长期照护服务供给研究
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摘要
通过梳理国外研究成果发现,长期照护服务是一种准公共产品,其服务提供具有信息不对称及劳动力投入成本高等特征。完全由政府提供会存在低效率的问题,而交由私人机构提供则可能出现服务质量低下的问题。建议借鉴发达国家有管理的竞争,即通过政府购买服务的方式引入市场竞争机制,发挥长期照护保险的支付机制作用,实现购买者与提供者相分离。
By studying the results of foreign research,we found that long-term care service was a quasi-public product with the characteristics of information asymmetry and high labor input cost. Long-term care services entirely provided by the government can be inefficient while entirely provided by private sector can be under qualified. We suggested to learn from the developed countries to introduce market competition mechanism through the government's purchase of services,and to play the role of long-term care insurance payment mechanism to achieve the separation of buyers and providers.
By studying the results of foreign research,we found that long-term care service was a quasi-public product with the characteristics of information asymmetry and high labor input cost. Long-term care services entirely provided by the government can be inefficient while entirely provided by private sector can be under qualified. We suggested to learn from the developed countries to introduce market competition mechanism through the government's purchase of services,and to play the role of long-term care insurance payment mechanism to achieve the separation of buyers and providers.
引文
[1] Kane, R.A, R.L. Kane.Long-term care:Principles. Programs, and Policies[M]. New York:Springer publishing Co, 1987.
[2] OECD. Long-term care for older people.OECD Publishing, 2005.
[3] Evashwick, C.The continuum of long-term care. Cengage Learning, 2005.
[4]杨团.中国长期照护的政策选择[J].中国社会科学, 2016(11):87-110.
[5]张文娟,魏猛.中国老年人的失能水平到底有多高——多个数据来源的比较[J].人口研究,2015(3):34-47.
[6]朱铭来,贾清显.我国老年长期护理需求测算及保障模式选择[J].中国卫生政策研究,2009,2(7):32-38.
[7]荆涛.建立适合中国国情的长期护理保险制度模式[J].保险研究,2010(4):77-82.
[8]郝君富,李心愉.德国长期护理保险:制度设计、经济影响与启示[J].人口学刊,2014,204(36):104-112.
[9]戴卫东.欧亚七国长期护理保险制度分析[J].武汉科技大学学报(社会科学版), 2016,18(1):12-16.
[10]江崇光.从供给侧改革看长期照护保险的经济学意义[J].中国市场,2016(3):160-162.
[11] Kahana, E. Long-term Care Facilities, edited by E.F. Borgatta and R.J.V. Montgomery.New York:Macmillan Reference,2000.
[12] James M. Buchanan. The Pure Theory of Government Finance:A Suggested Approach[J]. Journal of Political Economy,1949,57(6):496-505.
[13] Buchanan, J.M. The demand and supply of public goods.Rand McNally&Company,1968.
[14] Borzaga, C. and J. defourny. The emergence of social enterprise.New York:Routledge,2004.
[15] 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.
[16] 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.
[17] William J. Scanlon,A Theory of the Nursing Home Market[J].Inquiry, 1980,17(1):25-41.
[18] Baldwin, C.Y.and C.E. Bishop. Return to nursing home investment:issues for public policy[J].Health Care Financing Review,1984,5(4):43-52.
[19] Eric W. Christensen,Richard J. Arnould. The Impact of Asymmetric Information and Ownership on Nursing Home Access[J].International Journal of Health Care Finance and Economics,2005,5:273-297.
[20] Grabowski, D. C. A longitudinal study of Medicaid payment,private-pay price and nursing home quality[J]. International Journal of Health Care Finance and Economics, 2004(4):5-26.
[21] Kate A. Stewart, David C. Grabowski and Darius N. Lakdawalla,Annual Expenditures for Nursing Home Care:Private and Public Payer Price Growth, 1977 to 2004[J].Medical Care,2009,47(3):295-301.
[22] Tadashi Fukui and Yasushi Iwamoto.Policy Options for Financing Future Health and Long-Term Care Costs in Japan[M]. University of Chicago Press, 2007:415-442.
[23] Hirsch S. Ruchlin and Samuel Levey.Nursing Home Cost Analysis:A Case Study[J]. Inquiry, 1972,9(3):3-15.
[24] David C. Grabowski.The Market for Long-Term Care Services[J]. Inquiry, 2008,45(1):58-74.
[25] Judith R. Lave. Cost Containment Policies in Long-Term Care[J]. Inquiry, 1985,22(1):7-23.
[26] Howard Birnbaum, Christine Bishop, A. James Lee and Gail Jensen.Why Do Nursing Home Costs Vary? The Determinants of Nursing Home Costs[J].Medical Care, 1981,19(11):1095-1107.
[27] Weisbrod, BA. Nonprofit and propriety sector behavior in health care:Does institutional form matter? Presented at the annual meetings of the American Public Health Association, 1993.
[28] Michael D. Rosko, Jon A. Chilingerian, Jacqueline S. Zinn and William E. Aaronson.The Effects of Ownership, Operating Environment, and Strategic Choices on Nursing Home Efficiency[J].Medical Care, 1995,33(10):1001-1021.
[29] Nyman JA, Bricker DL, Link D. Technical efficiency in nursing homes[J]. Medical Care,1990,28(6):541.
[30] Nyman JA, Bricker DL. Profit incentives and technical efficiency in the production of nursing home care[J]. Rev Econ Stat,1989, 71:586.
[31] Holahan J. State rate-setting and its effects on the cost of nursing home care[J]. Journal of Health Polity Policy Law,1985, 9:647.
[32] Ullmann SG. Cost analysis and facility reimbursement in the long-term health care industry[J]. Health Services,1984,19:83.
[33] Frech, H. E, m. The Property Rights Theory of the Firm:Some Evidence from the U.S. Nursing Home Industry[J]. Journal of Institutional and Theoretical Economics,1985, 141(1):146-166.
[34] Fizel, J. and T. Nunnikhoven. Technical Efficiency of For-Profit and Non-Profit Nursing Homes[J]. Managerial and Decision Economics,1992,13(5):429-439.
[35]徐小波,江明修,刘静淳,等.国内非营利性组织管理法规之研究[Z].台北:“行政院研究发展考核委员会”,2001.
[36] Mehta K K, Briscoe C. National Policy Approaches to Social Care for Elderly People in the United Kingdomand Singapore1945-2002[J]. Journal of aging&social policy, 2004, 16(1):89-112.
[37] Erika Schulz.The long-term care system for the elderly in Germany.European network of Economic policy research institutes,2010:19-49.
[38]施巍巍.发达国家老年人长期照护制度研究[M].北京:知识产权出版社,2012.
[39] Anna Amirkhanyan.Privatizing Public Nursing Homes:Examining the Effects on Quality and Access[J]. Public Administration Review, 2008,68(4):665-680.
[40] Kai Leichsenring, Jenny Billings and HenkNies. Long-Term Care in Europe Improving Policy and Practice. PALGRAVE MACMILLAN, 2013.
[41] Adelina Comas-Herrera, Joan Costa-Font, etc. European Study of Long-Term Care Expenditure. Report to the European Commission, Employment and Social Affairs DG. Grant number VS/2001/0272. PSSRU Discussion Paper,2003:1840.
[42] Rhoades, J. N. Krauss. Nursing Home Trends, 1987 and 1996,MEPS Chartbook 3. Rockville, Md:Agency for Health Care Policy and Research(AHCPR),1999.
[43] Strahan, G. W. An Overview of Nursing Homes and Their Current Residents:Data from the 1995 National Nursing Home Survey. Rockville, Md:National Center for Health Statistics,Centers for Disease Control and Prevention, U.S. Department of Health and Human Services,1997.
[44]毕素华,陈如勇.发展民办养老机构的若干思考[J].苏州大学学报(哲学社会科学版),2005(5):125-128.
[45]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.
(1)文中根据“the Rate Setting Commission”的规定把养老院成本分为12类:护理成本(nursing)、伙食成本(dietary),医疗供给之外的成本,管理人员和一般员工的薪酬支出成本(salaries),房/地产成本(property),运营成本(operations),折旧(depreciation),机构管理成本(housekeeping),日常洗衣(laundry and linen),娱乐和康复(recreation and rehabilitation),包括医师薪酬和医疗供给在内的其他服务成本(other services),以及包括坏账、公司税、联邦收入税等(other)。
[2] OECD. Long-term care for older people.OECD Publishing, 2005.
[3] Evashwick, C.The continuum of long-term care. Cengage Learning, 2005.
[4]杨团.中国长期照护的政策选择[J].中国社会科学, 2016(11):87-110.
[5]张文娟,魏猛.中国老年人的失能水平到底有多高——多个数据来源的比较[J].人口研究,2015(3):34-47.
[6]朱铭来,贾清显.我国老年长期护理需求测算及保障模式选择[J].中国卫生政策研究,2009,2(7):32-38.
[7]荆涛.建立适合中国国情的长期护理保险制度模式[J].保险研究,2010(4):77-82.
[8]郝君富,李心愉.德国长期护理保险:制度设计、经济影响与启示[J].人口学刊,2014,204(36):104-112.
[9]戴卫东.欧亚七国长期护理保险制度分析[J].武汉科技大学学报(社会科学版), 2016,18(1):12-16.
[10]江崇光.从供给侧改革看长期照护保险的经济学意义[J].中国市场,2016(3):160-162.
[11] Kahana, E. Long-term Care Facilities, edited by E.F. Borgatta and R.J.V. Montgomery.New York:Macmillan Reference,2000.
[12] James M. Buchanan. The Pure Theory of Government Finance:A Suggested Approach[J]. Journal of Political Economy,1949,57(6):496-505.
[13] Buchanan, J.M. The demand and supply of public goods.Rand McNally&Company,1968.
[14] Borzaga, C. and J. defourny. The emergence of social enterprise.New York:Routledge,2004.
[15] 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.
[16] 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.
[17] William J. Scanlon,A Theory of the Nursing Home Market[J].Inquiry, 1980,17(1):25-41.
[18] Baldwin, C.Y.and C.E. Bishop. Return to nursing home investment:issues for public policy[J].Health Care Financing Review,1984,5(4):43-52.
[19] Eric W. Christensen,Richard J. Arnould. The Impact of Asymmetric Information and Ownership on Nursing Home Access[J].International Journal of Health Care Finance and Economics,2005,5:273-297.
[20] Grabowski, D. C. A longitudinal study of Medicaid payment,private-pay price and nursing home quality[J]. International Journal of Health Care Finance and Economics, 2004(4):5-26.
[21] Kate A. Stewart, David C. Grabowski and Darius N. Lakdawalla,Annual Expenditures for Nursing Home Care:Private and Public Payer Price Growth, 1977 to 2004[J].Medical Care,2009,47(3):295-301.
[22] Tadashi Fukui and Yasushi Iwamoto.Policy Options for Financing Future Health and Long-Term Care Costs in Japan[M]. University of Chicago Press, 2007:415-442.
[23] Hirsch S. Ruchlin and Samuel Levey.Nursing Home Cost Analysis:A Case Study[J]. Inquiry, 1972,9(3):3-15.
[24] David C. Grabowski.The Market for Long-Term Care Services[J]. Inquiry, 2008,45(1):58-74.
[25] Judith R. Lave. Cost Containment Policies in Long-Term Care[J]. Inquiry, 1985,22(1):7-23.
[26] Howard Birnbaum, Christine Bishop, A. James Lee and Gail Jensen.Why Do Nursing Home Costs Vary? The Determinants of Nursing Home Costs[J].Medical Care, 1981,19(11):1095-1107.
[27] Weisbrod, BA. Nonprofit and propriety sector behavior in health care:Does institutional form matter? Presented at the annual meetings of the American Public Health Association, 1993.
[28] Michael D. Rosko, Jon A. Chilingerian, Jacqueline S. Zinn and William E. Aaronson.The Effects of Ownership, Operating Environment, and Strategic Choices on Nursing Home Efficiency[J].Medical Care, 1995,33(10):1001-1021.
[29] Nyman JA, Bricker DL, Link D. Technical efficiency in nursing homes[J]. Medical Care,1990,28(6):541.
[30] Nyman JA, Bricker DL. Profit incentives and technical efficiency in the production of nursing home care[J]. Rev Econ Stat,1989, 71:586.
[31] Holahan J. State rate-setting and its effects on the cost of nursing home care[J]. Journal of Health Polity Policy Law,1985, 9:647.
[32] Ullmann SG. Cost analysis and facility reimbursement in the long-term health care industry[J]. Health Services,1984,19:83.
[33] Frech, H. E, m. The Property Rights Theory of the Firm:Some Evidence from the U.S. Nursing Home Industry[J]. Journal of Institutional and Theoretical Economics,1985, 141(1):146-166.
[34] Fizel, J. and T. Nunnikhoven. Technical Efficiency of For-Profit and Non-Profit Nursing Homes[J]. Managerial and Decision Economics,1992,13(5):429-439.
[35]徐小波,江明修,刘静淳,等.国内非营利性组织管理法规之研究[Z].台北:“行政院研究发展考核委员会”,2001.
[36] Mehta K K, Briscoe C. National Policy Approaches to Social Care for Elderly People in the United Kingdomand Singapore1945-2002[J]. Journal of aging&social policy, 2004, 16(1):89-112.
[37] Erika Schulz.The long-term care system for the elderly in Germany.European network of Economic policy research institutes,2010:19-49.
[38]施巍巍.发达国家老年人长期照护制度研究[M].北京:知识产权出版社,2012.
[39] Anna Amirkhanyan.Privatizing Public Nursing Homes:Examining the Effects on Quality and Access[J]. Public Administration Review, 2008,68(4):665-680.
[40] Kai Leichsenring, Jenny Billings and HenkNies. Long-Term Care in Europe Improving Policy and Practice. PALGRAVE MACMILLAN, 2013.
[41] Adelina Comas-Herrera, Joan Costa-Font, etc. European Study of Long-Term Care Expenditure. Report to the European Commission, Employment and Social Affairs DG. Grant number VS/2001/0272. PSSRU Discussion Paper,2003:1840.
[42] Rhoades, J. N. Krauss. Nursing Home Trends, 1987 and 1996,MEPS Chartbook 3. Rockville, Md:Agency for Health Care Policy and Research(AHCPR),1999.
[43] Strahan, G. W. An Overview of Nursing Homes and Their Current Residents:Data from the 1995 National Nursing Home Survey. Rockville, Md:National Center for Health Statistics,Centers for Disease Control and Prevention, U.S. Department of Health and Human Services,1997.
[44]毕素华,陈如勇.发展民办养老机构的若干思考[J].苏州大学学报(哲学社会科学版),2005(5):125-128.
[45]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.
(1)文中根据“the Rate Setting Commission”的规定把养老院成本分为12类:护理成本(nursing)、伙食成本(dietary),医疗供给之外的成本,管理人员和一般员工的薪酬支出成本(salaries),房/地产成本(property),运营成本(operations),折旧(depreciation),机构管理成本(housekeeping),日常洗衣(laundry and linen),娱乐和康复(recreation and rehabilitation),包括医师薪酬和医疗供给在内的其他服务成本(other services),以及包括坏账、公司税、联邦收入税等(other)。