社会市场经济模式下德国长期照护变迁及启示

The changes in long⁃term care in Germany under the social market economy and its implications

社会市场经济强调在保护竞争、充分发挥市场机制作用的同时,政府进行适度的干预,保障社会公正。德国长期照护体系的建立体现了国家对社会公正的重视。同时,由于该体系除了包括以保险给付的形式进行再分配,还涉及社会服务的提供,因此不可避免地需要考虑市场参与的问题。而对于社会公正和市场效率的平衡,在《长期照护保险法》建立之初已有所体现。随着社会的变迁,照护体系也不断发展,社会公正和市场效率间的天平逐渐发生倾斜。个人负担比例不断攀升,照护机构市场化趋势越发明显,社会不平等加剧。因此,就长期照护体系而言,市场效率被放在了更加重要的位置,从而在一定程度上削弱了社会公正。我国在建立长期照护制度时,应在制度建设、资金可持续性和服务供给方面进一步完善,以期更好地兼顾社会公平和市场效率。

Social market economy emphasizes that while protecting competition and maximizing market mechanisms,the government should intervene appropriately to ensure social justice.The establishment of German long⁃term care services reflects the state’s emphasis on social justice.Since the system not only includes redistribution in the form of insurance benefits but also involves the provision of social services,market participation inevitably needs to be considered.The balance between social justice and market efficiency has been reflected in establishing the Pflege⁃Versicherungsgesetz.With the changes in society,the system continues to evolve,bringing a gradual skew in the balance between social justice and market efficiency.The rising proportion of personal burden coupled with the increasing trends toward marketization of professional care institutions have increased social inequality.Therefore,market efficiency has been placed in a more crucial position in the long⁃term care system,thereby weakening social justice to a certain extent.China should further improve institutional construction,financial sustainability,and service supply to balance social equity and market efficiency better.