关于完善老年服务和长期护理制度的思考与建议

Thoughts and suggestionson improving the elderly care service and long-term care system

我国以家庭为基础,社区为依托、机构为补充、医养结合的多元福利体系已经建成。本文认为与医疗有关的长期护理应纳入基本医疗保险,与生活有关的长期照料属私人事务,当私人在经济上和服务上不能提供有效供给时,政府需要"兜底线",瞄准对象,建立长期照护津贴制度,为弱势家庭提供长期生活照料的帮助;财政支出政策应由"补供方"为主转向"补需方"为主。文章认为现阶段社会长期护理保险不适合中国国情,建议完善健康养老、积极养老政策降低失能概率;构建"支持和维护家庭"的养老和长期照护政策体系。

In China,the pluralistic welfare system that is based on family,community support,institutional supplement,and combined with medical and elderly care has been established.This paper holds that long-term care related to medical care should be included into basic health insurance,whereas for the long-term care related to livelihood is a private matter.When private sector cannot provide effective supply in cash and services,the government should build the bottom line and target the objects by setting up a long-term care allowance system that provides long-term living care for the vulnerable elderly.The fiscal expenditure policy should therefore be shifted from targeting the"supply-side"to focusing on the"demand-side".The paper put forward that social insurance for long-term care is not suitable for China's current national conditions.It is recommended to improve the policies regarding healthy pensionand active pension in order to reduce probabilities of disability.The"family supporting and maintaining"policies should also be built up in the elderly care and long-term care systems.