广东养老服务供给侧改革研究

广东作为老年人口大省,面临着养老服务供应滞后、供给结构失衡的困境。为提高广东养老服务供给规模、质量及供需匹配度,最大限度满足广大老年人口养老服务的需求,广东养老服务业供给侧改革须从增加制度、要素和产业三个层面的供给发力。以供给为中心,优化养老服务的供给结构;按市场化方向,配置养老服务要素;通过制度改革培育养老服务的多元供给主体;以需求满足为目标,扩大老年群体的有效需求。     

服务供给侧改革背景下城市社区服务需求探析——以肇庆市端州区社区为例

随着供给侧改革政策的提出,国家经济调控的重点由"需求侧"转向"供给侧".供给侧结构性改革意味着从提高供给质量出发,推进结构调整,扩大有效供给,提高供给结构对需求变化的适应性和灵活性.供给侧改革为社区服务主体提高服务质量带来了新的发展机遇.社区居民对养老、 医疗、 就业及心理咨询等服务需求大,但现有的社区服务质量不能满足社区居民的需求,居民满意度较低,社区需要积极探索居家养老新模式,加快发展社区就业服务,深化发展志愿服务事业,进一步培育发展和规范管理社会组织.     

非营利组织将成未来养老服务主力

老年人口规模的扩大和老龄化速度的加快，使养老服务需求与供给之间的差距越来越大，但传统养老服务中的主要供给主体——政府和家庭——由于社会经济环境、人口结构和家庭结构的变化，已不能提供完全、充足的养老服务，亟需第三方介入以提供有效服务。非营利组织凭借其本身的特点，将在未来养老服务体系中占据越来越重要的地位。     

进一步创新发展上海养老照护服务

养老照护服务作为养老服务中最主要、最基础的服务项目,其发展程度和水平是养老产业总体发展状况的重要衡量指标,同时也是影响养老产业发展的重要导向因素。应充分发挥不同养老服务供给主体的作用,明确政府和市场的边界,积极发挥市场的主体作用。大力促进具备市场潜力的养老照护产业发展,重点培育认知症照护、到宅助浴、老年营养膳食、非医康养等领域的品牌企业,以带动整个养老产业的发展。     

微山县“五个一”工程构建老年服务设施网络

近日,微山县出台《关于推进养老服务社会化的实施意见》,加强养老服务设施建设,“十一五”期间在全县开展“五个一”老年服务设施建设,构建以县级老年服务中心、乡镇中心敬老院、老年服务中心、社区老年服务站和村老年文化大院为主体的老年服务设施网络,保障老年人的生活水平和生活质量。     

上海养老服务思路与对策研究

养老服务业是各类服务主体围绕老年人需求所开展的各类服务的综合。当前,上海人口老龄化速度快,纯老家庭、独居老人较多,老龄人口总量大,养老服务业有巨大的市场需求。养老服务业发展要与培育养老文化相结合、与养老保障相结合、与住房政策相结合、与医疗护理相结合、与智慧城市建设相结合。要通过老年人长期照护保障计划和制度的建立,推动政府主导的机构养老服务资源的整合;强化社区居家养老,积极扶持家庭养老。     

潍坊市、县(区)领导寄语老龄事业

1 潍坊市委书记许立全: 尊老敬老是中华民族的优良传统,助老扶老也是保障和改善民生的重要内容.各级都要高度重视发展养老事业和养老产业,创新思维、多措并举,积极发展不同类型的养老机构,大力发展各种形式的养老服务,努力满足老年群体多层次、多元化的现代养老服务需求. ——2月4日走访高新区敬老院讲话     

加快完善上海社会养老服务体系的思考

上海人口老龄化进入时期早、加剧速度快、影响时间长,且高龄化、少子化特征明显,只有充足的养老服务供给和较高的养老服务水平作为支撑,才能应对未来养老服务的需求压力。上海应充分发挥改革创新精神,遵循"事业与产业并重,以事业为基础,以产业为支撑"的基本原则,立足"9073"基本养老服务格局,进一步强化养老事业,全面布局养老产业,通过"体系、制度、产业、智慧养老、队伍"的建设,逐步完善符合特大型城市人口老龄化发展特征,满足各类老年群体养老服务需求的,全面覆盖的社会养老服务体系,全面提升养老服务能力和水平。     

基于“智慧养老”与“医养融合”的新型养老模式路径研究

养老问题历来是社会民生的热点话题。随着智能技术的发展,一种新型的养老模式逐渐兴起,即基于“智慧养老”与“医养融合”的新型养老模式。探讨新型养老模式的目标和应用,并研究新型养老模式的发展背景、具体内容以及实现路径,为养老服务需求和服务供给的合理匹配提供理论支持。     

关于加快推进河北省养老服务体系建设问题的政策问答

（接上期）二、推进措施 （一）完善落实优惠政策。各级各部门要认真落实国家和省有关非营利性老年服务机构建设的扶持政策。优先保障养老机构建设用地，对各类投资主体新建、改建、扩建的养老服务项目和养老服务设施，要优先予以立项。对新办的非营利性养老机构建设用地，可采用划拨方式优先供地。     

Caring for informal caregivers: policy approaches to the provision of direct support services

Despite being the backbone of modern welfare states, the informal care sector for elderly people in need of long-term care is highly dysfunctional. The majority of informal caregivers are overburdened on account of their care-related activities, although an evolving market for support services directly aimed at relieving informal caregivers is observable. In this paper, we examine the reasons for the imperfect exchange between demand and supply in this market, applying the economic theory of market failure. Through a case study of Austria based on an empirical, qualitative survey of all direct support services and their suppliers on the national level as well as in three provinces, an understanding of this market's main players and mechanisms is derived. Thus, the authors determine that three different system types can be identified beyond the historical regional discrepancies. They illustrate the approaches to service provision for informal caregivers: centralized and public, laissez-faire and private, and a radically decentralized network for informal caregivers. Still, lack of information, social and psychological barriers, as well as high transaction costs, are identified which undermine the support service market for informal care. If the costs of the formal long-term care sector are to be contained despite demographic developments, better policy approaches will be necessary to overcome this challenge. In light of this, recommendations are derived to ensure a better exchange between supply and demand. By providing an initial empirical understanding and analysis of this market and its imperfections, the authors pioneer future quantitative research in this field.     

Long-term care funding in Canada: a policy mosaic

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.     

Long-Term Care Funding in Canada

Summary

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.     

Understanding the pattern of support for the elderly: a comparison between Israel and Sweden

Cross-cultural comparison can offer critical input to analyses of the interplay between formal and informal services for the elderly. Israel and Sweden have very different population structures and represent different points on the spectrum of welfare state development: Sweden has a much higher percentage of elderly, a less traditional family structure, and a much more developed system of public support. In addition, there are thought to be different attitudes toward family ties, with a less family-oriented value structure in Sweden. The natural question is to what extent these differences translate into differences in the extent and nature of family support for the elderly. In this article, family structure, living arrangements, disability rates, and formal and informal sources of help in Sweden and Israel are compared at various points in time. While there is a greater rate of formal service provision in Sweden and some substitution for family support seems to have occurred, informal care has nevertheless remained important. In both countries, residential patterns are critical: it is when the elderly live alone that the formal system has tended to replace the family. The rate of institutionalization is particularly important in determining the rate of disabled elderly requiring care, both formal and informal, in the community.     

Understanding the Pattern of Support for the Elderly:

Cross-cultural comparison can offer critical input to analyses of the interplay between formal and informal services for the elderly. Israel and Sweden have very different population structures and represent different points on the spectrum of welfare state development: Sweden has a much higher percentage of elderly, a less traditional family structure, and a much more developed system of public support. In addition, there are thought to be different attitudes toward family ties, with a less family-oriented value structure in Sweden. The natural question is to what extent these differences translate into differences in the extent and nature of family support for the elderly. In this article, family structure, living arrangements, disability rates, and formal and informal sources of help in Sweden and Israel are compared at various points in time. While there is a greater rate of formal service provision in Sweden and some substitution for family support seems to have occurred, informal care has nevertheless remalned important. In both countries, residential palterns are critical: it is when the elderly live alone that the formal system has tended to replace the family. The rate of institutionalization is particularly important in determining the rate of disabled elderly requiring care, both formal and informal, in the community.     

The role of the health care sector in the U.S. economy

This Issue Brief discusses factors that contribute to the growth of health care expenditures and the reasons that many individuals, employers, and policymakers consider health expenditures too high. In addition, it describes various industries that make up the health care delivery system and their role in the U.S. economy as employers, producers, exporters, and suppliers of research and development. The report also discusses the economic implications of rising health care expenditures for individuals, employers, and the federal government and the potential impact of proposed health care reform on the health care sector and the U.S. economy as a whole. Health care delivery industries such as pharmaceuticals and medical equipment suppliers have higher than average research and development levels, in addition to a positive balance of trade. Moreover, while the total number of jobs in the private sector declined between 1990 and 1993, the number of jobs in the relatively high paid health services sector continued to grow. In aggregate, employer spending on health care represents only 6.6 percent of total labor costs. In comparison, wages and salaries represent 83 percent of total labor costs. Consequently, the growth rate of health care expenditures has a smaller impact on the growth rate of total compensation than does the growth rate in wages and salaries. Using job multipliers developed by the U.S. Department of Commerce, it is estimated that the 18,600 health care services jobs in Rochester, Minnesota in 1993 created another 32,000 jobs in the area. Any contraction of the health care sector in cities that have a large concentration of employment in health services would result in reduced employment in restaurants, retail stores, janitorial services, and other local businesses. EBRI's simulations estimated that between 200,000 and 1.2 million workers could become unemployed as a direct result of a mandate that employers provide health benefits to their employees, assuming that wages and salaries did not adjust at all. Others find that approximately 50,000 individuals would lost their jobs, assuming that wages and other labor costs adjust downward to completely account for increased costs. As is apparent, the estimates of job loss (and of the total costs of the policy) are extremely sensitive to the assumptions used in the simulation.     

Where Is “Place” in Aging in Place? Transnational Issues for the Danish State and Its Retirement Migrants Abroad

The aim of this article is to contribute a transnational perspective to the field of environmental gerontology and the concept of aging in place. Seniors from the northern hemisphere, among them Danish citizens, are increasingly adapting to transnational lives as they move to warmer climates. This article builds on a qualitative study among Danish retirement migrants regarding their experiences with the need for care or support while living abroad. Denmark is a welfare state with a long history of public nursing homes and in-home care for frail elderly persons. This system of governance is influenced by universalism, aiming at equality in terms of access to health services and care. However, these welfare provisions seem to be deeply embedded in methodological nationalism, since only citizens with residence within the borders of Denmark have the right to live in public nursing homes or receive in-home help. It is argued that we should consider public solutions to the problems faced by frail Danish citizens in transnational settings, enhancing their opportunities to live abroad.     

Paying Kin for Care

The idea of giving compensation to family members who care for health-impaired elderly relatives is viewed with ambivalence by policymakers. If pay were given to such caretakers, the relationship between state-level community care programs and families could change. This paper reports on a survey of home care agency administrators in Illinois, a state that contracts with agencies to provide direct services to elderly persons. Agency administrators were asked to react to the potential impact on their agencies of the state allowing or encouraging the hiring of relatives as caretakers. Most administrators tended to view paid family members as different and more difficult to train and supervise than other workers. Possible explanations for this negative view are explored, including the fundamental difference between the goals of family and agency care and the impact of efficiency as an organizing principle of long-term care.     

Telemedicine,rural elderly,and policy issues

Historically, rural America has had a difficult time providing health care to its residents, particularly its frail elderly population. Rural health care is often faced with a shortage of health care specialists, facilities with inferior equipment, and insufficient resources compared to health care in more urban areas. It is anticipated that the use of telemedicine will help address many of the problems facing the delivery of health care services to rural elderly. This paper reviews some innovative projects delivering services to the elderly. Also, the paper discusses several issues that need to be addressed before telemedicine can reach its full potential in improving access to health care, including reimbursement policies, patient and provider liability and confidentiality, and the infrastructure supporting telemedicine. Although telecommunications has tremendous potential to address the care needs of frail isolated elderly, without comprehensive reimbursement policies, guidelines for ethical conduct of a teleconsultation, acceptable security measures of patient records, and adequate as well as compatible infrastructure, that potential cannot be completely realized.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.