【作者】 王珍；

【导师】 马彦琳；

【作者基本信息】 华中科技大学 ， 行政管理， 2019， 博士

【摘要】 人口老龄化问题,已成为本世纪的世界性难题。我国从1999年进入老龄社会,近年间老年人口数量迅速增加,老龄化已是我国人口问题的核心,是一个关系全局的重大社会问题,必将对家庭和社会带来重大而深远的影响。居家养老是一种与机构养老相对应的养老模式,指政府和社会力量依托社区,以无偿、补贴和有偿的方式,向居住在家庭的老人提供生活照料、健康保健和精神慰藉等方面服务的一种社会养老服务形式。它融合了传统家庭养老与机构养老之长,同时也是家庭养老模式、机构养老模式的有力补充与更新,是我国发展社区服务、不断完善社会化养老服务体系的重要内容。居家养老作为当前一种主要养老服务模式,政府理应发挥主导作用,构建城市居家养老服务体系,并推进它健康有序发展。因此,探讨城市居家养老服务中政府行为,不仅对于完善城市居家养老服务体系和提升老年人生活质量有重要意义,同时也为探索社会管理创新、建设服务型政府提供积极参考。本研究从分析城市居家养老服务需求与供给多元化发展态势的角度出发,依据城市居家养老服务公私属性、福利性、公益性及私人性特征,将居家养老服务需求划分成基本、中间和高级三个层次,进一步分析政府在不同层次供需情景中的行为表现。本研究指出,基本层次城市居家养老服务只能由政府以直接生产和提供的方式向老年人供给,通过收入再分配的方式维护社会公平,满足老年人基本养老需求;中间层次城市居家养老服务属于混合物品范畴,应由政府间接生产和提供,即政府与非营利组织或企业合作,委托代理或购买居家养老服务向城市老年人提供无偿或低偿的生活照料、医疗救助服务以及精神慰藉等为老服务;高层次城市居家养老服务具备较高的私人产品属性,由市场发挥主导作用,直接组织生产和提供。政府应从宏观上不断完善对涉老企业的扶持政策,搭建优质服务平台,对企业提供的老年服务质量标准和服务水平进行监督和管理。目前我国城市居家养老服务体系运行中存在一定程度的政府行为错位、缺位、越位等失范现象,主要表现在:(1)基本层次城市居家养老服务投入与建设不足,服务管理不到位,以及对民间力量的培育和扶持不到位;(2)中高层次城市居家养老服务供给中,政府与其他治理主体之间权责不明确,进而造成政府职能越位现象。究其原因,主要是由于经济社会发展水平落后的制约、政府行为的“路径依赖”、政府的“经济人”动机、政府“有限性”和相关法律制度不健全等因素所导致。本研究借鉴国外城市老人社会照顾的先进经验,在善治理论及元治理理念基础上,提出了城市居家养老服务中政府行为的优化路径。治理理论强调多元主体共治,但与政府失灵、市场失灵一样,治理同样可能存在失灵。善治理论是治理理论的衍生,源于治理理论又高于治理理论。善治追求的是公共利益最大化,体现在城市居家养老服务供需情境中,就是政府、企业组织、非政府组织、社区以及老年家庭的协作共治。元治理则是指在承认协作共治模式下,对权力下放的治理过程进行一定引导和控制,即它既承认授权和分权,同时又意识到更强大政府控制的必要性(1),强调国家或政府应在治理的监管、驾驭和协调方面发挥关键的作用。(2)因此,政府元治理是实现城市居家养老服务供需情境下政府行为优化的战略选择。通过完善居家养老服务法律体系,深化养老保险制度改革,为城市居家养老服务规范化管理提供法律、政策等制度保障;通过加大政府财政支持力度,为城市居家养老服务提供经济保障;通过整合全社会养老资源,实现老年养老服务的资源共享;通过加强信息化建设,为城市居家养老服务提供现代技术保障。本研究以乌鲁木齐市为研究靶区,运用潜在类别分析(LCA)方法,对乌鲁木齐市居家养老服务对象进行潜在类别分析,将其划分为“医疗保健需求型”、“全面需求型”、和“无需求型”三大类,并依据老年人的人口学、经济环境、家庭环境、自评健康等方面的差异表现,运用多元Logistic回归方法,对分类结果的影响因素进行研究。乌鲁木齐市政府及民政部门探索推进“9073”养老模式,但总体而言,占养老服务体系90%的居家养老服务发展过程较为缓慢。因此,乌鲁木齐市政府应明晰在推进居家养老服务中的领导权责,从加强重视意识、完善政策保障体系、构建监管与评估制度等方面共同发展居家养老。更多还原

【Abstract】 The population aging problem has become a worldwide issue currently.China emerged as an aged society in 1999 and the number of elderly population increased rapidly in recent years.Consequently,the aging problem has appeared as the core population in China.This issue has significant implications to our society and will definitely impose substantial influence on families and the society.The Home-based care service for aged people is a pension model as compared to the traditional asylum for the aged.In this model,governments and the society provide free,subsidized or charged services through communities,including livingcare,health-care,spiritual comfort and other services to the elders who live in their family.The Home-based care service for the aged combines the advantages of the traditional family supporting and institutional care systems and acts as an effective supplement to these systems.It is also an important content of developing community services and continuously improving socialized system for the aged in China.Indeed,as quasi-public goods,establishment and operation of the home-based care service for the aged people means that the government should play a leading role in this process.Therefore,research on governmental behaviors in urban home-based care service for the aged people has significant importance to not only improving living standards of the aged,but also providing references for exploring innovative ways in social management and establishing service governments.Firstly,from the perspective of diversified development of demand for and supply of home-based services,the thesis categorized home-based services into basic,middle and high levels according to the public,welfare and private features of the services.Then the thesis analyzed government behaviors in the three service levels.The research indicates that the homebased care services at the basic level can only be provided by the government through direct production and supply.This is a way of using income redistribution to ensure social equity and satisfy the elderly’s basic aged-care needs.Middle level home-based care services are mixtures of public goods and private services.Services at this level can be produced and provided by the government indirectly,that is,the government can cooperate with NGOs and enterprises.Then former can authorize the latter or purchase home-based care services from the latter to provide free or subsided living-care,health-care,spiritual comfort and other services to the aged.Highlevel home-based care services have more private attributes and the provision of which should largely be achieved through the market.In other words,the market produces and provides services and the government only regulates and supervises the market at the macro level.There are some government behavior problems in the operation of home-based care service system in urban China.These include,firstly,there is a lack of investment and support in the establishment of basic level home-based care service system.The government does not act adequately in providing services and managing the system,as well as promoting development of NGOs in this area.Secondly,the rights and responsibilities of governments and other governing subjects are not clear,resulting in unharmonious cooperative relationship between the government and other governing subjects.The major reasons for these problems are the lower level of the economy and society,the "path dependence" feature of the governmental behaviors,the “profit-maximizing motivation” of the government,the “limited rationality” of the government and some defects in the legal system,and so on.The thesis,taking advanced experiences of social caring for the aged in other foreign cities,proposed a path to optimize government behavior in home-based care service on the basis of the theory of good governance and the concept of meta-governance.Governance theory emphasizes the governance of multiple subjects,like government failures and market failures,governance may also fail.The theory of good governance is the derivation of governance theory,which is derived from the theory of governance and higher than the theory of governance.What the good governance pursues is the maximization of public interest.It is the collaborative cogovernance of government,enterprise organizations,non-governmental organizations,communities and elderly families in the situation of supply and demand of urban home-based care service.Meta-governance refers to the guidance and control of the decentralized governance process under the recognition of the collaborative co-governance model,that is,it recognizes both authorization and decentralization,while at the same time recognizing the necessity of more powerful government control [1],emphasizing the key role of the state or government in the supervision,control and coordination of governance.Therefore,government meta-governance is a strategic choice to optimize government behavior under the supply and demand situation of urban home-based care service.By perfecting the legal system for homebased care service and by reforming the insurance system,institutional guarantees can be established to the standardized management of urban home-based care service.The increase of government financial support can provide financial guarantees to urban home-base care service.The integration of social endowment resources can help to realize the sharing of old-age pension service.In addition,a database construction can provide modern technique to strengthen the urban home-based care service.Taking the development of home care service in Urumqi as an example,the thesis,using latent class analysis(LCA)method,analyzed the potential categories of home-based care service in Urumqi,and divided them into “medical care demand”,“comprehensive demand” and “no demand" three potential categories.Based on the differences in demographics,economic environment,family environment and self-rated health of the elderly,multiple Logistic regression analysis was used to study the influencing factors of the classification results.It is found that with the increase of age and the weakening of physical function,the demands of the elderly for home-based care service are basically showed from “no demand” to “medical care demand” and then to “comprehensive demand”.In response to the above situation,the Urumqi Municipal Government and civil affairs department explored and promoted the “9073”pension model.But the overall situation is,the home-based care service which possesses 90% in old-age service system develops relatively slow.Therefore,the Urumqi Municipal Government should clarify the leadership responsibilities in promoting home-based care service,and develop home-based care from the aspects of strengthening awareness,improving the policy guarantee system,and building a regulatory and evaluation system.更多还原