笨狼发牢骚

发发牢骚,解解闷,消消愁
个人资料
笨狼 (热门博主)
  • 博客访问:
正文

未富先老

(2015-07-09 14:57:58) 下一个

不搞市场经济,光靠政府,够累的吧?

未富先老 中国式养老的现实困境
经济参考报

“一路研究下来,形势不容乐观,”刘继同说,“中国的传统文化提倡居家养老,如果把父母送到养老院,孩子们往往会被别人指指点点,可是居家养老,特别是当老人罹患重疾甚至生活不能自理时,常常会变成压垮一个家庭的最后一根稻草”。

刘继同是北京大学卫生政策与管理系的教授,当他的母亲因患糖尿病与心衰而被送医治疗时,母亲就成为他研究中国医疗服务和养老服务的一个样本。

“在老龄化汹涌来袭的今天,中国在养老制度建设方面须尽快走出一条符合国情的养老道路。”

在居家养老和养老院养老之外,如何找到一条更适合当前中国国情的养老模式是社会各界共同关心的话题,这不仅关系到个体家庭的福祉,也关系到中国未来发展的后劲。

“银发潮”之猛:60岁以上老人达2.12亿

来自民政部门统计数据显示,截至2014年年底,我国60岁以上的老人大约有2.12亿,其中15%为80岁以上的高龄老人,15%为失能和半失能老人。

中国社会福利基金会曾对中国的养老模式做过一次专项调研,该基金会副秘书长缪瑞兰指出,发达国家65岁以上老年人占总人口的比例从7%提升到14%大多用了45年以上的时间,而中国只需27年就可完成这个过程。

“在世界范围内横向比较,可以看出中国存在着明显的未富先老现象。西方国家的老龄化程度虽然高于中国,但是它们的富裕程度也远远高于中国。与中国人均国内生产总值相当的秘鲁和南非,老龄化比重仅为6.7%和6.1%,分别比中国低3个百分点和3.6个百分点,均未达到7%的国际人口老龄化社会荣枯线,这足以表明中国人口结构变化的严峻性。”缪瑞兰说。

更令学界担忧的是,虽然中国传统文化推崇“孝道”和家庭养老,但是落实这种“孝道”的现实基础却在逐渐弱化和动摇。最突出的表现就是家庭结构的变化,如今中国主流家庭结构已转变为只有一个孩子,这意味着年青一代的养老负担将变得非常繁重。此外,人口流动的加快导致代际分离现象日益突出,中国有相当多的老人独守家中,成为空巢老人。即使是与父母同居一个城市的年轻人,也因高强度的工作和快节奏的生活而很难抽出时间给予父母更多陪伴。

养老院之痛:安全隐患、护理不足、法规缺位

“欧美发达国家的确依靠养老院来养老,但他们的养老院,按照中国的标准来看,大都是高端养老院。而中国本土市场的特殊性就体现在如何满足低端需求上。当前应该在养老服务和机制上创新,让每个老年人都能及时得到医疗及养护服务。只有这样,慢慢变老才是一件幸福而有尊严的事情。”上海幸福9号老年乐园董事长王振认为,中国不能简单照搬国外的养老模式。建设养老院并不能完全解决老有所养的问题。“刚刚成家立业的年轻人发愁没房子住,而中国的老年人可不缺房子住,他们缺的是健康护理和关怀。如果盖的养老院基础设施还很差,安全隐患又多,那就更容易引发社会不满。”

事实上,从郑州市发生的养老院“虐老”事件、黑龙江海伦市联合敬老院纵火案、湖南双峰县养老院恶性杀人事件,到近期发生的河南平顶山市鲁山康乐园老年公寓火灾,频频发生在养老院的惨剧,折射出基层养老安全之痛。

近年来,在国家扶持政策和市场机遇的刺激下,各类社会化养老机构如雨后春笋般纷纷出现。然而,就在养老日益成为资本竞相追逐的“朝阳产业”的同时,公立养老院一床难求,城乡之间、大城市与中小城市之间养老资源分布不均衡、养老专业护理人员短缺、管理水平低下等问题渐渐暴露出来。

“事实上,有许多农村民办养老机构为节约成本,根本做不到消防达标。”西部某省民政部门工作人员介绍,不少民办养老院往往在前期投入阶段就存在资金紧张的问题,无法按照国家统一的养老机构建设标准进行建设,甚至存在偷工减料,以假乱真的情况。而面对养老事业的旺盛需求,地方监管审批部门往往“睁只眼,闭只眼”。

东部某县级市一家民办养老院院长曾艳红表示,二三线城市,特别是城乡结合部地区的养老机构起步晚,受传统思维的影响,往往将养老院看成是“孤老院”或“老年收容所”,因此多采用家庭式管理,软硬件配套不足。另一方面,不少城乡结合部的建筑物产权不明晰,消防配套不到位,导致民办养老机构拿不到执照,只能违规经营。

河南省延津县一家敬老院包括院长在内的6名服务人员,都是四五十岁的农村妇女,没有专业的护理技能,洗衣、做饭、喂饭、端尿、打扫卫生,几乎24小时都在院里忙活,每个月却只有800多元工资,很难吸引人、留住人。

福建安心民办养老院院长宋达介绍,当前只有各地市民政部门会不定期地举办护理专业技术培训,且仅限于初级培训。而老人作为一个特殊群体,往往面临身体机能退化、思想意识不清等问题,心理层面的精神慰藉往往被养老机构所忽略。

记者了解到,当前护工群体主要构成为进城务工人员,专业度不足。而我国护工专业也仅开设三五年时间,面临招生困难、师资不足、教材缺失、认可度低等问题。为此,护理人员培训成为不少民办养老机构的“自选动作”。

养老服务法规的缺位也是困扰养老行业的一大问题。宋达说,当前人们法律意识逐渐提升,但养老行业专门的法律法规却迟迟未见“音讯”,不少民办养老机构的入住协议只是养老院自行拟定,没有规范的格式和法律依据。

宋达说,养老院多是风险高发群体,出险率极高,但当前涉及养老机构纠纷多参考《消费者权益保障法》,缺乏明确法律支持,导致现实中因养老服务发生的纠纷往往因参考法规的不同而结果悬殊。

为了应对法律依据模糊的现状,宋达所在的养老院聘请了法律顾问,针对老人可能存在的问题,进一步细化相关规程,规范员工行为,“但大部分民办养老院没有这个意识,也没有相关经费,一旦出现问题,养老机构甚至直接被拖垮。”

养老保障之误:家庭责任还是国家责任

“我们现在的养老还是强调家庭责任,没有解决养老由国家承担的主体责任。如果研究发达国家的经验就会发现,针对老人的服务应该是福利性的、社会性的,只有利用社会化的机制才能实现风险共担和代际补偿,这样才能促进社会的稳定与和谐。”刘继同认为,要从根本上解决中国的养老困境,最核心的议题就是要明确养老的责任归属。

专家们认为,中国不能再把养老的重点放在提供物质帮助上,现在已经到了机制创新的关口,特别是在保险制度设计、养老服务多元化和资金管理安排上。

刘继同结合母亲的案例说,在德国创立长期护理保险后,日本加以借鉴创办了介护保险,凡是45岁以上的人,无论男女,除了交养老保险外,还要交介护保险,到生病时就有专门的护理员提供服务。但是在国内,老人生病住院最难找的就是专业护理员,整个行业的发展严重滞后于老龄化社会的需求。

由于老龄人口大都受到慢性病的困扰,老年人最需要的是康复性医院。但在国内,除非是做手术或罹患重症,否则老年人很难等到住院治疗的机会。刘继同认为,中国不仅缺乏医养结合的机构,而且也缺少提供临终关怀的医院,因此加快医疗机构的多元化发展也是当前迫切需要解决的问题之一。

刘继同说,很多人都认为养老保障是花钱的事,总是担心养老保险资金不足,其实只要在优化管理机制方面多下工夫,资金并不是问题。“社会保险原理是大数法则,当前国内实行的五大保险都是各自封闭运行,且单一保险都还没有实现省级统筹,不同的保险基金归不同部门管理,难以形成合力。”

专家们指出,中国作为发展中国家,在养老模式上应该借鉴国际经验,比如与中华文化渊源很深的新加坡就利用税收优惠对奉行居家养老传统的家庭给予鼓励,凡是与老人合住的家庭都会享受住房公积金贷款优惠,而计税则是以家庭收入做标准,充分考虑家庭的收支需求,而非个人的收入水平。

王振认为,中国应效仿西方国家的做法,通过政府购买服务的方式培育养老医疗社会服务产业。他说,与其由政府出资办养老院,质量参差不齐,不如由政府补贴市场来建设养老机构和日间看护机构,而补贴的标准则取决于政府、社会以及老人、子女对这些机构运营质量的评级和监督。

刘继同说,现在居家养老条件跟不上,一个主要原因就是养老服务跟不上。如果能在每个社区都培育一个多学科的养老服务团队,为老年人提供医疗保健康复、日间看护等服务,老年人在家就能住得安心。

养老保障并非一个“无底洞”,这是探索中国养老模式必须改变的一个认识上的误区,社会福利不仅商机无限,而且对社会、政治、经济的发展都有深远的正面影响,这是受访专家和业界人士的共同观点。

(记者 程云杰、赵丹丹、刘姝君、陈曦、梁军、谭剑、姜刚、周畅、毛振华、闫平、周蕊 综合报道)


“医养结合”:看上去很美

 安徽省合肥市第一人民集团医院滨湖医院老年科内,两人间的病房里独立卫生间、悬挂式电视机、落地玻璃窗、红色储物柜等一应俱全,床头分布着各种功能的白色插头和按钮,老人和家属可随时通过按钮呼叫,今年84岁的张建廷和老伴都住在这里。

“在别的地方,病看好了就得出院,不舒服了再来住院,有的老同事就一直辗转各大医院。我们年纪大了,不想在各个医院来回跑,也折腾不起,就想有个既能看病、又能养老的地方。”张建廷说。

张建廷所在的滨湖医院老年科于2010年正式运行,该科设立“托护养老”和“医保住院”两种管理路径。“医”,即入院老人需要疾病诊疗,进入“老年科住院病人”信息系统,按照“医保住院”管理路径进行住院管理。“养”,即为“托老”模式,进入“老年护理院”信息系统,享受专业照顾、病情观察、心理护理、健康教育和康复指导,不纳入医保报销。“医”“养”互换时仅切换信息和管理路径,改变床头标识,无须搬移床位。

辽宁省大连市目前也在探索医养结合新模式。大连市中山区桂林养护院一楼是社区卫生服务中心,二楼、五楼是养护院。“养护院共有115张床位,现在已经住满了。”院长周淑媛说,老人在这里连同吃饭、床位、生活护理等每个月需3000多元。如果需要治疗,可办理家庭病床,用医保卡支付,最长时间两个月。楼下的社区卫生服务中心里,有七八个全科医生,B超、X光、心电图等设备相对齐全。

一些地方还在探索机构养老内设医疗机构的医养结合新模式。目前,上海市660多家养老机构,内设医疗机构的130余家,提出内设医疗机构纳入医保联网结算申请要求的103家,已全部纳入医保。

尽管医养结合受到社会各界欢迎,有的甚至“一位难求”,但目前运行仍面临不少成长中的“烦恼”。首先是身份难界定。“医养结合过程中最大的困惑在于没有相应的政策和标准,不知道应该怎么发展。”合肥市第一人民集团医院滨湖医院老年科主任陈雪羚说。其次是市场供需脱节。大连金石滩医院副院长戴经跃说,医养结合是系统工程,国家探索这条路是要解决就医难、养老难问题,所以医养结合非常急迫。但现实情况是,大量高端医疗机构主要集中在大城市,大医院人满为患,而大量的二级医院、社区医院被闲置。目前,许多慢性病、退行性疾病患者需要康复治疗,但市场需求与供给脱节,服务设施不足,全科医生不足。再次是标准难统一。医养结合监管主体涉及民政、医保、卫生等多个部门,一位基层民政部门负责人说,以评估标准为例,民政与卫生部门各有一套护理等级分级制度,卫生部门的标准以身体健康水平为基准判断进护理院,民政的标准以生活照护水平为基准判断进养老院,对不同水平的老人进入不同的轮候区,这就造成了同一名老人,按不同的体系评估后,进入不同的机构享受的待遇是不同的。

业内人士呼吁,国家能明确是否提倡、鼓励医养结合的发展方向,明确机构的性质、发证单位、运营规章,并予以支持。在护理、医疗、病人准入等方面,国家应出台统一明确、操作性强的标准或评价体系。在所有的医疗网点为老人建立健康档案,将医疗和养老信息打通。




《金融时报》
Favourable GDP data reflect reality, says China

China’s National Bureau of Statistics on Wednesday rejected suggestions that the inflation gauge it uses is flawed and exaggerates the country’s real economic growth rate.
Before the release of Wednesday’s second-quarter gross domestic product estimate, China’s nominal GDP growth rate had plummeted from almost 20 per cent to 5.8 per cent since 2011, a much sharper decline than the inflation-adjusted figures that have trended downwards from 9.5 per cent to 7 per cent over the same period.

The difference between this year’s first-quarter nominal and real growth figures implied that the so-called GDP deflator — a broad measure of inflation that covers all types of goods and services — was negative, at -1.2 per cent, for only the third time in nearly two decades. That transformed the government’s 5.8 nominal growth figure into 7 per cent real growth — bang on Beijing’s growth target of “about 7 per cent” for the full year. But it also implied that China suffered from nearly unprecedented deflation in the first quarter.

Sheng Laiyun, NBS spokesman, declined to say what the deflator was for China’s second-quarter growth figure, which also came in at 7 per cent. But analysts calculate that it has stabilised at 0.1 per cent, compared with -1.2 per cent in the first quarter.

In other words, nominal GDP growth rebounded from 5.8 per cent to 7.1 per cent between the first and second quarters.

“The inconsistency between the GDP deflator and other price measures seems to have gone away in the second quarter, after having been rather extreme in the first quarter,” says Andrew Batson at Gavekal Dragonomics, a Beijing research house.

Andrew Polk, resident economist at the Conference Board think-tank in Beijing, noted that there had been a similarly sharp upwards adjustment in the deflator between the first and second quarters of 2014.

Mr Sheng said the NBS had done “diligent research” on doubts raised by other analysts about China’s deflator series, adding they had “a lack of understanding about our calculation methods”.

“There is room for improvement,” he said. “But in general China’s GDP deflator hasn’t been underestimated, nor has GDP growth been overstated. Both objectively reflect the real situation.”

Mr Sheng noted that China uses the output-based “production approach” to calculate its GDP, which works out value added from agriculture, industry and services, also known as primary, secondary and tertiary industry. This, he added, differs from the expenditure approach favoured by some other countries, which is composed of consumption, investment and net exports.

翻译

《金融时报中文网》
中国GDP高估了?

《华尔街见闻》点评
中国GDP到底有没有被高估?
超预期的GDP背后 中国经济进入“平底锅的锅底”


《经济学人》
Whether to believe China's GDP figures

IT ALL seems a little too perfect to be true. The Chinese government set a growth target of “about 7%” this year. And for a second consecutive quarter, despite ample evidence of stress in its industrial sector, it managed to hit that right on its head. In the three months from April to June, the economy expanded 7% compared with the same period a year earlier. Cue the chorus of scepticism: Chinese data just cannot be trusted, goes the usual refrain. Yes and no. There is a difference between smoothing data and totally fabricating it. Evidence suggests that China is guilty of the former (the lesser charge) but not the latter (the more serious allegation).

China has a history of ironing out the ruffles in its growth figures. No less an authority than Li Keqiang, now the premier, once said that local GDP data were "man-made and therefore unreliable". The most notorious case of manipulation came in 1998 in the aftermath of the Asian financial crisis. Many Asian countries suffered recessions but China claimed to grow by a hefty 7.8% that year. Looking at other indicators, many economists concluded that growth was in fact closer to 5%. The manipulations can occasionally work in the opposite direction. In the early 2000s, when China reported growth of 8-9%, some reckoned that it really expanded by closer to 10%. Why would China understate its growth? One possibility is that statisticians missed big parts of the economy. Another is that the government downplayed its strength to avoid arousing anger at a time when its export juggernaut was beginning to rev up.

As China’s economy has become more crucial to rest of the world, its data have also come under closer scrutiny. The theory was that this would make it harder for its boffins to play with GDP numbers. In the first quarter, though, major doubts resurfaced. Industrial production fell to its weakest growth since the depths of the global financial crisis, while the property market, a pillar of the economy, slumped. When China reported real growth of 7% year-on-year in the first quarter, economists noted that this did not stack up with its nominal growth of 5.8%. The only way to arrive at the higher real figure was to record a GDP deflator of -1.1%, implying that the economy suffered broad-based deflation, a bizarre development when consumer prices rose by more than 1% at the same time. Had the GDP deflator been accurately estimated, Chang Liu and Mark Williams of Capital Economics reckoned, real growth in the first quarter would have been about one or two percentage points lower.

China’s new data, published today, appear to be more credible. In nominal terms, growth rebounded strongly from 5.8% year-on-year in the first quarter to 7.1% in the second quarter. The corollary is that the GDP deflator went from deflation of 1.1% to inflation of 0.1%, a reading that is much more consistent with rising consumer prices and falling producer prices. Still, there were signs of some tampering. Without providing any explanation, the national bureau of statistics lowered the quarter-on-quarter growth rate of the second quarter of 2014 to 1.9% from 2%. The effect was likely to lower the base of comparison for the second quarter of 2015, flattering the year-on-year growth rate. The impact, though, would have been relatively small: a few tenths of a percentage point, not a few percentage points.

What’s more, the sources of Chinese growth in the second quarter were less mysterious than in the first quarter. While investment continued to slow, services accelerated. The industrial sector grew 6.1% year-on-year in the first half, down from 6.4% in the first quarter. By contrast, the services sector jumped to 8.4% growth from 7.9% in the first quarter. That matters since services now occupy a larger share of Chinese GDP than industry. There is reason to doubt the sustainability of the services strength. It was predicated to a large extent on financial services benefiting from the stockmarket bubble that popped last month. But the gains for financial services, whether transient or not, were real. China’s statisticians did not invent them.


《路透社》
China GDP surprise leaves central bank on the hook
路透社金融词典


《统计局》
2014上半年
2015上半年
(此数据不含修改,不能用于计算)
国家统计局新闻发言人就2015年上半年国民经济运行情况答记者问



《彭博》
China's Debt-to-GDP Ratio Just Climbed to a Record High
《华尔街见闻》翻译

 

[ 打印 ]
阅读 ()评论 (0)
评论
目前还没有任何评论
登录后才可评论.