从家庭照顾到社会护理——迈向“最优混合”的日本护理保险制度

From Family Care to Social Care: "Optimal Mixture" of Long-term Care Insurance in Japan

自2000年起实施的护理保险制度是日本福利体制转变的重要标志之一。为了聚焦该制度的实施过程,本文从家庭照顾关系变化出发,理解护理保险制度设计的初衷,并关注该制度实施后引发的护理服务主体与对象之间的新变化。该制度不断修订,试图应对照顾系统的改变,但在面对孤寡、独居老人的护理问题时却引发了新的问题。为解决这些问题,实现制度完善的可能路径在于依靠多元主体间的协作机制,尤其是发挥社会工作的功能。最后,文章通过描述护理保险制度中的多元主体关系,勾勒出一种"最优混合"的社会护理体制,以期为中国的护理制度建设提供相关启示。

The Long-Term Care Insurance System initiated in 2000 is an important symbol of the transformation ofsocial well-being system in Japan. From the departure of the shift from family care to social care, the author exploresthe motivation of the Care Insurance System and its consequences on the part of care providers as well as receivers.Though the care system has been accordingly reformed from time to time, new problems turn up. The author,therefore, proposes that a tentative solution relies on social work and the cooperation between multiple subjects andthat multi-subjects coordination should be established on the “optimal mixture” of social care system to address theissues concerned.