Research On The Government Responsibility Of Community Home Care Services In Long-term Care Insurance

With the continuous weakening of the family 's elderly care function in our country,the social needs of long-term care,especially long-term care for the elderly,are becoming more and more vigorous.The “Guiding Opinions on Piloting Long-term Care Insurance System” was promulgated,and it was decided to conduct a pilot program of long-term care insurance in 15 cities nationwide.Among them,Shanghai,as a pilot city,started a long-term insurance pilot on January 1,2017,and it mainly targets the elderly population who are 60 years old and above to participate in Shanghai occupational insurance and residence insurance.In the past three years,Putuo District was the first batch of pilot administrative districts in Shanghai.From the initial working mechanism construction to the adjustment and improvement of the working mechanism in the second year,to the basic establishment of the working mechanism in the third year,the grassroots government has made active explorations and beneficial attempts.Accumulated rich experience and encountered many problems.Looking at global social security,governments all assume varying degrees of responsibility,and this responsibility is constantly changing as the needs of security change.Long-term care insurance,as a new social security system in China entering the new era,the most outstanding performance is the active guidance and vigorous promotion of the government.Therefore,it is not only of theoretical significance,but also of great practical value to study the government's responsibility positioning,role and specific status in the process of building a long-term care insurance system in China.Based on the review of relevant domestic and foreign literature,this article takes public choice theory,public product theory,and responsible government theory as the theoretical basis,and demonstrates that it is necessary to play a role when the long-term care needs of normal households cannot be maintained without social support.The positive role of the government assumes four basic responsibilities: system design,financial supply,organization and implementation,and supervision and management.The "Shanghai Pilot Measures for Long-term Care Insurance"(enacted in 2016 and revised in 2017)has identified three service forms: "Community Home Care","Elderly Care Institution Care" and "Inpatient Medical Care" This research is based on the practice of Putuo District,and selects the "community home care" service with the highest proportion of participants to discuss the role of government responsibilities and existing problems.Specifically,by investigating the actual feelings of insured persons and the subtle changes in health indicators,we can grasp which responsibilities of the government have achieved good results and which responsibilities deserve further strengthening and improvement."Community home care" in Putuo District can be further subdivided into "services provided by nursing stations" and "services provided by community aged care service institutions" from the perspective of service supply.The former's competent authority is the Health and Family Planning Commission(after the institutional reform in 2019,it was renamed the Weijian Commission),and the latter's competent authority is the Civil Affairs Bureau.In order to compare the different impacts of different authorities' responsibility positioning on the results of nursing care,this article selects samples from nursing stations and community aged care service institutions to compare the services they provide,the physical and mental changes of the elderly after using the service,and the recognition of long-term care insurance.Knowledge,opinions and suggestions.It is found that there is a big difference between the services provided by nursing stations and community pension service agencies.The old people and their families' knowledge of long-term care insurance reveals that the actual effect of policy publicity is poor.The demand for long-term care services of the old people and their families is The actual service supply is not well matched.In response to the above problems,this article further combines the current government responsibility positioning,analyzes the main causes of the problem,and proposes countermeasures and suggestions from the aspects of improving government responsibility,and provides references for the development of the next stage of long-term care insurance system.