“元问题”视域下中国养老服务体系的改革与发展

Reforming Elderly Services System with Chinese Characteristics from the Perspective of“Meta-Problems”

长期照护压力溢出家庭、市场供需结构性失衡、照护成本分担悬而未决,是人口老龄化时代养老服务面临的三大“元问题”。从这个角度审视,我国养老服务体系存在多元主体责任重叠与空白并存,供给整合机制运转不畅,以及财政效率偏低、人才队伍建设迟缓、监督管理滞后等短板。为此,建议以解决“元问题”为基点和靶向,构建以七个子系统为骨架的中国特色养老服务体系。这具体包括:基于有益品理论的责任共担体系;多元混合的资金保障体系;事业产业融合发展的供给体系;智能化支撑的机构、社区、居家相协调的递送体系;医养康养相结合的老年健康服务体系;政府支持的养老服务人才队伍建设体系;符合现代养老服务业发展要求的监管体系。

Long-term care needs exceeding the ability of family support, the imbalance between supply and demand, and unresolved care cost sharing are the three major "meta-problems" facing elderly care services in the aging society. From this perspective, there are some problems with China’s elderly service system: the coexistence of overlaps and the vacuum of responsibilities;the poorly-functioning mechanism for coordinating diversified suppliers;the inefficient use of public financing, human resource shortage, and the lack of supervision. Targeting the "meta-problems", we suggest that China should build an elderly care service system with seven components, namely: a responsibility sharing system based on the "merit goods" theory;a financing system with diversified funding sources;a supply system integrating public and private suppliers;a service delivery system coordinating institutional care, community care, and home care;an elderly healthcare service system combining medical care, rehabilitation nursing, and long-term care;a training system supported by the government for elder care professionals;and a new elderly care services regulatory system to discipline elderly care services.