摘要
中国已经步入老龄化加速期,面临日益严峻的养老服务问题和挑战,充分吸收借鉴发达国家在应对老龄化、促进养老服务方面的经验教训,有助于建好制度、少走弯路,是我们作为后发国家的特殊优势,也是有效破解养老服务难题的科学路径。为此,本研究着眼于中国养老服务体系建设的现实关切,在系统梳理总结发达国家和地区养老服务发展的现状与趋势、典型模式、主要问题及对策的基础上,发现各国大多在政策理念上倡导积极老龄化,在管理体制上强调立法与放权,在供给主体上借力市场与社会,在递送模式上倾向社区居家服务,在服务内容上推动专业化、标准化、精细化,在质量控制上注重受众评价,在保障水平上坚持适度可持续,并在此基础上形成了市场导向型、普惠共济型、风险共担型、家庭基础型、多元混合型等养老服务典型模式。基于上述发现,结合中国实际,本文从法治建设、政府职责、供给主体、医养结合、体系建设、服务质量等方面提出应对策略,探索具有中国特色的科学化养老服务道路。
With the accelerated aging, China is facing increasingly grave questions and challenges. The experiences and lessons on aging and pension services in developed countries will benefit us to establish a sound legal and policy system to solve the difficult questions we face in aging services with the late-mover advantage. After we summarize and analye the current situation, development trend, typical models and main questions in developed countries and regions, we find most countries make policies to encourage active aging, emphasize legislation and delegate powers to lower levels, give full play to the role of market and society, focus on community care and in home services for the elder people, promote professionalism, standardization and refinement, attach importance to the evaluation of audience on quality control and insist the sustainable development. There are many models in aging service in the world, such as market oriented, universalism, risk-sharing and home-based care services. Based on the above, combined with Chinese situation, we put forward recommendation of appropriate solutions on legal construction, governmental responsibility, supplying subject, system building, service quality in order to create the path of socialism with Chinese characteristics on aging services.
引文
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(1)多元混合型养老服务模式在一定程度上是“福利社会”思潮的制度产物。米什拉将“福利社会”笼统地视为“福利多元主义”或“混合福利经济”的同义语。
(1)钱随人走(Money Follows the Person,简称MFP)”计划是2004年小布什总统执政期间“新自由倡议(New Freedom Initiative)”的一部分,计划在之后的5年里由联邦政府划拨专门款项给各州政府,用于支付将老年人从护理院等机构中转出,回到家庭或社区中接受照护服务的一年的全部费用,这个计划的目的就是直接激励长期照护服务由机构提供转向家庭和社区提供。
(2)“Olmstead v.L.C.判例”,指的是1999年7月美国最高法院对Olmstead V.L.C.&E.W.判决一案。L.C.和E.W.是佐治亚州两位患有精神疾病的女性,她们常在精神病治疗机构接受治理。经二人的主治医生确定,二人的精神疾病状况最好在社区而非机构中生活,但是由于缺乏必要的照护,二人即便回到自家所在的社区也无法正常生活。因此,L.C.和E.W.依据残疾人保障法提起对州政府相关部门的诉讼,认为后者未能为残疾人提供可融入社区的生活设施,涉嫌歧视残疾人。美国最高法院基于此案判定,按照《美国残障人士法案》的“融合条款(integration mandate)”要求,各州公共机构必须为有能力的残障人士保持社会融入的机构提供服务,除非该州有能力证明这些举措动摇社会项目的根基。否则就是对残障人士的歧视。
(1)“社会性住院”是指这样一种现象:由于医疗费用的负担低于老人看护设施的负担,许多人选择长期性住院而不愿意到老人看护机构。
(1)“今井事件”发生于2014年的日本神奈川县的一家养老院,名为今井隼人的24岁养老院护理员在两个月内先后将院内居住的三名老人从阳台扔下致死,老人分别为87岁、86岁和96岁,在老人死亡之初都未能发现其真正死因,直到发现这三人均在今井值夜班期间非正常死亡警察才慢慢发现事件真相。来源:新华侨报,《是什么让日本护工将老人残忍扔下楼》,2016年2月18日,http://www.chinanews.com/hb/2016/02-18/7762885.shtml。
(1)Inter RAI是一套由33个国家的研究人员参与开发而成的老年卫生需求评估体系,已有三十余年历史。在欧美,这套体系由一系列用于不同场所的评估工具和一个信息网络平台组成,其目标是通过评估实现对老年人和残疾人卫生服务的有效管理。Inter RAI在欧美各国等应用效果良好。
(1)全国人大相关负责人就“人大监督工作”答问,新华网,http://www.xinhuanet.com/politics/2018lh/zb/20180312b/wzsl.htm,2018年4月12日。