医养结合养老创新的逻辑、瓶颈与政策选择

破解养老难题的关键是创新养老模式,改变养老和医疗的双轨分离状态,整合资源,提供一体化的养护服务,这既符合健康养老需求,同时也是发达国家养老服务供给改革和政策创新的普遍趋势.当前我国医养结合养老创新在服务内容与体系、服务实施主体、服务费用支付模式和服务从业人员等方面亟待突破以下瓶颈:服务序列未形成、服务供给部门壁垒未打破、支付保障体系尚无统一规划、服务所需的人力资源匮乏等等.要突破上述瓶颈需以政策创新对医养结合改革进行支持、引导与监管,包括医养结合的梯度服务序列政策、跨部门协作策略、探索性的长期护理保险覆盖政策、所需人力资源储备政策等等.     

医养融合型养老模式下老年人群生命质量的实证分析及影响因素研究

随着我国人口老龄化程度的不断加剧,医养融合型养老模式在国家政策的推动下,不少地方的试点取得了初步成效.文章应用WHOQOL-BREF(世界卫生组织生存质量测定简表)和自制问卷在南京市秦淮区医养融合型养老机构及社区进行调研,测算并比较医养融合型养老服务模式下老年人与非医养融合型养老服务模式下老年人生命质量得分,并利用相关定量模型进行实证分析.研究发现:医养融合服务较显著地提高了老年人的生命质量,医养服务满意度及子女负担状况会对医养融合服务模式下老年人的生命质量产生影响.鼓励推行医养融合型养老服务模式,准确定位医养融合发展路径;全面优化医养融合服务水平与层次;积极转变养老理念,给予老年人群更多的关注与支持是进一步提高医养融合型养老模式下老年人群生命质量的有效策略.     

“二元经济”与农村养老保障改革

本文介绍了城乡两种不同养老模式,指出我国农村养老方式变化滞后于"二元经济"结构的变动,农村养老问题日益迫切.最后结合国际上有关理论与经验,提出了三点对策建议.     

医养结合与老年消费——理论与机制

在寻求扩大内需的大背景下,讨论我国近年来实施的医养结合政策试点如何影响老年家庭的消费行为,这为如何利用公共卫生政策间接激发老年消费潜力以及解决潜在的“老年储蓄之谜”问题提供了新的视角。在理论分析基础上,利用具有全国代表性的中国老年社会追踪调查数据进行实证检验。研究发现：医养结合政策对老年家庭人均消费具有显著的正向推动效应,这主要体现在消费规模的扩大和消费结构的优化上。机制分析表明,一方面,医养结合改善了老年人的健康状况,有助于减少因应对未来医疗与健康风险而增加的预防性储蓄;另一方面,医养结合显著降低了老年人的抑郁倾向,提高了社会适应能力,增加了更多积极社会互动的机会,从而促进了消费观念和行为的转变,推动了消费升级。此外,研究还发现社区医疗和养老服务使用均能显著刺激老年家庭消费,特别是对医疗服务影响更大。异质性分析显示,城市家庭、经济发达程度高、公共基础设施水平好的地区在医养结合政策下更易实现老年家庭消费提升。研究结论为优化当前医养结合的运营模式和挖掘老年经济潜力提供了重要的现实启示。在未来,医养结合政策应注重提升服务质量,重视老年人的心理和社会需求,优化医养服务的结合,并考虑区域和人群...     

网络化治理视角下的居家养老模式之构建

面对我国人口老龄化日益严峻的形势,网络化治理模式下的社会化居家养老服务体系建设为解决我国养老问题提供了一种现实选择。本文以网络化治理理论为指导,针对居家养老治理网络的设计、运行及监管这三个核心问题,提出了通过构建合同关系、强化政府引导,实施数字化连接、加强信息沟通,明确各方责任、强化绩效评估等措施来构筑一条网络化治理居家养老的新路径。     

中国农村多支柱的养老模式研究

文章在界定养老模式这一基本概念的基础上,对中国农村家庭养老模式、自我养老模式和社会养老模式进行了分析和评价,认为在中国现阶段的国情下,单一的农村养老模式难以有效保障农村老年人的基本生活,提出应该按照三种类型的农村地区构建家庭养老、自我养老和社会养老三支柱相结合、互为补充的养老模式。     

住房养老保险模式及其微观经济效应分析

我国正迅速步入老龄化社会 ,养老压力日益突出 ,传统养老模式已不能适应和满足市场经济条件下的养老需求。房产一般是家庭主要财富之一 ,但由于流动性差 ,在养老过程中其价值未得到充分利用。本文尝试通过一种新的模式设计 ,将房产价值和养老有机结合起来 ,提出住房养老保险模式 ,并从微观层面对其经济效应进行深入分析。     

农村多元养老模式的现实解读：区域比较的视角

随着中国老龄化趋势的不断演进,养老问题已成为了迫在眉睫的重要课题,农村养老形势尤其严峻,传统养老模式独木难支,新型养老方式尚未成熟。文章主要选取了东部的江苏南通和西部的陕西榆林两个地区作为调查地点,对各自养老模式的实施与发展情况进行了比较,并深入分析了其发展中存在的问题。研究发现．农村养老模式呈现出“嵌入性”特征,即完全与地方的文化与经济社会结构相融合,且各具特点与问题。对此,应有针对性地积极探索建立适合各地农村实际的多元养老模式。多途径解决农村养老问题。     

家庭养老研究的拓新之作——《家庭养老制度的传统与变革》评析

穆光宗 (现名穆治锟 )博士是中国人民大学人口与发展研究中心的教授 ,是国内“不可多得的优秀青年学子”。自 1 993年在《人民日报》率先撰文呼吁关注“精神赡养”、全面理解老有所养以来 ,至今已发表著述数十万言 ,并先后提出了“共融、共建、共享”的养老理念、“3+ 2”的综合养老模式、根据养老支持力来划分人类三种基本养老模式、老年发展理论以及实现成功老龄化战略等重要理论和政策主张。最近几年 ,他十分关注家庭养老问题的多学科研究且成绩卓著 ,去年即有两部专著问世 ,其中《家庭养老制度的传统与变革———基于东亚与东南亚地区的…     

老年人社区医养融合养老模式选择意愿影响因素分析--基于ISM-AHP方法

老年人社区医养融合养老模式选择意愿受众多因素的影响,这些因素涉及范围广且关系复杂。为厘清各影响因素之间的层次关系和影响程度,本文从身体特征、家庭特征、认知特征和环境特征四个方面构建了影响因素指标体系。首先采用解释性结构模型分析得到由表层直接影响因素、中层间接影响因素和深层根本影响因素组成的3级多层递阶有向图,然后应用层次分析法对各因素指标的影响力进行排序,建立指标综合权重体系。结果表明：表层直接影响因素包括ADL、医疗支出能力、健康自评等8个,中层间接影响因素包括慢性疾病数量、社会关注度、医疗保障水平等8个,深层根本影响因素包括家庭收入水平、政府支持力度和发展阶段3个。其中,家庭收入水平、ADL、医疗保障水平、慢性疾病数量、政府支持力度等是老年人社区医养融合养老模式选择意愿的主要影响因素。     

Comparing Life Satisfaction of Immigrants and Natives Across Europe: The Role of Social Contacts

Research on immigrants’ assimilation is widespread both in the U.S. and Europe. While it has been extensively studied how immigrants fare compared to natives on socio-economic indicators, few studies have focussed on immigrants’ perception of their position. In this paper we focus on comparing life satisfaction of immigrants and natives across Europe and on the role of social embeddedness. Using data from the first six rounds (2002–2012) of the European Social Survey, a repeated cross-sectional survey, we find that life satisfaction among immigrants is lower than among natives even though differences diminish over generations. For first generation immigrants part of the life satisfaction gap is explained by the lower level of social embeddedness they have compared to natives. We also find that social embeddedness is a key explanatory factor for life satisfaction for both immigrants and natives. For two out of the three indicators of social embeddedness that we consider we however find different patterns of association with life satisfaction for immigrants compared to natives.     

Effects of Social Networks on Health from a Stress Theoretical Perspective

This paper focuses on the relevance of quantitative and qualitative aspects of social networks in a health context. The study combined a stress theoretical perspective with theories of social support and social capital in order to investigate the mechanisms behind the association of social network size and self-rated health. The main research question in the study is whether social integration affects health by changing stressor appraisal (perceived stressor intensity or anticipated stressor burden). The study used a survey of an Austrian student sample (n = 246) to measure two models of hypothetical exposure to a potentially stressful event. The findings indicate that individuals with larger trust and support networks consider potential stressors to be less threatening, which leads to a reduced level of stress symptoms and a better subjective health condition. The influence of network size on stressor appraisal is fully mediated by the perceived social embeddedness that these ties induce.     

Transnationale Projektarbeit. Berufsbiografische Strategien der Sicherung von Autonomie, Zugehörigkeit und Identität

The article intends to broaden the discussion about the globalization of management by analyzing an intermediate, operative level of management in the context of transnational project work. In contrast to Kanter’s (1996) thesis of the emergence of a “world class of management” the identity concepts, career strategies and social embeddedness of this level of management clearly show the contradictions and ambivalences peculiar to this kind of work. Drawing on group discussions as well as problem-centred interviews three types of biography politics in the context of transnationalization are discerned. By more or less intentionally unfolding these politics in the course of their biographies, the subjects are struggling for autonomy, affiliation and individual history.     

Aging in America: Limits to life span and elderly care options

Expanding longevity among the elderly and fertility decline are contributing to an aging US population. The number of persons 65 years or older is projected to double from about 32 million in 1990 to 66 million by 2030; the elderly proportion is expected to increase from 13 to 22 percent over the same period. Chronic illness and functional disability afflicts a significant proportion of older persons. An estimated 80–85 percent of people over age 65 have at least one chronic illness, and nearly one-half of older people report that chronic illness limits their activity to some degree. Altogether, about one-third of the population over 65 may need some kind of medical or social assistance. This paper discusses the three primary modes of care available to older persons: (1) the informal network of the family, (2) the more formal arrangements of home and community care, and (3) the institutionalized care of nursing homes. Of particular policy interest are the questions: Who provides the care? What type of care is available? Who receives the care? How much does each type of care cost? and Who pays? The current patterns and costs especially of long-term care provide a framework for planning future options. A discussion of research and policy recommendations concludes the paper.     

正式照料抑或非正式照料:照料模式对高龄老人临终照料成本的影响

本文基于2014～2018年中国老年人健康影响因素跟踪调查数据(CLHLS),尝试探究了机构照料、社会照料和家庭照料3种照料模式对我国高龄老人临终照料费用和天数的影响.结果发现,家庭照料和社会照料均与较高的临终照料费用与临终照料天数显著相关,但机构照料仅与较高的临终照料天数显著相关.此外,临终老人的照料依赖程度对于不同...     

Break-out im türkischen Lebensmittelhandel

Based on a qualitative-empirical study of the Turkish food retail sector in Vienna, this article discusses the social embeddedness of break-out-processes. In socio-scientific literature, the term “break-out” is used to describe the process by which immigrant entrepreneurs leave their “ethnic enclave economy” by gaining consumers beyond their own community. While research appears to reduce break-out to an individual and economically driven marketing strategy, the social dimension has been neglected so far. Our findings demonstrate that the entrepreneurs’ market orientation is located between the contradictory contexts of different expectations—those of the immigrant community as well as those of the majority community. On basis of a typology of different ways of dealing with these expectations we want to reveal the interrelationships between economic and social factors and, furthermore, to contribute to a deeper understanding of the social embeddedness of immigrant economies.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

发展性关怀抑或反思性关怀？--对中国农村留守人口社会关怀研究的梳理与反思

国外学者对社会关怀提出了两层含义,第一层含义侧重强调关怀者和被关怀者是一种发展关系,第二层含义重点阐释社会和个体关于谁需要关怀,以及如何关怀的认知对关怀资源生产和分配的影响。本文以这两层含义为维度,界定出当前我国学者针对农村留守人口存在着两种关怀：发展性关怀和反思性关怀。发展性关怀在一定程度上减缓了农村人口所面临的困境,但这种关怀依旧处于发展主义框架中。反思性关怀超越发展主义对关怀的限制,追求人本性关怀,从中深刻理解留守人口的境遇,对社会关怀研究的推进与完善具有重要的引导作用。分析发现,留守人口在关怀需求和关怀资源、关怀付出和关怀收获上存在着不对称;一种单一的、齐化的,以经济增长为衡量指标的发展主义意识形态成为判断标准,使得对留守人口的社会关怀不断的理性化、商品化。