【作者】 罗小华；

【导师】 王学义；

【作者基本信息】 西南财经大学 ， 人口学， 2014， 博士

【摘要】 自1999年开始,中国已进入老龄化社会,2010年第六次全国人口普查数据显示,我国60岁及以上老年人口达到1.78亿,在总人口中比重为13.26%,全国65岁及以上老年人口达1.19亿,占总人口的比重达8.87%,预计到2020年,中国老年人口将达到2.48亿,占总人口的比重达17.17%。随着当前我国老龄化的不断加剧,老年人的社会问题逐渐成为了政府以及公众关注的焦点,老年人口比重的持续增加已经给社会发展带来了沉重负担,老年人的社会公共品支出不足、养老体系不够完善,由此引发市场供给的严重不足和服务标准的缺失,再加上老年人口的日益高龄化,使得老年人口的长期照护问题变得越来越严峻,特别是失能老年人口的长期照护问题更是亟待解决。目前,由我国实行计划生育政策所导致的养老问题日益严峻,这在世界上也是独一无二的,加上我国的社会养老保障制度尚处于改革完善中,城市失能老年人口的长期照护问题已经成为难以回避的重大社会问题之一,这无疑向全社会提出了如何迅速建立针对城市失能老年人口长期照护需求的、功能齐全又结构完善的养老服务体系的严峻拷问。基于此,论文在马克思主义方法论的指导下,运用需求理论、全人理论、福利经济思想的演化和福利多元主义理论,采用规范研究与实证研究相结合,定性研究与定量研究相结合,宏观研究与微观分析相结合,人口学研究与多学科介入研究相结合的研究方法,在厘清城市失能老人长期照护问题的理论脉络基础上,分析了造成我国城市失能老人长期照护困境的原因,提出了我国城市失能老人长期照护体系的基本框架和发展战略。具体而言,论文共分为八章。第一章为导论。主要是对问题的提出和意义、核心概念、内容框架与研究方法及论文的创新与不足等进行介绍。认为中国面临巨大的养老压力,城市失能老人的长期照护问题较为突出,研究这个主题的实质是在回答极具现实意义的重大问题。第二章为理论基础与文献述评。主要对论文所涉及到的理论基础和相关文献研究进行了述评,国外文献主要探讨的内容包括老年人的需求及其评估、长期照护的分类、长期照护体系的构成等。而国内文献主要探讨的内容则主要包括失能老人长期照护的模式、我国城市失能老人长期照护的现状问题以及对策、我国城市失能老人长期照护体系的构建和完善等。无论是着眼于般老人还是失能老人,这些文献从不同侧面对相关群体的长期照护问题进行了研究,这些成果都具有很强的理论和实践意义。对需求理论、福利经济等理论的分析和阐述为论文奠定了良好的基础。第三章为国外失能老人长期照护的成功经验与启示。研究表明,许多西方发达国家已经根据自身的历史文化传统和具体国情,建立了比较适合自己国家实际情况的长期照护体系,这些国际经验对于我国建立城市失能老人长期照护体系具有较强的启示和借鉴意义。第四章为我国城市失能老人长期照护的现状分析。研究表明,伴随着人口老龄化和人口高龄化趋势的不断发展,我国失能老年人的规模将会不断扩大,而解决失能老人长期照护问题显得非常紧迫,但我国现有的老年长期照护服务体系难以有效应对这一严峻形势。我国城市失能老人长期照护还面临着供需矛盾,床位不足与床位“空置”并存、服务内容不能满足失能老人的需求,也出现了服务对象“反向选择”的现象。追根溯源,本质上是失能老人数量增长快与长期照护事业发展缓慢的矛盾、失能老人服务需求多元化与照护水平单一的矛盾等。第五章为我国城市失能老人长期照护存在的问题研究。当前,我国城市失能老人长期照护体系面临服务供给的主体、筹资模式、制度建设等若干方面的问题,这些现实问题的存在是统筹解决城市失能老人长期照护问题的切入点。第六章为我国城市失能老人长期照护困境的原因研究。研究表明,造成城市失能老人长期照护困境的主要原因有长期照护的政策制度缺乏、长期照护的保障要素不足、长期照护的有效需求不足、家庭照护失能老人的功能逐渐弱化等,这些原因有的是客观因素造成的,有的是主观观念导致,有的是老龄化过程中长期缓慢形成的,有的是高龄老人人口数量在短期内急剧增长引发等。原因的探寻为长期照护体系的构建找到了依据。第七章为我国城市失能老人长期照护体系的建构对策。在战略层面,要在全社会树立长期照护的新理念,要明确政府、市场、社会的合作与分工,要建立健全失能老人指导性法律法规,加快制定长期照护的中长期规划。在制度供给层面,要建立健全长期照护保险制度、长期照护服务补贴制度、长期照护服务管理体系、长期照护评估监督机制等。在照护支持体系层面,要鼓励发展照护养老机构、要创新多样化、高质量的长期照护服务项目,要培育高素质、专业化的长期照护服务队伍、要建立健全要素保障支撑体系。在服务模式层面,要构建“三位一体”的长期照护模式。第八章为结论与展望。对论文的基本的结论进行了梳理,对未来进一步的研究方向予以了展望。以上八章共同构成了论文的四个部分：研究基础、基本状况、现实考察、结论对策,这四个部分有着较为严密的逻辑关系,相互联系,层层递进。本文循着如何统筹解决城市失能老年人口的长期照护这一问题的总思路,在研究过程中,首先回答“为什么研究这个主题”“研究的基础是什么”?然后,对国外失能老人长期照护的成功经验与启示进行分析,回答了“国际先进地区的经验怎样”?接着,以抓住供需矛盾分析这个方法对我国城市失能老人长期照护的现状予以回答,并对我国城市失能老人长期照护模式存在的问题,我国城市失能老人长期照护模式困境的原因予以深入分析,搞清了“问题是什么样”?最后,给出了我国城市失能老人长期照护体系的建构对策,回答了“怎样解决问题”?本研究是以应用研究为主,具有一定的创新：一是较为系统地对我国城市失能老人长期照护问题进行了研究,回应了当前对该问题的重大理论和实践需求,从而为今后“人口老龄化”和“养老问题”的研究提供了较好的研究素材。二是提出了我国城市失能老人长期照护体系的建构对策,在战略层面、制度供给层面、照护支持体系层面、服务模式层面进行了分析和阐述,这一长期照护体系的确立,将会为人口老龄化理论的丰富以及这一问题的具体解决提供较好的研究资料和素材。三是较为系统地总结了国外失能老人长期照护的成功经验与启示,这些西方发达国家已经根据自身的历史文化传统和具体国情建立了比较适合自己国家实际情况的长期照护体系,这些国际经验对于我国具有较强的启示和借鉴意义。四是清晰地指出了城市失能老人长期照护还面临着的严峻供需矛盾,其本质是：失能老年人口数量增长快与长期照护事业发展缓慢的矛盾、失能老人服务需求提高与照护水平较低的矛盾、长期照护追求效率与实现公平的矛盾,并鲜明地指出随着未来人口老龄化的推进和加快,这一供需矛盾将会更加突出。当然,论文还存在一些不足：一是论文对典型案例观察、典型地区研究、典型方式方法的研究还显不足,囿于时间关系和经费支撑,论文虽对成都市5个区(金牛区、青羊区、锦江区、武侯区和成华区)进行问卷调查,但未能作出更进一步的人口学、经济学、社会学观察和思考,并以此作为论文观点的支撑和辅助。二是对理论与实践紧密联系还显不足。论文追溯了学科的理论源流和理论的具体阐述,但在给出和分析了这些理论,并以其为理论支撑之后,在结合实际问题研究中结合理论、实践理论、引申理论还很不足,在下一步的研究中加以改进。三是对国内外的失能老人长期照护的经验归纳性分析和总结不够,论文或多或少涉及了中西方的经验,但从理论的高度、从实践的操作性、从结合国情的深入细致阐述还有待进一步加强,特别是在中西方的比较与总结性研究中还做得不够。更多还原

【Abstract】 Since1999, China has entered the aging society. The sixth national population census’ data in2010shows that China has had178million old people aged60and above, the proportion of the population is13.26%; and has had119million old people aged65and above, the proportion of the population is8.87%; it is expected that in2020Chinese aging population total amount will reach about248million, accounting for17.17%. With the degree of the aging phenomenon becoming more serious in our country, the social problem of the elderly has become the focus of the government and the public. The proportion of the elderly is increasing, that brings heavy burden to the society, and causes a serious shortage of market supply and the social public expenditure for the elderly, the lack of service standard and the imperfection of the pension system and so on. With the development trend of the aging population to be clear and the aging of population step by step to the advanced age development, the problem of long-term care for the elderly has become more and more serious, especially that how to look after the elderly can’t take care of themselves is more urgent.The elderly pension problem caused by China’s family planning policy is unique in the world. Chinese social security pension system reform is developing, and how to look after the disable elderly in the city in a long-term time becomes an unavoidable major social problem. There is no doubt that it is a grim challenge for the whole society, that’s how to quickly set up the pension system with complete function and perfect structure, aimed at the need of looking after the disable elderly in the city in a long-term time.Under the guidance of Marxist methodology, applying Theory of Demand, Theory of Welfare Economics and Welfare Pluralism, combining with normative research and empirical research, qualitative research and quantitative research, macro research and micro analysis, demographic research and multidisciplinary intervention research, on the base of clarifying theoretical contexts of the problem of long-term care for the elderly in the city, the article analyzes the reason why it is in the trouble that looking after the elderly in the city in a long-term time, displays the basic framework and proposes the development strategy of the system that is long-term care for the disable elderly in the city.The article is divided into eight chapters.The first chapter is an introduction. It mainly introduces why to bring up the problem and the meaning of it, related concepts and theories, research methods, research innovation and shortage. The article offers that China faces huge pressure to pension, and the problem of long-term care for the disable elderly in the city is serious, so the essence of studying the subject is in response to the major problem with practical significance.The second chapter is the theoretical basis and literature review. It mainly reviews theoretical basis and related literature research involved in the article. The foreign literature mainly discusses the need of the elderly and its evaluation, classification and composition of long-term care system. While the domestic literatures mainly discusses the pattern of long-term care for the disable elderly, status and countermeasures of long-term care for the disable elderly in the city, construction and improvement of the system on long-term care for the disable elderly in the city. The literatures focuses on the general and disable elderly, studies the long-term care for related groups from different sides, and offers the result with theoretical and practical significance.The third chapter is abroad successful experience and inspiration of long-term care for the elderly. Research shows that according to its own historical and cultural traditions and specific national conditions, many western developed countries have set up long-term care systems suitable for their actual situations. There is a strong inspiration and reference for our country to establish the system of long-term care for the disable elderly in the city.The fourth chapter is the analysis on our country’s condition of long-term care for the disable elderly in the city. Research shows that with the development of a population ageing trend, the size of our country’s disable elderly will expand continually, so it is very urgent to solve the problem of long-term care for the disable elderly. Our country’s existing service system of long-term care for the elderly is very difficult to effectively cope with the serious situation. And our country’s long-term care system has many problems, such as the contradiction between supply and demand, shortage and "vacancy" of beds, and that service content cannot meet the needs of the disable elderly. And then the phenomenon of "reverse selection" is appeared in the service system. Research shows that there is the contradiction between fast increasing of the population of the disable elderly and slowly developing of the long-term care system, diversity of the needs of the disable elderly and simpleness of the level of care.The fifth chapter is the research on the problems about the pattern of long-term care for the disable elderly in the city. At present, there are many problems in the system of long-term care for the disable elderly in the city, includes the main body of service supply, financing mode and system construction. These practical problems should be resolved first.The sixth chapter is the research on the reasons for why our country’s pattern of long-term care for the disable elderly in the city is in the trouble. Research shows that the reasons include absence of long-term care policy, shortage of security elements of long-term care and effective demand of long-term care, weakening of the old man’s family care function. And these reasons are caused by objective factors or subjective ideas, the process of aging population, and the sharp growth of elderly population in the short term. Through exploring these reasons, it is found out the evidence of the construction of long-term care system.The seventh chapter is to put forward advice on how to set up our country’s system of long-term care for the disable elderly in the city. On the strategic level, we should establish new concepts of long-term care in the whole society, define the cooperation and division of government, market and society, establish and improve the guidance laws and regulations on the disable elderly, and speed up the development of long-term care in long-term planning. On the system supply level, we should establish and improve the system of long-term care insurance, the system of long-term care services subsidy, the system of long-term care services management and the supervision mechanism of long-term care evaluation. On the care support system level, we should encourage the development of old-age care institutions, provide diversified and high-quality long-term care services, train high-quality and professional long-term care services, establish and improve elements security supporting system. On the service pattern level, we should establish the pattern of "family, community and institutions" long-term care.The eighth chapter is the conclusion and prospect. The chapter generalizes the basic conclusion, and has an outlook to the future research direction.The theme of the article is how to solve the problem on long-term care for the disable elderly in the city. The article has four parts, which are foundation of research, basic situation, study of the reality and the conclusion. Firstly, the article answers the questions of "why study the theme" and "what is the basis of the study". Secondly, on the analysis of abroad successful experience of long-term care for the disable elderly, the article answers the question of "how about the experience in developed countries". Thirdly, on the analysis on our country’s condition of long-term care for the disable elderly in the city, on the analysis the problems about the pattern of long-term care for the disable elderly in the city and the reasons for why our country’s mode of long-term care for the disable elderly in the city is in the trouble, the article answers the question of "how serious is the problem". Fourthly, putting forward advice on how to set up our country’s system of long-term care for the disable elderly in the city, the article answers the question of "how to solve the problem".The article is given priority to the application research. Firstly, it is a systematic study on the problem of long-term care for the disable elderly, and provides good material to the future research on "population aging" and "pension problem". Secondly, it is to put forward advice on how to set up our country’s system of long-term care for the disable elderly in the city. It analyzes on the strategic level, the system supply level, the care support system level, and the service pattern level. The establishment of long-term care system will supply much research data and material to enrich aging of population theory and solve this problem. Thirdly, it systematically summarizes the abroad successful experience and inspiration of long-term care for the disable elderly. According to its own historical and cultural traditions and specific national conditions, the western developed countries have set up long-term care systems suitable for their actual situations. There is a strong inspiration and reference for our country. Fourthly, it is clearly pointed out there is the contradiction between supply and demand on long-term care for the disable elderly in the city, fast increasing of the population of the disable elderly and slowly developing of the long-term care system. And with the future development of population aging, the contradiction between supply and demand will be more prominent.Furthermore, there are some shortcomings in the article. Firstly, there is not enough typical case observation, typical area research and typical method. Being short of time and expenditure, the article is just given a questionnaire to the five districts of Chengdu, as Jinniu District, Qingyang District, Jinjiang District, Wuhou District and Chenghua District, but there is not further observation and thinking in demography, economics and sociology, and it doesn’t be used to support the theme of the article. Secondly, there is not enough connection between theory and practice. The article traces the theory origin of the discipline and analyzes these theories, but doesn’t give enough combination of practical problem and theory. It should be improved in the further research. Thirdly, there is not enough analysis and summary of experience about long-term care for the disable elderly at home and abroad. The article is more and less involved in the experience of Chinese and western countries, but is remained to be further strengthened the explaining of the theory and operability. And there is not enough comparative and summative research in the experience of Chinese and western countries.更多还原