【作者】 曹煜玲；

【导师】 张军涛；

【作者基本信息】 东北财经大学 ， 社会保障， 2011， 博士

【摘要】 联合国的统计指标规定,当一个国家或地区60岁以上的人口占总人口的10%,或者65岁以上人口占总人口的7%,就称为人口老龄化。早在1965年,法国就率先进入了老龄化社会,是全世界第一个进入人口老龄化社会的国家。继法国之后,世界上众多发达国家先后步入老龄化社会。如今,人口老龄化已逐渐成为全球性问题,无论发达国家还是发展中国家,经济的发展和社会的进步都不同程度地受到了人口老龄化的困扰和影响。自1999年起,我国也步入了老龄化社会。截止到2009年底,全国60岁以上的老年人口已经达到了1.67亿,约占全国总人口的12.5%。其中,80岁及以上的高龄老人已达1899万,失能老人1036万,半失能老人2123万,他们都不同程度地需要社会为其提供照料服务。中国的老龄化呈现出不断加快增长的趋势,高龄老人、生活不能自理的老年人、空巢老人队伍庞大。我国的人口老龄化是在经济尚不发达,或者说经济基础相对薄弱的情况下出现的,属于典型的“未富先老”。同时,我国老年人口基数大、老龄化速度快、地区间不平衡等特点十分明显。《2006年世界卫生报告》指出：中国人口的平均期望寿命为男性70岁、女性74岁,人均寿命72岁。然而,我国老年人口的健康状况却不容乐观。卫生部的相关统计资料显示,老年人群中60%-70%有慢性病史,平均每位老人患2-3种疾病,60岁以上的老年人慢性疾病的患病率是总人口患病率的3.2倍,患病天数是一般人群的2.2倍,伤残率是总人口伤残率的3.6倍。虽然,中国老年人的平均寿命延长了,但是,大多数老年人需要不同程度的护理服务,一些老年人的晚年是在身体不健康的状况下度过的。据测算,平均每位80岁及以上高龄老人的照料与医疗成本开支约为65至74岁老人的14倍多。随着老年人口数量的增加,有养老服务需求的老年人口也越来越多,并且几乎呈几何级数增长。我国《关于加快发展养老服务的意见》里明确指出：支持发展老年护理、临终关怀服务业务,支持兴办老年护理、临终关怀性质的医疗机构,鼓励医疗机构开展老年护理、临终关怀服务。根据实际情况,对开展老年护理、临终关怀服务的机构按规定给予政策扶持。然而,由于我国老年护理事业起步较晚,老年医疗保健体系还很不完善,也没有建立起一个科学的养老服务体系。我国的养老服务在制度上和现实中面临着双重困境。人口老龄化及老年人服务缺失是现阶段我国面临的重大问题之一。在这一现实背景下,研究如何建立一个结构完善、功能齐全、满足老年人多层次养老服务需求的养老服务体系就显得十分重要和迫切。正是在这样的情景下,本文在进行系统的理论分析的基础上,选择大连这一具有老龄化特征,而且在目前养老服务体系建设相对比较完善的城市为调查分析样本,对城市居民的养老服务意愿进行了深入研究和分析,从现实层面解析了大连市的养老服务体系。基于上述研究和分析,结合我国经济社会的发展现实和未来的发展趋势,设计了我国城市养老服务体系的基本框架和发展战略。本文的创新之处主要体现在：(1)对中国养老服务模式的演进历程进行了系统的梳理和分析；通过对调查样本的统计分析,深化了对影响城市居民养老服务意愿的关键因素的认识。(2)提出了构建“适度普惠型”城市养老服务体系的理念,并且认为,“适度普惠型”城市养老服务体系应当能够确保老年人享受养老服务的自立性、普遍性、权利性、公平性和选择性。(3)将家庭养老、居家养老、机构养老和依托社区开展的各种养老服务进行系统整合,构建了透视城市养老服务体系的多维视角；设计了养老社会服务的援助网络模式,改变了以往多数研究只关注其中一个方面的单向性研究思路。(4)根据调查数据及国家相关战略,提出了我国城市养老服务体系的发展目标,即在适度普惠的基础上,由基本保障型养老服务体系→服务型养老服务体系→发展型养老服务体系。本文认为,我国“适度普惠型”城市养老服务体系的发展应分为三个阶段：2011—-2015年为“基本保障型”养老服务体系发展阶段,2016—-2020年为“全面服务型”养老服务体系发展阶段,2021—-2050年为“快速发展型”养老服务体系发展阶段。经过三个阶段的发展最终使我国的老年群体能够享受到社会化、产业化、网络化和高质量的养老服务,使老年人能够过上具有较高质量的、体面的老年生活。本文的主要观点是：“适度普惠型”城市养老服务体系追求的是“适度普惠”,养老服务的提供者包括政府组织和非政府组织。一方面,受经济发展水平的限制,我国政府的财力物力有限,还不能实现国家统包统揽的高福利,在政府提供基础性养老服务的同时,还需要企业和非政府组织的广泛参与。另一方面,国家统包统揽的提供方式由于排斥了竞争性,会导致服务供给的低效率。养老服务体系是适度普惠的,更应该是高效率的。政府是基础性养老服务的主要提供者,政府可以通过补贴、购买服务等方式为老年人提供基础性的养老服务。非政府组织主要包括社区、企业、家庭、个人、各类社会组织等,在市场机制下,主要提供可供选择的养老服务,同时,还提供部分基础性的服务。政府和非政府组织同时作为养老服务的提供者,实际上体现的是政府与市场的分工,可以避免单纯由政府提供服务的高成本和低效率,也能够使非政府组织在养老服务提供的过程中培养高度的社会责任感,达到政府与市场相互补充、相互促进的目的。同时,我国城市养老服务体系的健康运行需要相关的政策和法律法规的支持。如果没有一个完善的法制环境,一些养老服务制度将难以有效运行。作为一种具有竞争性的公共物品,城市养老服务体系的建设和发展对于一个国家和地区经济社会的发展具有十分重大的意义。然而,也有许多问题需要在今后的工作中加以深入研究。更多还原

【Abstract】 According to the statistical indicators of United Nations, when the population over the age of 60 reaches to 10% of the total population or the population over the age of 65 reaches to 7% in a country or region, it is called aging of population. As early as 1965, France took the lead into the aging society, the first country to enter into aging society. After France, many developed countries in the world entered into aging society one after another. Nowadays aging of population is gradually becoming a global issue. In both developed and developing countries, the development of economy and progress of society are all impacted by aging of population to different extent.Since 1999, China has entered into aging society. Till the end of 2009, the population over age of 60 all over the country has reached to 167 million, accounting for 12.5% of the national population. The aging of China shows the trend of accelerating growth while senior citizens, the elderly incapable of taking care of themselves and the empty nesters compose a large group. Chinese aging population comes under undeveloped economy or relatively weak economic basis which belongs to "aging before rich". Meanwhile, Chinese aging of population is characterized by such distinct features as large population base, fast aging speed and regional imbalances and so on."World Health Report 2006" points out, the average life expectancy of Chinese population is 70 years old for men and 74 years old for women, and the average life expectancy is 72 years old." However, the health of the elderly population in China is not optimistic. The statistics from the Ministry of Health show, "about 60 to 70 percent of the elderly population has chronic diseases, among them everyone may suffer from 2 or 3 diseases. For the elderly people over the age of 60, the rate of suffering from chronic diseases is 3.2 times of the total population; the number of sick days is 2.2 times the general population, the total disability rate is 3.6 times of the population disability.Although the average life expectancy of elderly in China prolongs, most of them require different levels of care, a number of senior citizens in retirement are under unhealthy conditions. It is estimated that on average the care and medical cost for each 80 years old and above is 14 times more, compared with those who are 65 to 74 years old. With the growing elderly population, the aging people in need of care are also increasing, and rising almost exponentially. Because the average life span continues to extend, it makes elderly nursing care time get longer. With the rapid development of Chinese endowment services, elderly care has gradually been taken seriously. However, the aging of Chinese current status and future trends, are clearly inadequate. "The views of speeding up the development of endowment services" indicates that it will support the development of ageing care, hospice services; support to set up elder care, medical institutions with the nature of hospice care; encourage medical institutions to develop elderly care and hospice services. According to actual situation, the agencies which carry out elderly care, hospice services shall be given to policy support. However, because of the late start of aging care, elderly health care system is far from perfect. It has not yet established a scientific and comprehensive pension service system. Our system of pension service is facing a double dilemma both in policy and fact.Population Aging and Construction of Endowment Service System are to present one of the important issues facing our country in this stage. The paper, not only aims to build a perfect system, but also wants to find a suitable service system for China, which is very important and urgent.In this paper, on the basis of theory analysis, the elderly services will of urban residents and the urban endowment service system have been researched, with a case study of Dalian. Combined with the economic and social development of reality and the future, the framework of the urban old-age service system and development strategy also has been designed.The innovation of the article mainly lies in:(1) The evolution and development of Chinese Security Model have been systematic organized and analyzed; With the sample’s statistical analyses, the key factors which have deepen impact on the residents’dwellers were researched. (2) The Concept of moderate generalized preferential was proposed. It can ensure that the self-reliance, universality, rights, fair, and the selectivity. (3) The family endowment, home endowment and community endowment have been combined in order to build a multidimensional view and to make a systematic and comprehensive research, changing the normal research which only focus on one aspect of the research. (4) According to research data and relevant strategy, the development goals of urban endowment service system have been put forward. It is includes the basically guarantee, service, and rapidly development of urban endowment service system, on the basis of moderate generalized preferential. It can be divided into three stages. In 2011-2015, it would be basically guarantee. In 2016-2020, it would be a service one. In 2021-2050, it would be a rapidly development of urban old-age service system. Through the three stages of development, the Chinese old age groups will be able to enjoy the high level services whith the socialize, industrialize, and the net work. It would also to enable the old people have a higher quality and decent life.The urban endowment service system is for the moderate generalized preferential. The providers should includ the government organizations and non-governmental organizations. On the one hand, the high benefits don’t fit china; when the government provices the basicly services, the enterprises and the non-government organizations need to participate in. On another hand, it will lead to low efficiency since the government provides featuring and dominating which repels competition. The urban old-age service system is moderate generalized preferential, and more should be efficient. The government can through subsidies and purchase of services for the elder people to provide basicly service. The community, enterprises, family, personal, and the other social organizations are part of the non-governmental organizations. It mainly provides the alternative service and the basicly services.The government and non-governmental organizations at the same time as the elderly service providers, reflect the division of government and market. It will to prevent the high costs and low efficiency when the services are provided only by the government. In this process, it will also to enable the non-governmental organizations developing a high degree of social responsibility. At the same time, the Chinese urban endowment service system needs of the relevant policy and legal support.As competitive public goods, the construction and development of urban endowment service system will have a great significance for a country and a region. However, there are many problems need to be further researched.更多还原