日本“地域综合照护模式”的实践及启示

Practical Research and Enlightenment on Japan’s“Community-based Integrated Care System”

在少子老龄化、家庭照护功能弱化的社会背景下,日本自20世纪70年代开始构建“地域综合照护模式”的社会养老保障服务体系。地域综合照护模式既受到日本本土文化因素的影响,也受到现代社会文明发展理念因素的影响。在形成过程中出现“两化”特征,一是以基层为抓手,培育试点,再以点带面的系统化;二是不断通过实践检验、研讨做好顶层设计进而制度化。该模式的各构成要素相互联结形成了地域性、综合性、照护性、系统化“三性一化”的多元立体的、可持续性的结构。本文进一步考察了该模式在日本50个地区的实践情况,发现其呈现多样性、多元化两大特征。地域综合照护模式已从一个让老年人有尊严、能自立地安度晚年的养老服务模式成长为以地区全体居民为对象、具有地方特色的福利、权益保障模式。鉴于此,我国应从养老服务系统化的路径建设、鼓励社会力量积极参与等两方面着手构建具有我国地方特色的养老服务模式。

Under the social conditions involving financial deterioration,population aging and weakening of family care function,the Japanese government began to build a public old-age security service system called the“regional comprehensive care system”in the 1970s.This paper first examines the process of the model regarding its emergence,development and institutionalization;the development includes top-down and bottom-up approaches.Such development is not unidirectional,resulting from the interaction among various factors,including the influence of local Japanese culture,global developed countries and modernized ideas of civilization development.Two characteristics are found in the process:first,take the grassroots as the starting point,discover bright spots,cultivate pilot projects,and then carry out systematic work from point to area;and second,continue to do top-level design through practical tests and institutionalized work.In addition,we find that elements within the model are interconnected,forming a regional,comprehensive,caring,multi-dimensional and sustainable system.Furthermore,the practice cases of such a model in 50 Japanese regions illustrate its characteristics of diversity and variability.This model has certainly grown from a pension service model that allows the elderly to live their old age with dignity and independence to a welfare and rights protection model with local characteristics for all the region residents and a social governance mechanism for regional revitalization.Finally,this paper puts forward three suggestions for constructing the old-age service model with local characteristics in China.