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1.
<正>随着我国人口老龄化进程的不断加速,高龄、空巢和失能老人的长期护理问题越来越得到社会重视。20世纪80年代以来,联合国曾多次召开老龄化问题世界大会,并将老龄化问题列入重要议题。调查数据表明,我国约有3250万老年人需要不同形式的长期护理。越是经济发达地区,养老护理需求越高。但是目前专为老年人提供护理服务的设施严重不足,护理服务的项目和内容不全,老龄护理服务的数量和质量都远远不能满足社会需求。如何能够做好老年人护理工作,尽可能保障老年人健康,提高生活质量,实现积极老龄化?为此,在5.12国际护士节来临之际,本刊专访了第37届南丁格尔奖章获得者——卫生部北京医院原护理部主任曾熙媛。  相似文献   

2.
随着我国人口的老龄化和高龄化,老年人的长期护理问题日益凸显,这决定了在我国建立长期护理保障制度的必要性和迫切性。鉴于我国的国情,老年人长期护理保障制度可采取分步构建的步骤,首先从国家主导、个人自愿投保的长期护理初级保障形式起步,随着条件的逐步成熟,最终发展为强制性的、完善的社会保险制度。  相似文献   

3.
我国老年人口不断增加,已经成为全球老年人口最多的国家,但是相应的我国老年人护理方面发展缓慢,形势不容乐观。由于人口基数大,城乡资源分布不均,东西部资源分布不均等原因,导致我国老年人护理面临重重问题。因此,建立健全老年人护理制度迫在眉睫。而我国已经开始尝试建立健全长期护理保险制度,虽然取得了一定的成果,但面临的问题也尤为突出。本文综述了我国试点城市现状以及国外长期护理保险制度带来的启示,以期为我国建立完善的长期护理保险制度提供参考。  相似文献   

4.
随着社会发展,我国社会目前面临着不可避免的老龄化问题。为解决这一问题,必须重视对老年人的护理,建立一个高效可持续的长期护理保险体系,为老年群体提供优质的服务保障。美国在长期护理保险体系建设方面已发展较为成熟,本文重点分析了美国长期护理保险的现状,在总结其特点与不足的基础上,提出对我国长期护理保险发展的启示。政府参与长期护理保险体系建设对该行业的发展起着重要作用,因此我国应在了解行业现状与市场需求的基础上,构建多层次、多类型的长期护理保险体系,以满足消费者的个性化需求,进而保障体系的高效可持续发展。  相似文献   

5.
我国的半失能与失能群体,尤其是老龄化社会下众多的半失能和失能老年人产生的长期护理费用对家庭和社会造成了沉重的经济负担,同时也对我国护理服务的供给提出了挑战。针对目前存在的中重度失能人群数量庞大、长期护理服务供不应求、护理服务费用难解决以及长期需求经济负担重等问题,基于公共产品理论,提出在我国推广长期护理保险制度应当明确准公共产品性质、作为社会保险强制推行、体现政府公共责任及实行社保商保相结合模式的思路,以及构建多样给付方式、引导居民优先选择居家服务和借鉴家庭医生签约工作经验等具体推广路径。  相似文献   

6.
在健康中国战略背景下,失能老人的长期护理不足成为亟待解决的问题,与我国同属儒家文化圈的日本与韩国分别于2000年和2008年建立了长期护理保险制度,并形成了完善的体系,我国也于2016年展开长期护理保险制度试点。通过总结日本与韩国的成功经验,运用福利多元主义理论,立足我国发展国情与实践,以期为解决我国长期护理保险运行过程中出现的问题,提高长期护理服务可及性,满足老年人多层次的养老、照护需求提供参考。  相似文献   

7.
目前老年人的健康问题成为社会关注的焦点,也是医学界研究的重点课题.我国是人口大国,老龄化现象更加严重,因此先进的居家护理模式是解决社会负担满足老年人需求的必经之路.《中国护理事业发展规划纲要(2011-2015年)》明确提出,需进一步完善医疗服务体系,逐步建立和完善"机构为支撑,以居家为基础、社区为依托"的长期居家护理服务模式.  相似文献   

8.
随着老龄化社会的到来,我国失能、失智人口增长迅速,失能老人养老问题严峻,长期护理服务成为一种公共需要。公共产品以公共需要为导向,这种需要是不可或缺、必须满足的需要,因此公共产品的供给不可或缺。长期护理保险作为解决失能、半失能人群长期护理问题的一个新险种,该制度在保障失能、半失能老年人健康权益中发挥着重要作用。通过深入调研苏州市这一典型试点城市对长期护理保险制度的实施,系统总结苏州市所取得的成功经验,分析第一阶段制度运行过程中出现的问题和原因,探索第二阶段完善性施策和发展路径,为长期护理保险在全国的进一步推广提供参考和经验,为解决我国养老问题提供新思路。  相似文献   

9.
以长期护理保险的发展现状为出发点,分析长期护理社会和商业保险的实践经验及挑战,提出通过建立健全相关政策法规,加大财税支持、完善统一评估体系、建立长期护理数据共享平台、提高公众的护理风险防范意识、加强长期护理人才队伍建设等途径,构建符合我国以长期护理社会保险为主、商业保险为辅的多层次长期护理保险体系,以满足老年人多元化长期护理服务需求。  相似文献   

10.
新疆石河子市失能老年人长期护理需求调查   总被引:1,自引:0,他引:1  
[目的]了解石河子市失能老年人长期护理需求,以便政府和社区为失能老年人制定相关保健护理策略提供依据。[方法]采用分层整群抽样方法,对石河子市640名失能老年人进行入户问卷调查。[结果]640名失能老年人中有长期护理需求意愿的550人(85.94%),不清楚的90人。其中需要1项长期护理服务意愿106人(16.56%);需要2项长期护理服务意愿202人(31.56%);需要3项及以上长期护理服务意愿242人(37.8%)。经多元线性回归分析:文化程度和社会支持是影响失能老年人长期护理需求的主要因素。[结论]失能老年人长期护理服务需求大、内容多,应针对失能老年人的不同特点,积极开展以社区为主的居家照护体系,大力发展机构照护为补充的长期护理服务模式。  相似文献   

11.
Despite concern over increased health services utilization with population aging, few studies describe health services utilization by long-term-care (LTC) residents. An investigation was designed to compare health services use before and after LTC admission. Comprehensive 1988 to 1999 data for all LTC residents (N = 47,510) in Alberta, Canada, were obtained. Utilization comparisons involved equal pre/post timeframes. Only non-hospital physician services increased post-LTC admission. Home care was not provided after admission (51% had been recipients). Hospital and ambulatory services use declined, with these patterns stable for 5 years pre- and post-LTC admission. When hospital or ambulatory care was sought by LTC residents, they were not disadvantaged in the type or scope of care as compared to the care received prior to LTC admission. These findings should raise interest in the services provided by LTC facilities and the outcomes of long-term, facility-based care. LTC services could be beneficial for people with advanced age and dependency.  相似文献   

12.
Variations across Finland in the use of six different long‐term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards by using national registers. We studied how the use of LTC was associated with characteristics of the individuals and in particular characteristics of the municipalities in which they lived. Analyses were conducted with multilevel binary logistic regression. Data included all individuals (34,753) who died in the year 2008 at the age of 70 or over. Of those, 58.3% used some kind of LTC during their last 2 years of life. We found considerable variations between municipalities in the use of different kinds of LTC. A portion of the variation was explained by municipality characteristics. The size and location of the municipality had the strongest association with the use of different kinds of LTC. The economic status of the municipality and morbidity at the population level were poorly associated with LTC use, whereas old‐age dependency showed no association. When individual‐level characteristics were added to the models, these associations did not alter. Results indicated that the delivery system characteristics had an important effect on the use of LTC services. The considerable variation in LTC services also poses questions with respect to equity in access and to quality of LTC across the country.  相似文献   

13.

Introduction

The demand for long-term care (LTC) services is likely to increase as a population ages. Keeping pace with rising demand for LTC poses a key challenge for health systems and policymakers, who may be slow to scale up capacity. Given that Singapore is likely to face increasing demand for both acute and LTC services, this paper examines the dynamic impact of different LTC capacity response policies, which differ in the amount of time over which LTC capacity is increased, on acute care utilization and the demand for LTC and acute care professionals.

Methods

The modeling methodology of System Dynamics (SD) was applied to create a simplified, aggregate, computer simulation model for policy exploration. This model stimulates the interaction between persons with LTC needs (i.e., elderly individuals aged 65 years and older who have functional limitations that require human assistance) and the capacity of the healthcare system (i.e., acute and LTC services, including community-based and institutional care) to provide care. Because the model is intended for policy exploration, stylized numbers were used as model inputs. To discern policy effects, the model was initialized in a steady state. The steady state was disturbed by doubling the number of people needing LTC over the 30-year simulation time. Under this demand change scenario, the effects of various LTC capacity response policies were studied and sensitivity analyses were performed.

Results

Compared to proactive and quick adjustment LTC capacity response policies, slower adjustment LTC capacity response policies (i.e., those for which the time to change LTC capacity is longer) tend to shift care demands to the acute care sector and increase total care needs.

Conclusions

Greater attention to demand in the acute care sector relative to demand for LTC may result in over-building acute care facilities and filling them with individuals whose needs are better suited for LTC. Policymakers must be equally proactive in expanding LTC capacity, lest unsustainable acute care utilization and significant deficits in the number of healthcare professionals arise. Delaying LTC expansion could, for example, lead to increased healthcare expenditure and longer wait lists for LTC and acute care patients.  相似文献   

14.
Older people of lower socioeconomic status (SES) are disproportionately affected by chronic conditions, yet less able to compensate health limitations through use of formal long‐term care (LTC) at home, a preferred type of care for most. Some, like older women and single people, are particularly vulnerable. Under the Austrian public cash‐for‐care scheme, which aims to incentivise care at home and empowerment of LTC users, this study analyses: (i) interdependencies between SES, gender and ‘informal’ or family care, and (ii) how these factors associate with the use of old age formal home care in Vienna. An adaptation of Arber and Ginn's theory is used to identify material resources (income), health resources (care needs) and informal caring resources (co‐residence and/or availability of family care). Gender aspects are also considered as a persistent source of inequalities. Administrative and survey data, collected by public authorities between 2010 and 2012 in Vienna, serve to compare home care use in old age (60+) to other support forms (residential and informal care) using logistic regression analysis. Results show a pro‐rich bias in home care use among single‐living people, with high‐income single people being less likely to move to a care home, while there are no significant income differences present for non‐singles. Second, traditional gender roles are salient: female care recipients co‐residing with a partner are more likely to use formal care than men, reflecting that men's traditional gender roles involve less unpaid care work than women's. In conclusion, in an urban setting, the Austrian cash‐for‐care scheme is likely to reinforce stratifications along gender and class, thus implementing the general policy objective of care at home, but more likely for those with higher income. A support mechanism promoting empowerment among all older people might contribute to unequal degrees of choice, especially for those with fewer resources to manage their way through a fragmented system of LTC delivery.  相似文献   

15.
Using nationally-representative register data for older people in Finland in period 1998–2003 we study how the number of days in acute hospital and long term institutional care services varies by age and proximity to death and how these use patterns change as mortality improves. Acute health care use depends more on proximity to death than on age, a finding often interpreted as showing that the need for care services among older people will be substantially less than would be expected based on the likely increase in population numbers. We show that this assumption is too optimistic for three reasons: (1) the increase in population numbers will be concentrated mainly among the “old old” where use of services is substantial; (2) earlier findings of much lower use of acute care services by older than younger people who are close to death are not observed; and (3) any savings in acute care are more than offset by greater use of residential long-term care (LTC). The main consequences of improving mortality are: (1) to postpone rather than to reduce overall demand for health care; (2) to shift the balance of care from acute to long-term care services; and (3) to increase considerably the average age of time spent in care. We further construct a new indicator “care-free life expectancy” based on number of days in hospital and long-term care to summarise care use patterns for cohorts under a range of plausible mortality assumptions. As mortality improves, lifetime use of acute hospital and long-term care after age 65 and the proportion of life spent in LTC increases for later cohorts, but the proportion spent in acute care decreases slightly.  相似文献   

16.
Demographic situation, changes in the role of women in society and growing demand for long-term care (LTC) of older people have challenged the ability to meet the growing LTC needs in most developed countries. In countries where responsibility for LTC is still largely laid on families, it is, however, even more critical and calls for improvements in formal LTC systems. More intensive stakeholder collaboration in LTC policy development, organising and delivery are of primary importance in improving LTC systems. Such collaboration, however, is not always successful; thus, it is critical to understand what makes it effective and efficient. In this paper, we specifically look into multistakeholder collaboration in LTC in Lithuania, one of the fastest ageing countries in the EU, with the demand for LTC services growing fast and exceeding the supply despite rising business and NGO engagement. To determine facilitators of such collaboration, we build on the data obtained through eight focus group discussions with all key stakeholder representatives (LTC policymakers, organisers and service providers [public, private and NGOs], 54 participants in total). Our findings indicate that in addition to national and organisational level facilitators studied in prior research, there are important individual level factors, such as meaningfulness at work, concern and care for others, possibility for personal growth and development, satisfaction with supervision, a sense of belonging and role clarity. On the other hand, our results show that collaboration is constrained by a shortage of human resources, increased workload caused by growing LTC demand, bureaucratic requirements, legal restrictions, lack of awareness of LTC service availability among elder persons, and prevailing social norms and attitudes to institutionalised care. Interestingly, a lack of financial resources is not perceived as a major constraint.  相似文献   

17.
ObjectivesThis study aimed to examine the effect of increased cost sharing on long-term care (LTC) service utilization among home-dwelling older adults, using nationwide long-term care insurance (LTCI) claims data in Japan.MethodsIn August 2015, the coinsurance rate for Japanese LTCI increased from 10% to 20% for higher-income beneficiaries. We analyzed 27,911,076 person-month observations between April 2015 and July 2016 from 1,983,163 home-dwelling older adults (aged ≥ 65 years). We employed a difference-in-differences approach to estimate the effect of the increased coinsurance rate on overall LTC service utilization and for each of the four main service subcategories. The control group comprised those whose coinsurance rates remained at 10%.ResultsThe treatment group, whose coinsurance rate increased, accounted for 9.6% of all participants. The raised coinsurance rate caused statistically significant reductions of 0.46% (95% confidence interval [CI]: 0.36%, 0.56%) and $25.7 (95% CI: $23.7, $27.8) in the percentage of utilization of LTC services and total monthly LTC expenditures per person, respectively. Service utilization decreased in each of the four service subcategories.ConclusionsThe increased coinsurance rate resulted in statistically significant but small reductions in LTC service utilization overall and in each service type among higher-income home-dwelling beneficiaries. Requiring more cost sharing from higher-income individuals may alleviate the fiscal burden on LTC systems without serious reductions in service utilization.  相似文献   

18.
ObjectivesThe COVID-19 outbreak severely affected long-term care (LTC) service provision. This study aimed to quantitatively evaluate its impact on the utilization of LTC services by older home-dwelling adults and identify its associated factors.DesignA retrospective repeated cross-sectional study.Setting and ParticipantsData from a nationwide LTC Insurance Comprehensive Database comprising monthly claims from January 2019 to September 2020.MethodsInterrupted time series analyses and segmented negative binomial regression were employed to examine changes in use for each of the 15 LTC services. Results of the analyses were synthesized using random effects meta-analysis in 3 service types (home visit, commuting, and short-stay services).ResultsLTC service use declined in April 2020 when the state of emergency (SOE) was declared, followed by a gradual recovery in June after the SOE was lifted. There was a significant association between decline in LTC service use and SOE, whereas the association between LTC service use and the status of the infection spread was limited. Service type was associated with changes in service utilization, with a more precipitous decline in commuting and short-stay services than in home visiting services during the SOE. Service use by those with dementia was higher than that by those without dementia, particularly in commuting and short-stay services, partially canceling out the decline in service use that occurred during the SOE.Conclusions and ImplicationsThere was a significant decline in LTC service utilization during the SOE. The decline varied depending on service types and the dementia severity of service users. These findings would help LTC professionals identify vulnerable groups and guide future plans geared toward effective infection prevention while alleviating unfavorable impacts by infection prevention measures. Future studies are required to examine the effects of the LTC service decline on older adults.  相似文献   

19.
老年人卫生服务利用情况及影响因素分析   总被引:8,自引:0,他引:8  
陈方武  杨旭丽  刘杰 《现代预防医学》2007,34(16):3083-3085
[目的]了解江西省60岁以上人群医疗服务利用情况及其影响因素,为卫生服务管理与决策提供依据。[方法]采用整群抽样,以家庭卫生服务调查表及问卷调查的方式对老年人的一般健康状况及卫生服务利用情况进行调查。[结果]老年人中两周就诊率7.01%,年住院率6.00%。城市老年患者主要选择县区级医院就诊,农村老年患者主要选择私人开业的医疗场所就诊,对社区卫生服务站的利用较低。人均住院费用占人均医疗总费用的79.49%。两周门诊就诊费用和住院费用都主要集中在县级医院和省级医院,占总各费用的81.01%和68.29%。[结论]医疗费用与经济收入成为影响老年人对卫生服务的合理利用的重要因素。完善医疗保障制度,积极开展社区卫生服务是解决老年人医疗保健问题的有效途径。  相似文献   

20.
The Arizona Long-Term Care System (ALTCS), Arizona's Medicaid program for long-term care (LTC) beneficiaries, capitates contractors to provide a full range of acute and LTC services to financially-eligible beneficiaries determined to be at risk of institutionalization. This article compares the acute care utilization experience of LTC beneficiaries in ALTCS with those in a fee-for-service (FFS) Medicaid program, linking data from both the Medicare and the Medicaid program files. Patterns of use observed in Arizona seem more consistent with a managed care environment than those observed in the FFS comparison. Rates of acute care utilization observed for both the capitated and the FFS program should be of interest to States considering incorporating LTC beneficiaries into their Medicaid managed care program.  相似文献   

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