Research On Government Responsibility Of Home-based Care Service In China

The government responsibility for home-based elderly care services is the most important part of academic research on home-based care,and it is also a key link in social practice for the government to ensure the realization of the needs of elderly care services.At this stage,the aging process of China’s population has accelerated significantly,and today’s society is also facing severe elderly care issues.Although the legislative documents on home-based elderly care services issued by the central and local governments have relatively detailed regulations on government responsibilities,there are also problems such as insufficient theoretical support and unsatisfactory operation effects.Changes in the elderly care service model lead to changes in government responsibilities.At this stage,there are many difficulties in the operation of the family-based and institutional-based elderly care service models,and the home-based elderly care service model is gradually taking the leading role,all of which have put forward new requirements for the government to assume responsibility.Affected by factors such as the miniaturization of family size,the core of family structure,and the increase in the proportion of empty-nest families,the production function of the family has weakened and the number of children who bear the responsibility of supporting them has been decreasing.The problems existing in the institutional-based elderly care service model,such as single service content,small scope of protection objects,and structural shortage of elderly care institutions,also make it difficult for this model to effectively meet the needs of the elderly for personalized and diversified elderly care services.The home-based care service model integrates the advantages of family care and institutional care services,emphasizing that the elderly live in a familiar family environment,and the government,social organizations,market enterprises,and families provide formal or informal diversified care services.Although the joint participation of multiple subjects is emphasized in home-based care services,there are differences in the responsibilities undertaken by different subjects.It is necessary to establish a coordinated development situation of multiple subjects on the basis of clarifying the responsibilities of each participating subject.Among which the government responsibility plays a leading role in the home-based care service responsibility system.The government’s responsibility also has an impact on the responsibility of other participants.The government’s active responsibility can create favorable conditions for the implementation of the responsibilities of other entities,and the implementation of other entities’ responsibilities also requires all-round support from the government.The responsibilities of the government for home-based elderly care services involve a wide range of areas,including the efficient and convenient meeting of the hierarchical and personalized needs of home care services for the elderly by performing a series of duties such as policy formulation,service supply,financial support,supervision and management based on legal,contractual or moral provisions and agreements.And when they fail to perform their duties,they will be punished accordingly.The government responsibility for home-based care services is influenced by different theories,including social contract theory,welfare pluralism theory,responsible government theory,and meta-governance theory.The different development stages of home-based care services need to be guided by specific theories.The meta-governance theory has not replaced or completely surpassed other theories.In essence,it is the development and improvement of other theories.There is a high degree of compatibility between them,so at this stage,meta-governance should be used as the main theoretical basis for guiding home care services.The government responsibility for home-based care services has a solid legal basis and a specific value orientation.The relevant provisions of the Constitution and the law on the government’s responsibility for the elderly constitute the legal source of the government’s responsibility for home-based elderly care services.The government responsibility for home-based elderly care services itself includes three parts: the subject of responsibility,the object of responsibility,and the content of responsibility.The main body of responsibility mainly refers to government departments and their staff,organizations authorized or entrusted by the government and their staff.Systematic institutional arrangement is an important guarantee for the effective implementation of government responsibility for home-based elderly care services.The key lies in building an efficient government responsibility implementation system,accountability system and relief system.The responsibility of the government for home-based elderly care service is to achieve a variety of goals.It not only hopes that the rights of the elderly can be fully guaranteed,but also hopes to promote the modernization of the government’s governance capacity and governance system in elderly care services.The government’s home-based care service governance system mainly focuses on government governance.The specific elements included,and the governance capacity of the government’s home-based elderly care service focuses on the specific operation process,operation effect and function of these elements.In the pursuit of equality and fair value,many basic principles must be observed,including the principle of equalization of basic public services,the principle of reasonable differential treatment,and the principle of taking into account fairness and efficiency.The necessity for the government to take responsibility in home-based elderly care services is to resolve the risks faced in this field through a reasonable responsibility sharing mechanism.The problems of supply and demand mismatch,structural imbalance between supply and demand,single service content and low degree of specialization in the process of home-based elderly care services are also the main risks faced by China in the process of addressing the problem of population aging.Considering that it is difficult for families and society to effectively deal with the risks in the field of home-based care services through their own efforts,countries with more mature home-based care services outside the territory have adopted more measures to absorb the government,the market,families and individuals into the operation of home-based care services.The systemic risks in home-based elderly care services are resolved through the shared responsibility mechanism of multiple subjects.In this process,Japan and Singapore supported the development of home-based care services through the nursing insurance system and the central provident fund system respectively,while Sweden and Australia systematically regulate the responsibilities of the government by establishing a complete home-based care service system and home-based care legislation system.The United States,the United Kingdom and Canada support the development of home-based elderly care services through the medical insurance system.The government departments of major countries outside the region also attach great importance to and actively implement their own responsibilities in home-based elderly care services.The home-based care service model can actually be divided into three types: the residual welfare model,the system redistribution model,and the industrial achievement performance model.The corresponding types of government responsibility can be divided into the mode of the government taking the bottom line guarantee responsibility,the mode of the government taking the performance responsibility,and the mode of the government taking the guarantee responsibility.Countries that adopt the residual welfare model generally believe that the most effective way to meet the needs of home-based elderly care services is the market and the family.Only when the two cannot play a role or there is a supply failure phenomenon,the government will participate in the field of service supply as the final responsible subject.And it is mainly responsible for guaranteeing the bottom line.Countries that adopt an system redistribution model believe that the government should generally assume the responsibility for home-based care services,liberate individuals and families from heavy care work,and provide substantial support and subsidies to family members participating in care services,thereby ensuring that every elderly person who needs to be cared for at home can obtain high-quality elderly care services provided by the government.Countries that adopt the industrial achievement performance model believe that multiple subjects such as the government,society,and family should bear the responsibility to ensure the realization of the rights of the elderly at home,and the government plays the responsibility of ensuring the ultimate realization of home care tasks.By analyzing the main contents of China’s central home-based care service policy and local home-based care service regulations,as well as examining the implementation of government responsibility for home-based care services in China,the responsibility of the Chinese government in home-based care services can be classified as a bottom-up guarantee model.This model belongs to the disabled supplement model and takes specific elderly groups as the guarantee object,mainly to ensure the realization of the basic survival needs of these elderly people,but the government’s bottom-up guarantee model is not desirable at this stage.However,under the system redistribution model,the government undertakes to fulfill its responsibilities,which is also inconsistent with the actual situation of home-based elderly care services in China at this stage.For example,this model will bring greater pressure to the government’s financial expenditure.The concept of de-family emphasized by this model does not match the traditional concept of The old-age culture in China.During the operation of the government’s guarantee responsibility model,the relationship between the government and each participant is complicated,and the responsibilities are unclear.Therefore,in the future,China should build a more perfect government security responsibility model and learn from the advantages of different government responsibility models in foreign countries,such as effectively alleviating the government’s financial pressure,optimizing the supply mechanism of home care services,and improving the efficiency of home care service supply.The government should also Give full play to the regulatory role of incentive mechanisms and regulatory measures to improve the enthusiasm of diverse social entities to participate in home-based elderly care services,and provide corresponding support measures to other participants to enhance their ability to participate.Under this more perfect government security responsibility model,the responsibility for the care of the elderly at home is no longer solely undertaken by private sectors such as family and society,or entirely by the government and public departments,but by the construction of government security,The diversified responsibility-taking model of social participation can give full play to the synergistic effect of multiple participants,and then effectively share various risks that may exist in home-based elderly care services.Of course,this does not mean that the government’s responsibilities in home-based elderly care services are weakened or withdrawn.The government just withdraws from the field of direct supply of home-based elderly care services,and more efficient social organizations and market enterprises take on this responsibility.The function of the government has changed to supervise,motivate and ensure that the behavior of these private entities meets the expected results.The government will then assume heavier supervision and management responsibilities to ensure that the elderly home care service needs and elderly care rights can be better realized.In view of the shortcomings of the government’s responsibility for home-based elderly care services in my country and the mature experience of foreign countries,this thesis puts forward the following improvement suggestions: First,the government’s responsibility for home-based care services should always take ensuring the rights of the elderly and the full realization of their needs for home-based care services as the core goal.It is also necessary to classify the needs of elderly care services at different levels,and promote the realization of government responsibility stratification.Second,the realization of government responsibilities in home-based elderly care services must be based on the rule of law,an effective response to the government’s responsibility for home-based elderly care services in the Constitution and laws,and the introduction of special home-based elderly care services legislation to ensure better government responsibilities.Implementation should also achieve an orderly connection between legislation on home-based care services and laws such as social insurance and social assistance.Third,it is necessary to improve the system of government responsibility for home-based elderly care services.Optimize the government’s financial support responsibility system for home-based care services,and form a complete mechanism for raising funds for home-based care services.Implement the government’s nurturing responsibility system for each participant,and actively enhance the participation capacity of social organizations and market enterprises.A government-led supervision system shall be established,and a multi-level and all-round supervision model based on government guidance and social self-management shall be formed.Improve the government’s policy-making responsibility system and relief and guarantee responsibility system.Fourth,improve the implementation and accountability mechanism of government responsibilities for home-based care services,including establishing a comprehensive decision-making mechanism,cross-department coordination mechanism and accountability mechanism for coordinating the development of home-based care services and the implementation of government responsibilities.