残疾人托养照护筹资体系与政策的责任边界

The Financing System and Policy Responsibility Boundary of Care for the Disabled

托养照护是重度残疾人长期而迫切的现实需要。近年来,我国残疾人托养照护制度逐步建立,初步形成了财政投入为主、多项政策配合的筹资体系,重点保障了困难重度残疾人基本生活照护。现行政策与残疾人自主生活愿望和未来托付关切尚有较大差距,促进发展功能发挥不足,家庭自费和保险付费很少,服务系统处于松散配合的分割运行状态。从责任边界视角看,需要基于残疾人家庭照护能力、收入水平及需求层级,厘清各方职责与配合关系,强化保险和信托作用,建立以残疾人为主体、回应多层级目标的托养照护制度。

Long-term and urgent care for individuals with severe disabilities is a pressing reality.China's care system for the disabled has been gradually established in recent years,with a funding system primarily supported by government finances and complemented by various policies,focusing on ensuring the basic life care of severely disabled people.There is still a gap between the policy and the desires for independent living of individuals with disabilities,along with concerns about future care arrangements.The system falls short in promoting the full utilization of functional abilities,with minimal contributions from family self-payment and insurance.The service system operates in a fragmented and loosely coordinated state.From the perspective of responsibility boundary,it is necessary to clarify the responsibilities and relationships of all parties based on family care ability,income level and demand level,strengthen the role of insurance and trust,and establish a care system centered around disabled people as the main body and respond to multi-level goals.