many countries have entered the aging society earlier than our country. Through exploration and research, they have formed a relatively mature pension model that is in line with their own national characteristics, especially in the practice of "combination of medical care and nursing", which is worth learning from. So what's the "combination of medical care and pension" model in foreign countries? A brief introduction to the benefits of foreign medical care model.
With the increasing trend of aging population in China, the elderly's pension and medical problems are facing severe challenges. The traditional family pension model of "raising children and preventing the aged" is no longer suitable for China's national conditions. What kind of pension model can be established to solve the dual problems of pension and medical care for the elderly in China, which has become the focus and hot issue of national and social attention.
Many countries have entered the aging society earlier than our country. Through exploration and research, they have formed a relatively mature pension model which is in line with their own national characteristics, especially in the practice of "combination of medical and nursing" which is worth learning from in our country. Therefore, it is necessary to build a "combination of medical care and pension" model with Chinese characteristics in combination with China's basic national conditions and foreign experience.
The mode of "combination of medical care and pension" in foreign countries
1. the United States
Since the United States entered the aging society in the 1940s, its pension system is highly market-oriented commercial insurance care system. However, with the increasing of aging, it is difficult to maintain the professional medical pension institutions in the United States. At the same time, because people yearn for community life, the United States has started a community-based pension model. The main pension models in the United States are program of all inclusive care for the elderly (PACE) and home and community based services for the elderly (HCBS).
Pace model is an innovative project of the U.S. government to provide comprehensive medical care for the elderly, especially for the vulnerable elderly. It is the most practical in the long-term care system of the United States, suitable for the elderly with severe disability and major diseases.
HCBS model is a long-term care system for the elderly, which can make the elderly enjoy convenient life and medical care services at home, and it also has significant effect on the recovery of physical function of the disabled and semi disabled elderly. It is suitable for the younger and less disabled elderly. The main feature is to regard long-term care as an industry, and pay attention to the role of medical staff.
In the United States, home-based pension funds mainly come from medical insurance, and other parts come from personal savings, social donations and institutional assistance. In addition, the resource center establishes care management organization (CMO) in each state, which is responsible for managing the use of care grant funds and long-term care services, including family care, community co habitation facilities and institutional care, and provides different services for participants to choose from.
In terms of providing services, the United States adopts the method of case management, and entrusts agencies to assess the elderly who need comprehensive care, coordinate and integrate according to existing resources, and provide targeted services. There is a sanatorium for the treatment of elderly patients. After the condition is stable, the elderly who need to continue rehabilitation will be admitted to the sanatorium for rehabilitation. In the aspect of providing for the aged, we should promote centralized providing for the aged, build large-scale buildings with complete supporting facilities, and organize the activities of the elderly. The representative building is the "Sun City Center".
2. Japan
Japan is one of the most aging countries in the world. Its legal system is relatively complete. The social welfare law passed in 1963 established a long-term care institution for the elderly. In 1982, the old people's health care law was promulgated, and the focus of the old people's old-age care gradually shifted to home-based old-age care and nursing care. In 1989, the so-called "golden plan" was issued, which is a 10-year strategic plan for the promotion of health care and welfare for the elderly. Various apartments for the elderly, activity rooms for the elderly, and hospitals for the elderly were successively established. In 2000, the nursing insurance law was formally implemented, and the long-term care insurance system was started.
Advocate home-based family pension services, the main pension models include day care center, nursing home, elderly welfare center and elderly apartment. Each model is aimed at different groups of people, respectively providing services for the disabled elderly who need daily life care, providing health education, physical examination, family guidance and other services for the elderly within the jurisdiction of the welfare center, and providing services for life Elderly people who can take care of themselves provide care services. The prominent feature is to classify nursing according to different physical conditions, needs and economic burden of the elderly.
Japan implements long-term care insurance in pension fund, which is compulsory medical insurance. Most of the expenses are paid by medical insurance fund. The cost of elderly care mainly comes from 90% of insurance cost and public expense, and only 10% of the rest is borne by the elderly. In terms of providing services, Japan's elderly care institutions are equipped with special wards for the elderly, with professional doctors and full-time nurses. The elderly can receive special and long-term treatment and care in the wards after being diagnosed and approved by doctors. And there are special medical staff to provide care and nursing services. In terms of providing for the aged, there are community-based longevity villages and other centralized areas for the aged, and volunteers provide long-term home-based elderly care services.
3. Australia
Australia's elderly health insurance system has undergone two adjustments: the first is to divert patients who have been "pressed" in hospital for a long time to nursing home; The second time was in 1980, the government implemented the "family and community care" plan in the country, and began to emphasize the importance of family and community care, so that the pension model changed from institutional pension to community pension. Community care has also become the preferred pension mode for the elderly in Australia. The main pension mode is residential and home-based care services.
The residential service object is the elderly who can not live at home after evaluation, living in a nursing home, an apartment for the elderly or a rehabilitation center. Home based services include providing home-based care and community-based care as well as extended care and care for related services. In 1997, the passage of the elderly health care act not only provided legal protection for the health care of the elderly, but also clarified the responsibilities of the government. Its main feature is to form a good social competition mechanism, which enables service providers to improve service quality and reduce government expenditure through competition. Australia has a relatively sound endowment insurance system, which is maintained by three kinds of insurance systems: comprehensive pension system, occupational pension system and personal savings business insurance system. The medical funds mainly come from government grants.
In terms of providing services, Australia's geriatric nursing homes adopt hierarchical nursing methods, and set up an elderly care assessment group to assess the medical and psychological needs of the elderly and find the most suitable care for the elderly. There are also professional nutritionists in the elderly care institutions. After the elderly enter the nursing home, there are special physical therapists to make rehabilitation plans according to their different conditions. In the aspect of providing for the aged, Australia attaches great importance to the family pension and adopts the family doctor responsibility system. Family doctors visit the elderly once a week to assess their health. Family caregivers with self assigned personnel can get certain cash subsidies, and the state provides them with leave and other benefits.
4. Germany
The problem of aging in Germany attracted the attention of the government and society in 1990.
The German Parliament set up the Ministry of social welfare, prepared to establish six major social welfare organizations in Germany, and managed them. So far, each social welfare organization has its own senior apartment, senior nursing home, senior nursing training school and a series of supporting facilities, becoming the first country in the world to establish a public pension system.
The main pension models are home-based pension, institutional pension, expert care home and elderly care home. Home-based care includes home-based care, daytime care and guardianship apartments; institutional care refers to the care homes that provide general medical treatment, care and care; expert care homes provide services for the disabled and semi disabled elderly by professionals; elderly care homes provide services for the elderly who need rehabilitation treatment at the age of 65.
Its main feature is to encourage home-based care, forming a long-term care principle of "taking home-based care as the main body, relying on social services, and institutional care as the support". Germany's pension is paid by statutory pension, enterprise pension and private pension in the proportion of about 70%, 20% and 10%. The mode of direct payment by insurance institutions is adopted to organize interdisciplinary discussion, learning, evaluation and resource integration of personnel in pension, medical, health, management and other related fields to ensure reasonable distribution. In terms of providing services, there is a special elderly care training school to train special medical staff for the disabled elderly and form a senior care specialty.
The general assistant nurses in the old-age institutions only assist the professional medical staff to nurse the elderly, not to practice alone; the Dean should be the person who has received higher nursing education and management professional training. In the aspect of providing for the aged, it is usually a community-based providing for the aged. In addition to the special apartments for the aged, there are also elderly villages, which have their own living space and live in large families living in groups. And through the establishment of a 'community service network' in the residential area, the elderly can be provided with domestic services, medical services and other social services at any time.
The experience and Enlightenment of "combination of medical care and pension" in foreign countries to China
1. Establish a family pension model focusing on home-based pension
Under the influence of the traditional culture of filial piety and the traditional family pension model of raising children and preventing the aged, most of the elderly tend to support the aged at home. Through the research on the pension model of developed countries, we can see that the pension model of each country can not be separated from home-based pension. With reference to the experience of American community pension, home-based pension and Australian family doctor patrol, combined with China's tradition, we can establish a 'home-based, diversified' pension model. In addition to the family's own needs for supporting the aged, a community service station should be set up in the surrounding villages. The clinic should be set up in the service station to provide special services for the elderly, and provide home-based services for the elderly who are inconvenient to move; Every community in the city has clinics, and every street has community hospitals. The model of combining family pension with community home pension can meet the basic medical needs of the elderly through community hospitals, and realize the combination of family pension and medical care.
2. Form a government led and multi-party financing model
According to the experience of foreign developed countries, most of the funds needed for pension services are from insurance, government financial allocation, and a few are paid by individuals, and some social assistance and welfare organizations will also provide social services for pension and medical care. However, the development of China's pension service industry is relatively slow. In the face of the high amount of funds needed for pension and medical care, first of all, we need to increase government financial investment; Secondly, we need to mobilize the whole society to join in the elderly care service industry. The government needs to formulate relevant policies or take certain measures to encourage social capital to participate in the government construction or the independent construction of the "combination of medical and nursing" elderly care institutions. Finally, we need to encourage social welfare and social assistance organizations