中国城市养老机构的兴起:发展与公平问题

利用2009-2010年在南京市和天津市对养老机构的调查数据,描述了养老机构在两市的发展态势,比较了公办和民办机构在入住老人的健康状况及机构特征方面的差异。近10年来养老机构在两市迅猛增长,且以民办机构为主导。政府财政投入在两市公办机构的日常收入来源中占了相当的比重,而对民办机构的财政补贴则微乎其微。公办机构平均规模较大,在入住率上也远超民办机构。两市公办机构入住老人比民办机构入住老人在总体上更健康。公办机构在决定收住对象时比民办机构有更强的选择性。公众在享有现存养老机构资源时面临着机会不平等的问题。政府应确保在公办机构中公平、合理地分配公共服务资源,以最大程度地彰显其公益性,同时也应着力扶持民办机构,促进二者在社会化养老服务中公平竞争、协调发展。

The Rise of Long-Term Care Facilities in Urban China:Emerging Issues of Access Disparities

Using survey data collected during 2009-2010, we documented the growth of elder care homes in Nanjing and Tianjin and examined disparities in access to government-run vis-à-vis private-sector facilities. Our results indicate that elder care homes grew rapidly in both cities in the last decade, primarily in the private sector. Public financing accounted for a signili-cant portion of daily operating revenues in government-run facilities but little in private homes. On average, government-run homes were larger in size and had significantly higher occupancy rates than private facilities. Overall, residents in government-run homes were much healthier than those in private facilities, suggesting selective admission into government-run homes in favor of elders who were not severely impaired. In contrast, private-sector facilities housed more frail and high-acuity residents. These findings suggest disparities in urban elders' access to institutional long-term care. While market forces dictate the construction of more beds to meet rising demands, Chinese policy makers should strive to ensure equitable access to publicly subsidized long-term care services for those most in need.