我国养老服务的定位、问题与思考

Elderly Care Services:Positioning,Challenges,and Reflections

从集中与分散、持续与间隙、坐诊与行医三个维度来看,各种类型的养老服务各具优缺点。以往将60岁及以上老年人都视作需要赡养与照护对象的观点存在明显偏差,亟须重新确定老年人经济供养、生活照料、医疗护理、心理慰藉的起始时间。通过对联合国倡导的“在地老龄化”加以分析,我们发现我国居家养老与机构养老具有不同的使用场域与优缺点,而我国的少子老龄化对养老服务供给能力也构成了严峻挑战,甚至可能使传统的养老模式难以为继。以“自我养老服务为基础、家庭养老服务为依托、市场养老服务为支撑、社会养老服务为补充、政府养老服务为托底”的养老服务体系更适合我国的养老服务现状。与主流的“9073”或“9064”养老服务格局愿景相比,基于第七次全国人口普查数据而提出的“87—10—1—2”养老服务格局愿景更符合我国养老服务未来的发展趋势。

Based on the perspectives of agglomeration effects,economies of scale,and economies of scope,this paper dis⁃cusses the advantages and disadvantages of various types of services from three dimensions:centralized versus de⁃centralized,continuous versus intermittent,and in-clinic versus in-home.It further elucidates several biases pres⁃ent in China’s current elderly care system and attempts to correct them.First,it repositions the classic responsibili⁃ties of elderly care,innovatively proposing an elderly care system that bases itself on“self-care,supported by fam⁃ily care,bolstered by market services,supplemented by societal services,and underpinned by government ser⁃vices.”Second,it reflects on and critiques the mainstream“9073”or“9064”elderly care patterns,and based on data from the seventh national census,proposes a new vision for the elderly care structure“87-10-1-2.”Third,it corrects the traditional view of the elderly as solely dependents in need of support and care,clearly defining the start and end points for economic support,caregiving,medical services,and emotional solace for the elderly.Fourth,it challenges the United Nations’vision of“Aging in Place,”clarifying the different applicable contexts and strengths and weaknesses of home-based versus institutional elderly care,asserting that there is no question of which is better or worse.Fifth,it reconsiders the mainstream“needs-based”approach to allocating elderly care ser⁃vices,pointing out that“needs-based,supply-founded”is the guiding philosophy that considers both demand and supply and their balance.Reevaluating the positioning and understanding of mainstream or classic elderly care and timely correcting any biases or errors are crucial for advancing the high-quality development of China’s elderly care services.