新的养老模式探讨

第九个链接：一个pdf文档, “新的养老模式探讨“

New modes of delivering elderly care in Sweden

Per Gunnar Edebalk

School of Social Work, Lund University

Presentation at Nordic day, Paris, July 1, 2008

新养老模式的探讨

皮特，戛纳

社会工作学院，Lund大学

Introduction

1.Elderly care has for many decades been an important municipal task in Sweden. The number of municipalities or local authorities is 290 and they have a high degree of autonomy. Local authorities set their own taxes and local income tax is the main source of revenue for municipalities and for elderly care. Consumer fees finance only 5% of the costs for elderly care.

介绍

1.老年人护理几十年来，一直是瑞典政府机构的一个重要任务。瑞典地方当局的数目是290，他们有高度的自治权。地方当局设置了自己的税收和地方所得税方式，这些收入是照顾老人的主要收入来源。消费税大概只有5%是用来作为老年人护理费用。

2. The critical juncture around 1990

Home help in Sweden started 1950 by voluntary organizations. Experienced housewives were recruited for this purpose and the successful outcome was threefold; the elderly were pleased, the demand for places in old people’s homes went down, and recruiting predominantly middle-aged housewives who were not normally at the disposal of the labour market turned out to be fairly easy.

2。在1990年左右的关键时刻

瑞典的家庭帮助组织开始于1950年，由志愿者组织。招募了有经验的家庭主妇，其效果非常显著，老年人都非常高兴，老人院的需求开始下降，但是在劳工市场招募中年家庭主妇不是一件容易的事情。

3. The purchaser-provider split

An important organisational change which was made possible after 1990 was the purchaser-provider split. Community care of the elderly in Sweden was characterised earlier by a monopoly of the local authorities regarding both the assessment of an elderly person’s need of care and the providing of care. The person who assessed the care an elderly person needed was usually also in charge of the personnel who provided the service.

3。购買者与提供者間的分开

一个重要的组织变革，在1990年后购買者与提供者間的分开。早期的时候瑞典老人的护理的负责是由单方面决定的，评估机构和护理机构是同一个单位。这样情况下的话很容易造成在老年人护理领域形成垄断。

4. Contracting out

At the beginning of the 1990s, the increasing needs of elderly care and the financial limitations of local authorities had given the local authorities strong incentives to adopt strategies for making care of the elderly more efficient. Contracting out of elderly care, which represented one such strategy, increased rapidly in the

early 1990s. Measured in terms of numbers of elderly persons involved, care provided by private contractors has been increasing relative to care provided publicly. Nevertheless, contracting out still constitutes only about 12 percent of elderly care in Sweden as a whole. About 40 percent of the municipalities in Sweden purchase more or less elderly care by contract. Even if private companies being allowed to provide care, local authorities retain their official responsibility in connection with the care that is given, assessing the elderly person´s needs and determining the fees to be paid. The private providers are normally commercial companies run for profit.

4。外包老年人护理

在20世纪90年代初，随着老年人护理需求的增加，以及财政预算的有限，地方政府制定了目战略标希望能够在老年人护理这方面提高效率和质量。外包老年人护理行为于是在90年代初显著增加。外包的情况大概是12%，大约40%的地方政府外包的行为。

5. Consumer choice

In approximately 35 of Sweden’s municipalities, a more radical change has been introduced in the form of consumer-choice models. Consumer-choice means that the user is free to choose a care provider other than the municipal one. The financing of a consumer-choice system does not differ from traditional elderly care. In essence, it is thus local taxes that are used and the local government still exercises its municipal authority and the responsibility for assessments of care needs.

5.自由的选择

在大约35个行政地区，自由选择老年人护理服务的模式已经被应用，自由选择取代了那种只能选择地方政府提供的老年人护理服务的模式。

6. Summary

System failures led to a critical juncture for Swedish elderly care around 1990. The national government support of home help services was replaced by a neutral attitude from the State, the municipalities were given increased freedom to organise elderly care locally and they took over the responsibility for home-based nursing. That is the path presently under development and along which the local authorities are trying to find means of increasing the efficiency within elderly care.

6总结

系统性的缺陷导致90年代成为瑞典老年人护理的一个转折点。家庭护理帮助，自由选择，以老年人自家为中心的护理模式等。。有助于提高了老人年护理的效率和质量。