人口负增长背景下的失能照护保障:逻辑机理与治理路径

Care Support for the Disabled Elderly in the Context of Negative Population Growth:Logical Mechanisms And Governance Paths

人口发展有其内生规律与联动效应,出生率、死亡率的动态演变引起人口规模阶段性或长期性转变,联动年龄结构由扩张走向收缩,推动失能照护的阶梯型发展,其中,人口负增长是经济社会发展到一定阶段,无大量人口迁入、死亡率低位稳定、持续处于更替生育水平以下等因素的综合结果,并通过“环境逻辑、供需逻辑、主体逻辑”三大机理持续影响失能照护保障。我国长寿化与少子化趋势的长期交织,驱动人口负增长这一拐点正式显现,呈现“不可逆的长期性、复杂的内生性、趋势的渐进性、影响的系统性”四大特征,进而从筹资侧的“总体+家庭+保险+财政”与服务侧的“总体+家庭+市场+互助”两大机制对失能照护保障发展提出新的挑战。而相关国际经验、事实判断表明,人口负增长之下我国失能照护保障的发展,在理念层面应做好前瞻设计与系统方案,在制度层面应尽快推动长期护理保险落地,建立政府、家庭、社会多元主体共担机制,以及稳定服务、资金等关键要素保障。

Population development has intrinsic laws and linkage effects.The dynamics of birth and death rates cause a phase transition in the total population,linking the age structure from expansion to contraction and driving a stepwise development of disabled elderly care.Moreover,Negative population growth is the result of a certain stage of economic and social development,without a large number of people moving in,low and stable death rate,and continuously below the replacement fertility level,and continues to affect the care support for the disabled elderly through three mechanisms:“environmental logic,supply and demand logic,and subject logic”.The long-term interaction between longevity and childlessness in China has driven the turning point of negative population growth,which is characterized by“irreversible and long-term,complicated endogeneity,gradual tendency and systematic effects”.As a result,the two mechanisms of“total+family+insurance+finance”on the financing side and“total+family+market+mutual aid”on the service side will pose new challenges to the development of care support for the disabled elderly.Therefore,international experience and factual judgments show that for the development of care support for the disabled elderly under negative population growth,at the conceptual level,we should make forward-looking design and design systematic solutions,and at the institutional level,we should promote the implementation of long-term care insurance as soon as possible,and establish a mechanism for the government,families and social entities to share the burden,as well as to stabilize the provision of key elements such as services and funds.