Community medical endowment insurance service center

China is facing the severe challenge of aging. The results of the sixth national census show that the population aged 60 and above is 177648705, accounting for 13.26%, of which the population aged 65 and above is 1 1883 1709, accounting for 8.87%. Taking Hebei Province as an example, according to the data of the Provincial Civil Affairs Department, the elderly population in this province will continue to grow at an average annual rate of more than 3% in the future. By 20 15, the elderly population in the province will reach10.8 million, accounting for 15% of the total population. More importantly, the future will be the fastest growing period of the elderly population in our province, and the elderly population over 80 years old will increase rapidly [1].

After several years of exploration and development, home-based care for the aged has attracted more and more attention from the elderly, the government and society. This form of providing for the aged is mainly based on the family, relying on the community, taking professional services as the main service form, actively playing the leading role of the government, widely mobilizing social forces, and making full use of community resources to solve daily life difficulties for the elderly who care for the aged at home. The survey of the elderly in Shijiazhuang shows that more than 95% of the elderly want to live at home for the elderly, and only 3.04% of the elderly have the desire to live in an apartment for the elderly [2]. At present, although it is necessary to carry out in-depth research on core functions and target groups, strengthen internal reaction and open the operation mechanism [3], the urban social pension service system in China, which is based on home-based pension, supported by community service and supported by institutional pension, is forming a * * * understanding at the academic theory and government decision-making level.

Social pension service has also made great progress in practice. The party and the government attach great importance to the construction of old-age service institutions and have done a lot of fruitful work in the construction of community old-age service institutions. Many places have set up "daytime photo centers for the elderly" and "push-to-talk call centers for the elderly" in communities. In Shijiazhuang's "Implementation Opinions on Accelerating the Construction of Home Care Service Center", it is planned that by 20 15, a demonstration home care service center will be built in each street (township) and all communities will be built with home care service centers, so as to realize the basic coverage of street (township) and community care service facilities [4]. Tangshan City has also continuously stepped up spot checks and supervision on the construction of "happiness project", and more than 900 home care service stations have been built in the city.

However, whether in theory or in practice, we have neglected an important aspect and neglected to analyze and study the problem from the perspective of the elderly. At the same time, we need to consider such a problem: the elderly are the demanders and direct beneficiaries of this work, and the construction of community home care service centers in the future should listen to the opinions and suggestions of the elderly more. Based on the results of sampling survey in Shijiazhuang, this paper studies and analyzes the main problems existing in the construction of community service centers for the elderly from the perspective of the elderly, which has obvious guiding significance.

Second, the basic situation of the investigation

During the summer vacation of 20 12, the research group selected some communities in Chang 'an District and Qiaoqu District of Shijiazhuang City, among which Chang 'an District is a prominent county (district) in Shijiazhuang City. This survey * * * interviewed 74 elderly people in Guanghua Living Community, Ouhuayuan Community, Shangchengyuan Community, Bajiazhuang Yiyuan Community and Bajiazhuang Apartment. Because most elderly people have poor eyesight, it takes 2 months for the investigator to talk to each elderly person individually and fill out the questionnaire. The survey sample can cover the basic situation of the elderly.

Table 1 Interviewee profile

project

Nitrogen (%)

project

Nitrogen (%)

gender

man

woman

33(44.59)

4 1(55.4 1)

marital status

married

divorce

be widowed

be unmarried

58(78.38)

0(0)

15(20.27)

1( 1.35)

level of education

University or above

High school or technical secondary school

primary school

primary school

Never went to school.

5(6.76)

14( 18.92)

24(32.43)

20(27.03)

1 1( 14.86)

Number of children

1

2

three

4 or more

1( 1.35)

26(35. 14)

24(32.43)

14( 18.92)

9( 12. 16)

Judging from the basic data of the survey, it mainly reflects the following problems:

(a) Most elderly people can take care of themselves, but the proportion of elderly people is increasing.

The average age of the elderly in this random interview is 72 years old, of which 60-70 years old accounts for 43.24%, 70-80 years old accounts for 39. 19%, 80-90 years old accounts for 16.22%, and over 90 years old accounts for 1.35%. Among all the old people surveyed, only 13.438+0% can't take care of themselves. However, we have noticed that the proportion of elderly people over 80 years old is increasing. Among these elderly people, 6 1.54% can't take care of themselves. From another perspective, 80% of all elderly people who can't take care of themselves are over 80 years old.

(2) About half of the elderly do not live with their children, and the proportion of elderly people living alone is worthy of attention.

Figure 1 distribution map of living conditions of the elderly

This survey found that 50% of the elderly live with their children, and the other 50% do not live with their children. Among them, 39. 19% live with their spouses, and 10.8 1% live alone. See figure 1 for details.

(3) The income level of the elderly is generally low.

The survey results show that 75.68% of the elderly live on retirement wages or old-age insurance, with monthly income below 1000 yuan accounting for 18.92%, 1000-2000 yuan accounting for 32.43%, and 2000-3000 yuan accounting for 32.43%. The income level of the elderly is lower than the per capita disposable income standard of Shijiazhuang urban residents 20 1 1 [6].

Facing the lower income level of the elderly. We must consider the above realistic factors when promoting the construction of community home care service centers. Provide personalized, high-quality and low-cost (or free) services for the elderly, especially those who can't take care of themselves, don't live with their children and have low incomes.

Three, the main problems faced by the construction of home care service center analysis

This survey focuses on the elderly's cognition of community home-based care services, and the survey results are not optimistic.

(a) The awareness rate of elderly people about community home care services is very low.

During the investigation, the investigators introduced the basic situation of community home-based aged care service to every elderly person in detail, and publicized to them that it is a multi-faceted aged care service provided by the government, relying on community organizations and using resources in the community, which can be enjoyed by residents in residential areas at home.

However, before asking the elderly, "Do you know anything about community home-based care for the elderly?" Only 1.35% of the elderly said they knew this situation, 20.27% said they knew a little, and the remaining 78.38% said they didn't know it at all. It can be seen that at present, most elderly people simply don't know what community home-based care is, let alone "day care center for the elderly" and other similar service institutions.

In addition, when asked if they knew the "push-to-talk" mobile phone calling service for the elderly, 47.73% of the respondents said "no". This also explains the low awareness rate of home-based care services from another side.

The low awareness rate is related to many factors. The author makes a grey relational analysis on this issue, and chooses "knowing the situation" as the reference sequence. The average payment value of those who know the community home-based care for the elderly and those who know a little about the situation is "1", and the payment value of those who don't know the situation is "0". Choose age, income, gender, whether to live alone or not, and whether to pay attention to socialization as the comparison series. Age 1-4 grades, income 1-6 grades, gender 1 (male) and 0 (female), whether living alone or not, whether paying attention to social communication is 65438+. Finally, the grey correlation coefficient between each factor and "knowing the situation" is calculated. After data standardization (z-score standardization), the resolution ρ is 0.5, and the coefficient result is obtained by using the gray correlation formula. All the coefficients have passed the correlation test, as shown in Table 2.

Table 2 Grey correlation coefficient between awareness rate and other factors

Factor name

age

income

gender

Do you live alone?

Do you pay attention to socializing?

Grey correlation coefficient

0.6540

0.7372

0.7022

0.7827

0.8 182

From the results, the social factors of the elderly (such as "whether to pay attention to communication" and "whether to live alone") have the strongest relationship with the awareness rate, followed by economic factors (such as "income level") and finally natural factors (such as "gender" and "age"). This also shows that the more attention is paid to social interaction, the stronger the understanding of policies among the elderly. The survey found that those old people who pay attention to socializing are those who often chat with others, read books, read newspapers and listen to the radio. The important reasons for the low awareness rate may be that the policy propaganda is not in place, the propaganda is not in-depth and the propaganda method is inappropriate.

(2) The utilization rate of the aged care service is close to zero.

When asked about the elderly, "Is there a pension service institution in your community?" Almost all the old people gave the answer "No". We have listed some old-age care services for the elderly, including life care, centralized dining or home delivery, cleaning services such as laundry and haircut, accompanying medical treatment or physical examination services, fitness rehabilitation, agency services, heart-to-heart communication, reading books and newspapers, and psychological counseling. When the elderly have enjoyed any old-age care service, almost all the old people's answers are "no". This result is completely unexpected! This may be related to the lack of community samples randomly selected by us, and it also shows that the construction of community pension service institutions is still facing a more severe test and development space.

The news from Zhuo Da Property Management Company is also in line with the above situation. The company's six communities have launched more than 600 "community pension services" for the elderly. However, only a few projects such as "door-to-door delivery" and "property help nanny" have attracted more attention from the elderly, while other projects have almost been put into the "cold palace" and few people are interested.

In addition, 1 0,000% of the respondents answered "No" when asked whether to use the "push-to-talk" mobile phone service for the elderly. This also verifies the problem of extremely low utilization rate of old-age care services from another side.

The reason for the low utilization rate of old-age care services for the elderly is that the popularization rate of these services is low, and the elderly rarely know about it. Ideology is also an important factor. At present, the elderly are still relatively traditional. Just be a little tough and don't rely on others. Even if there are problems that need to be solved, they are still accustomed to relying on their families and rarely use community pension services.

(3) The elderly have different preferences for different pension services.

In the survey, when asked, "What kind of old-age care service do you want or are most interested in?" The old man gave different answers at that time. The results show that the four items with the highest degree of concern all exceed 50%, and the ones with the highest degree of concern are "accompanying medical or physical examination services", "life care", "cleaning services such as laundry and haircut" and "centralized dining or home delivery". These services are basically basic, and the rest are mostly spiritual, with low attention, followed by agency matters, fitness rehabilitation, reading newspapers, psychological counseling and so on.

Table 3 Preference of the elderly for different service items

service

project

Accompanying medical or physical examination services

life

nurse

Cleaning services such as laundry and haircut.

Centralized dining or door-to-door delivery

Act as an agent

project

health

And rehabilitation

read a book

Newspaper reading

intelligence

consult

other

watch out for

degree

82.43%

75.68%

68.92%

52.70%

3 1.08%

2 1.62%

12. 16%

5.4 1%

9.46%

It can be seen that the basic old-age care service has a high degree of concern, while the mental service has a low degree of concern. Among the basic old-age services, "accompanying medical treatment or physical examination service" has received the highest attention of the elderly, which undoubtedly provides a direction for the construction of community old-age service centers in the future. How to connect the community service center for the elderly with the community health service system is a subject that needs urgent attention and research.

(D) The elderly are most concerned about the fees and service quality of the service center for the aged.

When asked about the elderly, "Do you think it is necessary to set up an institution for the aged in the community", 89. 19% of the elderly think it is absolutely necessary or necessary. When asked, "What problems do you think the establishment of old-age service institutions in the community will face?", 93.24% of the elderly think it is a problem of funds. Where does the money come from and is it enough? This is a concern of the elderly.

If the elderly decide to enjoy community pension services, what issues are they most concerned about? The survey results show that 93.24% of the elderly think it is a matter of charging, and the level of charging directly determines their choice. 66.22% of the elderly think that we should also pay attention to the quality of service.

In the process of building a service center for the aged, increasing government investment and introducing social capital in various ways meet the needs of the elderly, and low fees and free projects are the future development trends. It is not in line with China's actual situation to blindly pursue economic benefits in the construction of the old-age service center. Whether low fees and free fees will cause the decline of service quality is also a problem worthy of attention.

Fourth, policy recommendations.

(a) to further increase publicity.

The party and the government have done a lot of work in the construction of community home care services, and achieved some typical results, which are often reported in newspapers, radio and television. However, through random sampling survey, we found that the awareness rate of elderly people on community home care service is not high, and the utilization rate is close to zero. This shows to some extent that our propaganda work should be further deepened.

It is suggested that the propaganda work should not only stay in the news media, but also be a simple introduction of typical experiences. We should introduce the community and preach to the elderly. All parts of our province have increased the construction of community home care service centers to varying degrees. At the same time, it is necessary to set up more publicity columns in the community to publicize the policy of serving the elderly and benefiting the people, organize college students to preach and explain this policy in the community during the summer vacation, and publicize relevant policies to the hearts of the elderly.

(2) Effectively implement the financial guarantee.

Because of the low income of the elderly, they generally refuse some charging items, so free items and low-charging items should be the top priority of community home-based care services, which means that the government should assume greater responsibilities in them.

For example, as stipulated in Shijiazhuang, the county (city, district) shall bear the funds for purchasing the facilities of the home care service center, and the municipal funds shall give a one-time construction subsidy of 6.5438+0.000 yuan to each home care service center built in the urban area and a one-time construction subsidy of 30,000 yuan to the street (town) demonstration home care service center. The cost of water, electricity, gas and heating shall be borne by the county (city, district) government. However, the financial imbalance between counties may affect the implementation progress of this policy in the future.

We suggest that on the one hand, we should effectively grasp and coordinate financial funds, which is the basic guarantee for the success or failure of the construction of home care service centers. On the other hand, we can consider giving some subsidies to low-income special groups. For example, we can consider adopting the method of "government purchasing services" in places where conditions are ripe, and give certain subsidies in the form of IC cards to low-income and key special care recipients over 60 years old to pay for services such as hairdressing, cleaning, catering and physical therapy.

(C) the introduction of social capital to meet the multi-level needs of the elderly

The needs of the elderly are diverse and multi-level. It is suggested that government-led pension service centers should provide free or low-cost services, such as medical care, nursing, beauty salons, catering, culture and entertainment. Services such as rehabilitation, fitness, agency and psychological consultation can be mainly solved by social capital, and private capital is encouraged to expand the content of home-based care services.

When providing services, on the one hand, we should avoid exceeding the needs and payment ability of the elderly, and combine the effective needs of the elderly with the guided consumption of the service providers. Gradually promote the demand for home-based care for the elderly to form a market with a certain scale, and accelerate the marketization and specialization of home-based care services. We should correctly handle the relationship between economic benefits and benefits of old-age services.

On the other hand, combined with the actual needs of the elderly, we should strive to explore the service model of "community health+community pension". The survey results show that in the future, the elderly will pay more attention to "medical treatment and physical examination services". It is suggested that the construction of community health centers and community pension centers should be closely integrated, not only in geographical location, but also in service content.

(four) do a good job in the construction of the old-age service team and strengthen the organizational system.

Service quality is the "lifeline" of home care service center. The results of this survey show that 8 1.08% of the respondents think that there is something wrong with the service quality of nursing homes, which also shows that the elderly also have great expectations for the service quality of home-based care centers, and the service quality will directly determine the recognition and operation effect of this service form for the elderly.

In addition to the hardware facilities will affect the quality of service, the quality of the staff of the old-age service center has also become another important factor. At present, the society should advocate and mobilize all walks of life to provide free public welfare services for the elderly, and the government should further strengthen community work and take the construction of the staff of the old-age service center as a systematic project. Guide more social workers to devote themselves to this cause, encourage college students to engage in voluntary service in pension service centers, guide college graduates to work in grassroots communities, incorporate more pension service posts into public welfare posts, implement preparation and treatment, and stabilize the talent team; Relevant departments can also entrust relevant units to carry out training for aged care service personnel.

Finally, to improve the service quality of the old-age service center, it is necessary to improve the system construction of the old-age service, including the organization system, planning system, operation system and monitoring system of the old-age service [7]. Only when the system structure is sound, the system runs smoothly and the demand is met reasonably can the quality of the aged care service be guaranteed.

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