长期护理保险制度下居家照护服务中的非均衡博弈与应对——基于上海地区护理站的分析

Unbalanced Game and Countermeasures in Home Care Service under Long-term Care Insurance System——Based on the Analysis of Nursing Stations in Shanghai

本文结合上海地区33家长期护理保险定点护理站及7户失能老人家庭的深度访谈,从非均衡博弈的视角,构建政府、护理站与家庭的三方收益矩阵,解释长期护理制度下居家照护体系运行过程中“低质量,高评价”的矛盾现象。分析发现,政府的宽松监管促使护理站选择降低服务质量;失能老人家庭衡量发现,低质量服务的收益高于付出的成本,进而接受服务并给予较高评价。笔者认为应通过政府、护理站和家庭三方联动的方式缓解该矛盾现象,具体举措为:增强长护险的支付灵活性,加大监管力度,缩小信息不对称,提高护理人员专业素养以及培养失能老人家庭的权利意识等,保证长护险制度下居家照护体系的健康发展。

This paper combines in-depth interviews with 33 nursing stations and 7 families.From the perspective of unbalanced game,building a three-way revenue matrix that includes the government,the nursing station and the family,in order to explain the contradictory phenomenon of"low quality,high evaluation".The analysis found that the lax regulatory environment encouraged nursing stations to provide low-quality services,family thought that the benefits of low-quality service were higher than the costs,thus gave a higher evaluation.The author thought that the government,the nursing station and the family should be combined to alleviate the contradiction.Specific measures should be taken as follows:enhance the payment flexibility of long-term care insurance,strengthen supervision,narrow the information gap,improve nurses'professional accomplishment and cultivate rights consciousness of the family,ensure the health of the long term insurance system.