds,wheth-er to provide medical services,whether to provide door-to-door services,monthly fees for the elderly,whether there is financial subsidy,length of operation,sources of housing use and so on. The multiple re-gression analysis model tries to explain the mystery of"low occupancy rate"of private nursing institutions.The empirical results show that the staffing allocation of each hundred beds,the length of the operation,thefinancial subsidy and the use of the house have significant influence on the occupancy rate of the private in-stitutions,but it is not found that the price of the aged service has a significant impact on the occupancyrate,that is,the"price determinism"has not been confirmed. Further analysis shows that there is no signifi-cant difference in occupancy rate between those private nursing institutions that have previously enjoyed fi-nancial subsidies but no longer enjoyed financial subsidies and those without any financial subsidies. Thatis to say,once private nursing institutions do not enjoy financial subsidies,their occupancy rate may be low-er. The results show that the low occupancy rate of private nursing institutions is mainly due to the low pro-portion of staffing,the length of operation and the sustainability of financial subsidies. Therefore,both thecurrent financial subsidy policy and the way to encourage social forces to provide care services for the aged need to further establish a long-term compensation mechanism and operating mechanism.
引文
[1]唐钧.中国老年服务的现状、问题和发展前景[J].国家行政学院学报,2015,(3):75-81.
[2]李中秋,王朝明.我国人口老龄化与养老资源市场的优化配置——基于特征价格理论的视角[J].西南民族大学学报(人文社科版),2015,(10):108-115.
[3]王方刃,李金钹,陈上仕.福州市社会养老机构现状及提供卫生服务能力的调查分析[J].中国卫生资源,2003,(5):217-218.
[4]崔树义,田杨.养老机构发展“瓶颈”及其破解——基于山东省45家养老机构的调查[J].中国人口科学,2017,(2):115-125.
[5]潘金洪.江苏省机构养老床位总量不足和供需结构失衡问题分析[J].人口与社会,2010,(1):15-20.
[6]马晓雯,肖文文,谢红.北京市养老机构床位使用率现状调查[J].中国护理管理,2015,(7):773-777.
[7]黄佳豪,孟昉.安徽省合肥市民办养老机构发展的现状与问题[J].中国卫生政策研究,2014,(4):62-66.
[8]常宗虎.怎么看,怎么办?养老机构入住率情况的调查与分析[J].中国民政,2000,(9):31-32.
[9]方福前.中国居民消费需求不足原因研究——基于中国城乡分省数据[J].中国社会科学,2009,(2):68-82.
[10]Thomas Boggatz,Tamer Farid. Factors Related to the Acceptance of Home Care and Nursing Homes among Older Egyptians:A Cross-sectional Study[J]. International Journal of Nursing Studies,2009,(12):1585-1594.
[11]李琳.民办社会养老机构低入住率困境的生成逻辑与优化发展[J].中共桂林市委党校学报,2017,17(4):53-57.
[12]席群,陆新华,夏雨.地区机构养老服务供需分析研究[J].价格理论与实践,2015,(11):132-134.
[13]李含伟,陈晔.我国机构养老收费标准的研究[J].价格理论与实践,2013,(9):94-95.
[14]赵迎旭,王德文.老年人对非家庭养老方式态度的调查报告[J].南京人口管理干部学院学报,2006,(4):30-31.
[15]Schaal D,Scho?nfelder T,Klewer J. Market Mechanisms among Nursing Homes:A Correlation Analysis of Price,Quality,and Demand[J]. Heilberufe Science,2015,6(2):43-47.
[16]张增芳.老龄化背景下机构养老的供需矛盾及发展思路[J].西北大学学报(哲学社会科学版),2012,(9):35-39.
[17]宋姗,王德,朱玮,王灿.基于需求偏好的上海市养老机构空间配置研究[J].城市规划,2016,(8):77-82.
[18]张盈华,闫江.中国养老服务现状、问题与公共政策选择[J].当代经济管理,2015,(1):51-56.
[19]曾奕婧.城市社区养老服务供给中的问题及原因分析[J].安徽行政学院学报,2017,(5):101-107.
[20]冯丹,刘建超.超长住院日影响因素的Logistic回归分析[J].中国医院管理,2009,(4):40-42.
[21]安俊美.民间资本参与社会养老服务提供的制度政策分析[J].财经理论研究,2014,(1):29-33.
[22]朱凤梅,王震.长期照护供需失衡的政策分析[J].中国医疗保险,2016,(9):34-37.
[23]李奇会,李斌,赵雷,周伟忠.大型护理型养老机构运营困境及解决途径[J].建筑经济,2017,(7):100-104.
[24]John Piggott,Alan Woodland. Handbook of the Economics of Population Aging[J]. Elsevier,2016,1(1):951-989.
[25]穆光宗.我国机构养老发展的困境与对策[J].华中师范大学学报(人文社会科学版),2012,(2):31-38.
[26]Luca Crivelli,Massimo Filippini and Diego Lunati. Regulation,Ownership and Efficiency in the Swiss Nursing Home Industry[J]. International Journal of Health Care Finance and Economics,2002,2(2):79-97.
[27]Evelien Eggink,Michiel Ras,Isolde Woittiez. Dutch Long-Term Care Use in an Ageing Population[J]. The Journal of the Economics of Ageing,2017,(9):63-70.
[28]周清.促进民办养老机构发展的财税政策研究[J].税务与经济,2011,(3):100-104.
[29]Buchanan,JM. The Demand and Supply of Public Goods[D]. New York:Rand McNally&Company,1968:54.
[30]John A Nyman. The Private Demand for Nursing Home Care[J]. Journal of Health Economics,1989,(8):209-231.
[31]Mukamel,Dana B. and Spector,William D. The Competitive Nature of the Nursing Home Industry:Price Mark Ups and Demand Elasticities[J]. Applied Economics,2002,34(4):413-420.
[32]田北海,王彩云.城乡老年人社会养老服务需求特征及其影响因素——基于对家庭养老替代机制的分析[J].中国农村观察,2014,(4):2-17,95.
[33]王振军.农村社会养老服务需求意愿的实证分析——基于甘肃563位老人问卷调查[J].西北人口,2016,37(01):117-122.
[34]Spector,William D,Thomas M Seldon and Joel W Cohen. The Impact of Ownership Type on Nursing Home Outcomes[J]. Health Economics,1998,(7):639-653.
[35]许福子.辽宁养老产业发展研究——基于对辽宁省10个地区的调查[J].社会福利(理论版),2014,(9):58-63.
[36]Linn MW,Gurel L Linn BS. Patient Outcomes as a Measure of Quality of Nursing Home Care[J]. AM J Public Health,1977,(4):337-344.
[37]Niccie L McKay. An Econometric Analysis of Costs and Scale Economies in the Nursing Home Industry[J]. The Journal of Human Resources,1988,23(1):57-75.
[38]朱蓉,郝勇,王菲菲.上海市老年人养老服务需求调查研究[J].社会保障研究,2013,(6):21-26.
[39]Grabowski,D C,and R A Hirth. Competitive Spillovers across Non-profit and For-profit Nursing Homes[J]. Journal of Health Economics,2003,(1):1-22.
(1)抽样调查方案采取分阶段抽样方式:第一阶段,从全国各省(自治区/直辖市)各选取一个省会城市和1-2个非省会城市;第二阶段,在被选取的2-3个被调查市中每市再抽取1-2个县。
(1)受篇幅限制,这部分稳健性回归结果未列出,作者备索。
(2)数据来源于王小鲁、樊纲、余静文《中国分省份市场化指数报告(2016)》。
[2]李中秋,王朝明.我国人口老龄化与养老资源市场的优化配置——基于特征价格理论的视角[J].西南民族大学学报(人文社科版),2015,(10):108-115.
[3]王方刃,李金钹,陈上仕.福州市社会养老机构现状及提供卫生服务能力的调查分析[J].中国卫生资源,2003,(5):217-218.
[4]崔树义,田杨.养老机构发展“瓶颈”及其破解——基于山东省45家养老机构的调查[J].中国人口科学,2017,(2):115-125.
[5]潘金洪.江苏省机构养老床位总量不足和供需结构失衡问题分析[J].人口与社会,2010,(1):15-20.
[6]马晓雯,肖文文,谢红.北京市养老机构床位使用率现状调查[J].中国护理管理,2015,(7):773-777.
[7]黄佳豪,孟昉.安徽省合肥市民办养老机构发展的现状与问题[J].中国卫生政策研究,2014,(4):62-66.
[8]常宗虎.怎么看,怎么办?养老机构入住率情况的调查与分析[J].中国民政,2000,(9):31-32.
[9]方福前.中国居民消费需求不足原因研究——基于中国城乡分省数据[J].中国社会科学,2009,(2):68-82.
[10]Thomas Boggatz,Tamer Farid. Factors Related to the Acceptance of Home Care and Nursing Homes among Older Egyptians:A Cross-sectional Study[J]. International Journal of Nursing Studies,2009,(12):1585-1594.
[11]李琳.民办社会养老机构低入住率困境的生成逻辑与优化发展[J].中共桂林市委党校学报,2017,17(4):53-57.
[12]席群,陆新华,夏雨.地区机构养老服务供需分析研究[J].价格理论与实践,2015,(11):132-134.
[13]李含伟,陈晔.我国机构养老收费标准的研究[J].价格理论与实践,2013,(9):94-95.
[14]赵迎旭,王德文.老年人对非家庭养老方式态度的调查报告[J].南京人口管理干部学院学报,2006,(4):30-31.
[15]Schaal D,Scho?nfelder T,Klewer J. Market Mechanisms among Nursing Homes:A Correlation Analysis of Price,Quality,and Demand[J]. Heilberufe Science,2015,6(2):43-47.
[16]张增芳.老龄化背景下机构养老的供需矛盾及发展思路[J].西北大学学报(哲学社会科学版),2012,(9):35-39.
[17]宋姗,王德,朱玮,王灿.基于需求偏好的上海市养老机构空间配置研究[J].城市规划,2016,(8):77-82.
[18]张盈华,闫江.中国养老服务现状、问题与公共政策选择[J].当代经济管理,2015,(1):51-56.
[19]曾奕婧.城市社区养老服务供给中的问题及原因分析[J].安徽行政学院学报,2017,(5):101-107.
[20]冯丹,刘建超.超长住院日影响因素的Logistic回归分析[J].中国医院管理,2009,(4):40-42.
[21]安俊美.民间资本参与社会养老服务提供的制度政策分析[J].财经理论研究,2014,(1):29-33.
[22]朱凤梅,王震.长期照护供需失衡的政策分析[J].中国医疗保险,2016,(9):34-37.
[23]李奇会,李斌,赵雷,周伟忠.大型护理型养老机构运营困境及解决途径[J].建筑经济,2017,(7):100-104.
[24]John Piggott,Alan Woodland. Handbook of the Economics of Population Aging[J]. Elsevier,2016,1(1):951-989.
[25]穆光宗.我国机构养老发展的困境与对策[J].华中师范大学学报(人文社会科学版),2012,(2):31-38.
[26]Luca Crivelli,Massimo Filippini and Diego Lunati. Regulation,Ownership and Efficiency in the Swiss Nursing Home Industry[J]. International Journal of Health Care Finance and Economics,2002,2(2):79-97.
[27]Evelien Eggink,Michiel Ras,Isolde Woittiez. Dutch Long-Term Care Use in an Ageing Population[J]. The Journal of the Economics of Ageing,2017,(9):63-70.
[28]周清.促进民办养老机构发展的财税政策研究[J].税务与经济,2011,(3):100-104.
[29]Buchanan,JM. The Demand and Supply of Public Goods[D]. New York:Rand McNally&Company,1968:54.
[30]John A Nyman. The Private Demand for Nursing Home Care[J]. Journal of Health Economics,1989,(8):209-231.
[31]Mukamel,Dana B. and Spector,William D. The Competitive Nature of the Nursing Home Industry:Price Mark Ups and Demand Elasticities[J]. Applied Economics,2002,34(4):413-420.
[32]田北海,王彩云.城乡老年人社会养老服务需求特征及其影响因素——基于对家庭养老替代机制的分析[J].中国农村观察,2014,(4):2-17,95.
[33]王振军.农村社会养老服务需求意愿的实证分析——基于甘肃563位老人问卷调查[J].西北人口,2016,37(01):117-122.
[34]Spector,William D,Thomas M Seldon and Joel W Cohen. The Impact of Ownership Type on Nursing Home Outcomes[J]. Health Economics,1998,(7):639-653.
[35]许福子.辽宁养老产业发展研究——基于对辽宁省10个地区的调查[J].社会福利(理论版),2014,(9):58-63.
[36]Linn MW,Gurel L Linn BS. Patient Outcomes as a Measure of Quality of Nursing Home Care[J]. AM J Public Health,1977,(4):337-344.
[37]Niccie L McKay. An Econometric Analysis of Costs and Scale Economies in the Nursing Home Industry[J]. The Journal of Human Resources,1988,23(1):57-75.
[38]朱蓉,郝勇,王菲菲.上海市老年人养老服务需求调查研究[J].社会保障研究,2013,(6):21-26.
[39]Grabowski,D C,and R A Hirth. Competitive Spillovers across Non-profit and For-profit Nursing Homes[J]. Journal of Health Economics,2003,(1):1-22.
(1)抽样调查方案采取分阶段抽样方式:第一阶段,从全国各省(自治区/直辖市)各选取一个省会城市和1-2个非省会城市;第二阶段,在被选取的2-3个被调查市中每市再抽取1-2个县。
(1)受篇幅限制,这部分稳健性回归结果未列出,作者备索。
(2)数据来源于王小鲁、樊纲、余静文《中国分省份市场化指数报告(2016)》。