(A) from the incremental start, cultivate the main body of the old-age service supply market.
Starting from the new market subject, the new supply subject of the aged care service is established or operated by the market subject in principle. The government has stepped out of the field of old-age care services and no longer intervened in specific operations. Whatever society can do well, it should be entrusted to social forces as much as possible.
First, clarify property rights and encourage private institutions to develop in the direction of "specialization, precision and Excellence". From the legal system, private pension service institutions are guaranteed to operate independently, conduct independent accounting, be responsible for their own profits and losses, and bear their own risks. In particular, according to the current management methods of private non-enterprise pension institutions, investors do not enjoy the ownership of the institutions. It is suggested that relevant laws and regulations should be revised to clearly define the ownership of private pension institutions, and the invested property should be owned by the organizers within a reasonable range. Encourage and support private institutions to provide special services, create a number of new service brands with strong technical ability, good service quality and high social praise, and change people's distrust of private institutions. The second is to open up channels for the flow of human resources. When employees of old-age care services move in different old-age care institutions, the interests closely related to employees, such as job title evaluation, seniority accumulation and research funds, are not affected, and the market guides the flow of high-quality resources.
(B) the supply of basic old-age services to the government to buy old-age services as a breakthrough to reduce market intervention.
The main body responsible for the supply of basic old-age services is the government, but this does not mean that the government should also act as a producer. The government can leverage the market by purchasing pension services, reduce direct intervention in market entities, and create a more level playing field for various market entities.
First, the government's purchase of old-age care services will be included in the government procurement system as soon as possible. In principle, procurement procedures are organized and implemented according to departmental budgets and government procurement procedures, and are planned and used in a unified way. Study and formulate the guiding catalogue for the government to purchase old-age services from social forces, clarify the types, nature and contents of government-purchased services, and make dynamic adjustments in time. The second is to establish an open and transparent purchase process for aged care services. Standardize and publicize the operation processes of service project application, evaluation, project establishment, bidding, contract signing, implementation, adjustment, closing, evaluation and feedback, ensure fair competition of all contractors, and introduce independent supervision institutions to supervise all aspects of entrusted cooperation. The third is to establish a strict supervision and evaluation system. On the basis of perfecting the mechanism and quantitative indicators, adhere to the result-oriented and customer-oriented, take the actual effect and customer satisfaction as the evaluation criteria, actively introduce an independent third-party professional evaluation mechanism, establish an all-round and three-dimensional supervision and evaluation mechanism composed of the government, the public and the third party, and establish a government purchase service withdrawal mechanism to form a dynamic adjustment mechanism for survival of the fittest.
(three) actively promote the separation of management and administration of public institutions and the separation of political affairs.
According to the data of the Ministry of Civil Affairs, by the end of 20 13, there were 42,575 old-age care institutions with 4.937 million beds, of which 72% were public old-age care institutions. The existing public pension service institutions should strive to promote the separation of management and administration, politics and affairs, become real market players, and achieve fair and effective competition among various institutions, which is a key step to play a decisive role in the market allocation of resources in the field of pension services.
The first is to promote the establishment of stock public pension service institutions to become independent legal persons in the full sense. Establish and improve the corporate governance structure of public institutions, and independently bear all civil and criminal legal responsibilities for all their activities. There are only differences in scale, service field and service level between the old-age service institutions, but there is no difference in administrative level. Government agencies delegate decision-making power and management power to pension institutions and gradually withdraw from micro-management of such institutions. Encourage and support qualified institutions to gradually transform into enterprises and participate in market competition. The second is to establish a cooperative relationship between the government and social capital in various forms such as PPP model. Public-run private enterprises, entrusted management, private assistance and PPP (public-private partnership model) are all effective forms to build the cooperative relationship between the government and social capital in the field of aged care services, which is especially conducive to changing the existing pattern of public institutions. Among them, PPP is the next model that China can focus on.
(D) Change the current management mode of private pension institutions, and ease the plight of private subjects.
In the process of investigation in many places, private pension institutions generally said that the current classified management system of for-profit and non-profit institutions directly caused operational difficulties. The vast majority of institutions are registered as private non-enterprises managed by the civil affairs department for the consideration of preferential taxes and fees and land use. But this means that they have lost their pricing power and the right to profit from capital. On the one hand, high taxes and high rents, on the other hand, it violates the nature of capital seeking profits, and private institutions are in a dilemma. Some places, such as Zhejiang, have explored outside the current policy, allowing the existence of reasonable profits.
Profit-making is the basic demand of social capital investment, and the profit-making of social capital cannot be denied because of the positive externality of old-age care services. In the next step, except for a few purely charitable institutions managed by the civil affairs department, other pension service institutions, regardless of the composition of investors, are registered as social enterprises in the industrial and commercial departments, allowing independent pricing and reasonable profits; At the same time, enjoy policy support in land and taxation. Establish and improve the exit mechanism according to law, and social capital has the right to recover the part corresponding to its investment. Implement consistent market access and support policies for domestic and foreign investment.
By changing the management mode, this pattern is finally created: first, the public welfare institutions run by the government make up for the market failure and provide free basic old-age services to the public according to government pricing; Second, the society runs charitable organizations, follows the principle of non-profit, and strictly controls financial management and processes. Once profit-making behavior is discovered, hell to pay; Third, other types of subjects providing old-age services, regardless of the form of capital contribution, are enterprises with social welfare nature, enjoying tax relief, land concessions, financial security and other support policies.
Two, attach great importance to home and community pension services, according to the need to develop institutional pension.
Although the national level and some local documents clearly point out that home and community care services will be the focus of the construction of China's social care service system in the future, the nationwide home and community care service system is far from being established, which leads to the mismatch between demand and supply in reality. In 20 13, the vacancy rate of all kinds of old-age care institutions in China was about 25%, and it was hard to find a bed in big cities such as Beijing and Shanghai, which coexisted with the high-altitude bed rate in a large number of second-and third-tier cities. At present, the funds for home and community services mainly come from the government, and the main suppliers are various government-run institutions. The service content stays in the basic public service, far from forming a diversified and multi-level estimation pattern. Based on the risk of population aging and the actual needs of the elderly, it is imperative to promote home-based care and community-based care.
(1) The focus of policy support has shifted to encouraging social capital to develop home-based and community-based aged care services.
At present, most of the subsidies are only aimed at the construction of old-age care institutions, and few really focus on the supply of home and community old-age care services. In many places, the development of old-age service industry is equated with the construction of old-age institutions and beds, and the development of old-age service industry has been seriously deviated. Overall, both macro and micro levels, home and community pension funds are seriously inadequate. In the long run, we must rely on social forces and take the market as the guide to form multi-channel sources of funds and expand the coverage of home-based care services. The next step is to change the direction of policy support, respect the laws of the market, guide supply by demand, cancel the market scale assessment indicators set by the government, increase subsidies for home and community pension services, and guide service supply out of the myth of institutional pension service supply.
(2) Strengthen community construction and form effective community home-based support for the aged.
The role of community in the old-age service in China is far from being fully exerted, and there are many problems in policy support, capital investment, service content, resource integration and personnel arrangement. It is necessary to build a new community pension service system by increasing the government's financial investment in the community, improving the management system of community pension services, improving the quality of community pension personnel, strengthening the construction of community pension institutions, and establishing an evaluation system for the effect of community pension services. By improving community facilities for the aged, developing various community-centered services for the aged, giving full play to the functions of the elderly community, and providing various forms of life services for the elderly, such as venues for activities, cooking, food delivery, housekeeping, etc., most elderly people can enjoy high-quality services for the aged without leaving their homes and communities, thus solving a series of problems faced by the elderly at home.
Promote various forms of mutual support for the elderly in the community. There are a large number of healthy elderly people in China, and their participation will bring new vitality and vitality to the community pension service and become a new force in the community pension service. Community service for the aged is not only to provide physical and mental help for the elderly, but also to meet their needs of exerting their residual heat, to provide them with jobs within their power, and to let the capable elderly participate in community service.
(3) Building an information platform to improve the matching degree between supply and demand.
Matching supply and demand is an urgent need to improve the development of home and community pension services. In the early stage of the development of the aged care service market, the government can focus on building an information platform for aged care services and an intermediary platform for market supply and demand. The virtual nursing home in Tianjin is actually an information platform construction, which saves a lot of costs, and more importantly, meets the needs of many elderly people for home services, making the service supply forms more flexible and diverse. For the social subjects who want to enter the old-age service, it also saves the cost of finding consumers and gains greater potential market space.
Third, strengthen the demand management of aged care services and form a benign interaction between supply and demand.
From the experience of mature countries and the local practice in China, if the demand does not go up and the supply has no power, an effective market will not be formed. Generally speaking, the reality of getting old before getting rich determines that the elderly in China have insufficient ability to transform their effective demand for old-age services. It is necessary to strengthen demand-side management at the same time as supply-side management to enhance their effective demand capacity. At the same time, we should pay more attention to the demand survey of the elderly in order to better match demand and supply.
(A) to strengthen the ability to transform the effective needs of the elderly
The first is to strengthen demand-side subsidies. The government can provide "pension vouchers" to the elderly, and the elderly can choose their own institutions to provide services, which is conducive to improving the efficiency and quality of services and improving the level of old-age security and monetary income in healthy competition. At present, the pension fund for retirees in China mainly comes from basic pension insurance, and the overall average replacement rate is less than 50%. If the pensions of government agencies and institutions are excluded, the replacement rate will be even lower. The next step is to establish a multi-level old-age insurance system for the needs of old-age services, especially to encourage enterprises to establish an annuity system through tax policies. Encourage insurance companies to develop all kinds of nursing insurance by reducing or exempting business tax and profit income tax.
The second is to establish a social care insurance system. Establish a basic social endowment insurance system for all the elderly. The nursing insurance project can be established in the medical insurance system, and the nursing insurance fund can be formed through the balance of medical insurance, and the nursing insurance fund is earmarked. The elderly in middle-and high-income families can choose commercial nursing insurance according to their needs, while the low-income or poor elderly should establish a social nursing assistance system to protect their basic rights and interests. Nursing insurance items are operated and settled separately from other medical insurance items. Governments at all levels should form a capital investment mechanism for nursing insurance projects and assume the responsibility of financial backing.
(B) to promote service supply content and demand matching.
The first is to speed up meeting the nursing needs of the disabled and semi-disabled elderly. With the increasing number of empty nests, one-child generation, pure old families and aging, the demand for nursing services for the disabled and semi-disabled elderly will become more and more urgent. In the future, the disabled elderly population in China will increase greatly (see figure 1 for the growth trend). The increasing medical expenses and old-age service expenses of the disabled elderly will cause great waste of scarce medical and old-age service resources, bring great pressure to the state, local governments and elderly families, and then affect the sustainable development of economy and society. As the country with the largest number of disabled elderly people in the world, China faces greater pressure on nursing services than any other country in the world. Long-term care for the disabled elderly, especially the completely disabled elderly, is not only the urgent needs of the elderly individuals and families, but also a serious social problem to be solved urgently.