中国养老服务70年(1949—2019):演变脉络、政策评估、未来思路

Elderly Services in China(1949-2019): Evolution, Policy Evaluation and Prospect

中华人民共和国成立以来,养老服务经历了计划经济时期、初识老龄化-基本制度构建、未备先老-主动发展的阶段。其发展理念历经从注重家庭和个人责任到多元主体责任并重,从强调单一政策发展到注重综合政策体系构建,从侧重宏观改革到讲求精细发展的逐渐优化过程。70年的政策实践使社区居家为主、机构为辅、医养结合的养老服务体系具备雏形,但资源供给总量不足与结构失衡并存;支持社会力量助力养老服务发展的步伐加快,但现实效果亟需改善;整合性养老服务初步发展,但有待系统化;借鉴西方典型经验日益强化,但与中国国情融合不够充分。新时代需遵循以老年人需求为导向,以社区居家的服务方式为主,以公建民营和民办公助的运营方式为主,构建理性的多层次养老服务体系。

Since 1949,elderly services in China have witnessed three stages:rudimentary development during the planned economy period,construction of a basic system alongside the emergence of an ageing society,and finally taking initiatives for development.Meanwhile,the ideas behind the development of elderly services experienced three transitions:(i)from being responsibilities assumed by families and individual to responsibilities shared by multiple stakeholders;(ii)from fragmented policies to integrated and comprehensive policy framework;and(iii)from focusing on macro-level reforms to elaborating on details.After 70 years’development,an elderly service system providing home community-based care with nursing homes as a supplement,as well as integrated medical and care services is taking shape,albeit the service supply remains insufficient and imbalanced-structured.Also,policies to stimulate the involvement of social resources into elderly services are strengthened,yet their effects need to be improved.Integrated elderly services began to develop,but to be systematic.Furthermore,China is keen to learn from the experiences of the Western welfare states,but fails to give full consideration to China’s realities.In the new era,a rational and multilayered elderly service system should be constructed to meet the diversified need of the elderly.Also,future elderly services should exploit both governmental and social resources,and focus on home community-based care.