城市老年人社区照顾服务模式探讨

随着我国人口老龄化程度的不断提高,老年人照顾问题日益凸显,已经引起全社会的广泛关注。传统家庭照顾和集中机构照顾都不能满足老年人的需求,实行社区照顾己成为共识。本文着重分析了实行老年人社区照顾服务的必要性及其存在的问题,进而提出大力发展老年热社区照顾的政策建议。     

中西合璧的老人支持体系——香港所追求的全面照顾模式

以老人照顾体系发展的四个阶段,回顾香港过去五十年来从家庭维系传统孝亲价值,政府角色对照顾责任的厘清,传统家庭对机构照料的忌讳,到近年来从"在社区照顾"发展至"就地养老"的概念;从人口结构的变化、社会经济发展的变迁以及政府角色与责任的不同作了探讨剖析。说明"全面照顾模式"如何结合上述价值与社会体系背景,将政府与民间的各层面力量融入成为全方位、多面向与多选项的照顾体系,说明了对于政策制定者、服务提供者以及社区工作者这又意味着什么样的挑战。     

照顾提供、性别平等与公共政策——女性主义经济学的视角

中国的市场经济转轨与经济结构的变化提高了人民的收入从而提高了中国妇女及她们家庭的福利。社会经济制度和经济结构的变化同时加剧了妇女在工作和孩子老人照料两者之间的冲突。虽然中国的计划生育政策意味着需要照顾的儿童数量在减少,但是生育率的快速下降以及人口平均预期寿命的延长使中国老年人比例迅速增加,并由此加大了照料服务的需要。妇女的工作与照顾责任的冲突对社会性别平等、对妇女本身及她们家庭的福利都有严重的负面影响。为推动对照顾提供问题的研究和公共政策对照顾提供的关注,介绍女性主义经济学对照顾经济的研究和发达国家照顾问题的公共政策,讨论这些理论和政策对我国的借鉴意义。     

上海高龄体弱老人家庭亲属照顾者的生活满意度:照顾资源的作用

对上海城区697对75岁及以上的体弱老人及其家庭亲属照顾者作了抽样调查和统计分析。家庭亲属照顾者的照顾资源是影响高龄体弱老人生活满意度的显著因素。经济资源充分、家庭和朋友支持充足、健康自评相对好、运用积极应对策略的照顾者有较高的生活满意度。要提升家庭亲属照顾者的心理健康,首要的任务之-是增强照顾资源,包括经济的、健康的、心理的、社会的资源。     

社区照顾及其在艾滋病防治中的应用

目前，传统艾滋病防治模式与方法已经无法适应日益恶化的趋势，社区关怀护理模式开始介入世界各国的艾滋病防治过程；分析传统艾滋病防治模式的缺陷与不足；探讨社区照顾模式在艾滋病防治中运用；提出建立适合我国国情的社区支持和家庭关怀服务模式的建议。     

城乡居民基本养老保险对隔代抚育的影响研究

隔代照顾是中国较为普遍的儿童照顾方式，但这一照顾方式的占比却在不断下降。社会养老保险制度不断健全可能是其中的原因之一。通过构建祖辈闲暇时间与消费决策的效用模型，并基于2018年中国健康与养老追踪调查（CHARLS）数据的实证研究发现，祖辈领取城乡居民基本养老保险金对孙辈的时间照顾及其劳动力供给均产生“挤出”效应，但在对孙辈的经济照顾维度上则产生“挤入”效应；且城乡居民基本养老保险金对隔代抚育的影响存在城乡间、性别间的异质性。鉴于此，需通盘统筹考虑“一老一小”问题，一方面加强政策设计，明确隔代抚育的社会经济价值，实现抚育—养老服务的有序转换，另一方面着力营造包容性政策环境，促进托育服务多元化有效供给。     

台湾地区健康养老产业发展的经验及建议

我国台湾地区养老产业发展起步较早,自1993年步入老龄化社会后,逐步将美日等国养老产业发展经验成功本土化,并为顺应市场发展创造出众多实用且独具特色的发展思路,建立起多层级的长期照顾体系.台湾地区老龄化发展的历史背景、基本情况、发展态势都与祖国大陆非常接近,在应对老龄化快速发展和养老产业发展政策方面的经验能为祖国大陆提供一些启示.基于祖国大陆人口快速老化、需照顾人口急速增长,老年人口规模大、尤其高龄老人规模大,家庭结构改变、家庭照顾功能日益薄弱,出生率快速下降、劳动人口的负担日益加重等发展实际,祖国大陆要在资金筹措、体系建设、制度和机构评估、人力资源发展等多个角度和各个环节实现可持续推动.     

转型期老龄化城市完善养老服务格局的研究——以上海为例

近年来,随着人口老龄化及高龄化趋势的不断加剧,上海的城市养老问题日益严峻。基于目前"9073"基本养老服务格局的界定,近90%的老年人将依托居家养老模式实现养老,但传统的居家养老模式由于家庭养老功能弱化、养老需求多元等因素的影响,已无法满足当前上海城市养老的现实需求,城市养老服务格局的完善势在必行。文章认为,上海城市养老服务格局的完善应引入国际"社区照顾"理念,以"强化居家养老"为突破,推进社区社会养老服务体系的建设,促使传统的居家养老模式向"家庭居住、社区照护、社会参与"的新型居家养老模式转变,实现"家庭—社区—社会—政府"间的联动协作,以巩固和完善"9073"养老服务格局,全面提高养老服务的能力和水平。     

关于养老服务产业化的几个问题

该文提出"养老服务产业化"就是建立在商品交换的基础上,使"居家养老"和"机构养老"等老年生活照顾服务成为营利性的生产经营活动的过程;指出我国养老服务的发展必须坚持产业化的方向。进而根据相关文献资料,从养老服务福利模式、社区照顾、非营利组织和志愿者提供的服务等方面,澄清和补充了人们对北欧国家、英国、日本等国"福利化"养老服务的不够全面、准确的认识,认为养老服务的"福利化"和"产业化"并不是互相抵触和矛盾的,而是并行不悖、互为表里、互相促进的。最后结合国情实际,提出促进我国养老服务产业化发展的思路。     

农村老人社区养老服务的选择及其影响因素分析——以安徽合肥地区为例

随着我国当前人口老龄化、高龄化程度不断加深,养老问题已成为社会普遍关注的问题。与城镇相比,农村人口老龄化问题更加严重,随着农村家庭小型化发展和农村"空巢"老人的增多,传统家庭养老功能日渐弱化,农村老年人照顾问题日益突出。而社区养老服务是解决好农村老年人养老问题,实现社会稳定与发展的重要举措。但是社区养老服务受到诸多因素的影响。采用文献研究方法、问卷调查法、访谈法和定量分析方法对安徽省肥西县进行实证分析发现,家庭子女个数、家庭经济状况、村级组织的帮助、所在社区是否有老年活动中心、对社区养老服务的了解度和地区因素等因素会显著影响社区养老服务的选择。提出了提高农村老年人对社区养老服务的认知、加强农村社区养老服务设施建设、以老年人需求为导向提供多样化养老服务、加强服务队伍建设等建议,希望可以为安徽省社区养老服务的建设发展提供参考。     

社区居家养老意愿的影响因素研究—以北京为例

根据2012年实地调研数据分析北京市家庭养老、社区居家养老、机构养老等方式的现状及其发展态势,使用回归分析考察了老年人意愿养老方式及其影响因素。家庭养老仍是主要的养老方式,社区居家养老备受青睐,尤其是中等收入的老年人更偏好于社区居家养老。建议养老资源更多地向社区配置,促进社区居家养老服务的快速发展。     

城市积极老龄化的探索——美国夏威夷 火奴鲁鲁社区花园对上海社区养老的启示

老龄化问题已经成为当前全球共同面临的挑战。分析 和归纳了美国夏威夷火奴鲁鲁城市社区花园应对老龄化的实践 经验，提出了社区花园对中国的适用性。针对上海已经出现社 区花园的背景，研究了适合上海养老模式的“积极老龄化”创 新路径，提出上海可以在社区更新改造过程中整合生产性景观 和园艺疗法，先期营造中等规模、开放式布局和场地活力高的 社区花园。同时指出未来需要多学科的融合才能使社区养老做 得更好。     

中国城乡老年健康及照料状况研究

人口老龄化背景下我国城乡的老年健康及老年照料问题日益严重。利用中国城乡老年人状况调查数据、全国残疾人抽样调查数据以及国家卫生服务利用调查数据,从两周患病率、慢性病患病率、残疾水平、自评健康以及健康预期寿命等方面分析了我国城乡老年人的健康状况,探讨了目前我国城乡老年人的照料提供来源。提出了人口老龄化趋势下提高老年健康水平,应对老年人口照料危机的政策建议。     

The prodigal son: does the younger brother always care for his parentsin old age?

Studies have shown that the older sibling often chooses to live away from his elderly parents intending to free ride on the care provided by the younger child. In the presented model, we incorporate income effects and depict a different pattern frequently observed in Eastern countries; that is, the older sibling lives near his or her parents and takes care of them in old age. By generalizing the existing model, we show three cases of elderly parents being looked after by (i) the older sibling, (ii) the younger sibling, and (iii) both siblings, depending on the relative magnitude of the income effect and the strategic incentive for one sibling to free ride on the other. Our study also investigates the effect of changes in relative income on the level of total care received by parents.     

Testing cointegration between health care expenditure and GDP in Japan with the presence of a regime shift

Using quarterly data from 1994 through 2013, this article is the first to use the Hansen and Seo (2002) tests to examine the long-term relationship between real per-capita GDP (PGDP) and real per-capita health care expenditure (PHCE) in Japan with threshold effects. We detect the presence of a threshold cointegrating relationship between the two variables. In addition, we find that error correction adjustments are significantly conducted only through PGDP in a typical regime, whereas both PGDP and PHCE drive the adjustments in the extreme regime. We find that the extreme regime occurred mainly after Q4 2008, implying that the policy introducing the late-stage medical care system for the elderly in April 2008, which expanded the ratio of personal expenses for the elderly, may be effective for attaining a long-run equilibrium between PGDP and PHCE.     

Informal parental care and female labour supply in Japan

Using the Japanese Study of Aging and Retirement, Japan’s first globally comparable panel survey of the elderly, we estimate the effect on female employment in Japan due to the provision of informal parental care. We observe that informal parental care has little impact on female employment, after controlling for endogeneity of informal care or individual unobserved time-invariant heterogeneity. This finding is consistent with those observed in Europe and the US, underscoring a limited association between care and work in Japan, which is facing ageing at the fastest pace among advanced economies.     

Counting Care Work in Social Policy: Valuing Unpaid Child- and Eldercare in Korea

This study demonstrates the usefulness of quantifying and valuing time spent on unpaid care work and explores the links between social policies, unpaid care work, and gender equality in the context of recent social care reforms in the Republic of Korea. Using information provided by two nationally representative surveys, this article elaborates on the gendered organization of care provision and the total costs of care services for children and the elderly, including unpaid family care, family expenditures on care services, and state support in the form of public expenditures. The study finds that omitting the role of family care services overestimates the state's role in caring for children and elderly adults. A closer look at the impact of long-term care insurance reveals the need for integrated analyses of the qualitative and quantitative aspects of the social organization of care, especially in regard to gender equality.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

The Impact of China's New Rural Pension Program on Elderly Labor,Grandchild Care,and Old-Age Support

ABSTRACT

This study examines how a social pension program changes paid work patterns and expectations about the source of future financial support for the elderly in China. Using the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study (CHARLS), the study finds that the New Rural Pension Program (NRPP) reduced the hours of farmwork and increased the hours of grandchild care among elderly rural men; and both elderly women and men reported less expected reliance on adult children for financial support when they become infirm. These differential effects probably occur because the size of the pension benefit is very small and because of previous gender differences in farmwork and grandchild care. Additionally, the study shows that adult children reduced out-migration and increased their hours spent in farming activities, indicating that the effect of the NRPP has spilled over to younger members of the household.     

老年人养老方式选择的影响因素研究——基于CHARLS数据的实证分析

本研究在CHARLS调查所获得的微观数据的基础上进行,首先对老年人养老方式选择的结果和老年人人口特质、健康状况、经济状况等方面的6个变量进行关联分析,再通过二项Logistic回归模型,将是否选择机构养老作为被解释变量进行回归分析。结果表明非机构养老方式仍是老年人的主要选择,年龄、婚姻状况、慢性疾病情况、经济状况等因素与老年人养老方式的选择存在显著的关联并对选择结果产生影响。