First, Japan's aging situation and its trend
The first characteristic of Japan's aging is its rapid development.
Although Japan's aging process started late, it developed rapidly. In 2000, it has basically surpassed other developed countries in Europe and America, and become the country with the fastest population aging development in the world. The international comparison of population aging speed is shown in the following table:
It took only 24 years for Japan's aging population to grow from 7% to 14%, and it took 40 ~ 100 years for European and American countries except China, where the aging speed is close to Japan. Japan's aging rate is two to five times that of these countries, and it currently ranks first in the world.
The second feature of Japan's aging is the decline in the proportion of elderly people living with their children.
According to the statistics of Japan's National Institute of Social Security and Population Research, in 1980, the proportion of elderly people living alone is 8.5%, the proportion of elderly couples living alone is 19.6%, the proportion of elderly families (the sum of the two) is 28%, and the proportion of families living with their children (including unmarried children and married children under 18) is as high as 69. But by 2004, the proportion of elderly families exceeded 50%, and the rate of cohabitation with children dropped to 46%. (See the table below) This shows that the traditional way of family members taking care of the elderly is changing.
The "social relationship capital" closely related to caring for the elderly also shows a weakening trend. The propaganda department of the Japanese Cabinet Office conducted public opinion surveys on social awareness in 1975 and 2004 respectively. In 1975, the proportion of "close contact with neighbors" was 53%, and in 2004 it became 22%. From the point of residence, rural areas account for 35%, small cities account for 23%, medium-sized cities account for 19%, and big cities account for 14%. It can be seen that the proportion of "close contact with neighbors" has been declining in the past 20 years, and this downward trend is most obvious in cities, especially big cities.
Moreover, in terms of family and social security, the situation in rural areas and cities is different. In rural areas, due to the continuous outflow of population to cities and the influence of declining birthrate, the aging process has accelerated, and many villages are difficult to maintain. At the same time, coupled with the lack of social medical care and welfare in rural areas, the living conditions of the elderly are extremely difficult. In cities, families whose children are office workers, the elderly are usually alone at home during the day, becoming "empty nesters", unable to obtain intensive community services and their living conditions are not optimistic.
With the increase of the absolute number of elderly people, medical care and health care benefits become more and more important. At the same time, enriching the spiritual life of the elderly and protecting their physical and mental health can not be ignored. How to live after retirement? Is there the possibility of "social participation"? This is also a problem that has been discussed in the process of aging in Japan.
Second, the development process of Japan's welfare security system for the elderly
The establishment and development of Japan's social security system has gone through three stages, and the welfare security measures for aging are mainly formed and developed in the second and third stages. The following are introduced in chronological order.
(A) the basic preparation period (post-war to the mid-1960s)
After the war, the average life expectancy of Japanese people has increased year by year, and the number of elderly people who need care has increased rapidly. However, the expansion of the proportion of employed women and the birth of small families have increased the number of elderly people living alone, and the ability of family-based nursing has declined, resulting in some nursing problems such as suicide and elder abuse. Therefore, during this period, the Japanese government made great efforts to solve the post-war problems, implemented welfare policies and established a security system by making plans and laws. The Welfare Law 6, known as the Basic Welfare Law, was promulgated at this time. [Including Law on Life Protection (1946), Law on Welfare for the Elderly (1963), Law on Welfare for Mothers and Widows (1964), Law on Welfare for the Physically Disabled (1964) and Law on Welfare for the Mentally Weak (1964). After the promulgation of the Welfare Law for the Elderly, the elderly became independent for the first time.
One of the objects of welfare protection.
The first stage of welfare is mainly implemented as administrative actions such as "measures", and the welfare object lacks subjectivity and has no right to decide and choose service items. In addition to the public welfare facilities and services provided by the state, the business of folk welfare is mainly entrusted to social welfare legal persons. Social welfare legal persons obtain operating funds from the state and bear direct responsibility to the government, and the scope of responsibility to the clients is not clear, so it is difficult for welfare undertakings to form a competitive will to improve service quality.
(b) The initial stage of social welfare (from the mid-1960s to the late 1980s)
In the second period, the laws formed in the first period continued to be used, and the purpose of social welfare changed from "saving poverty" to "preventing poverty", and some specific measures began to be applied in practice.
At present, Japan is in a period of rapid economic growth. On the one hand, people's living standards are constantly improving, on the other hand, social problems brought about by aging are gradually emerging. The concept of welfare and security for the elderly has begun to take shape, and some government agencies, such as administrative and social welfare departments, have also begun to cooperate with the private sector. For example, in order to solve the problem of insufficient welfare facilities for the elderly, a five-year plan to set up social welfare facilities in 197 1 was implemented. 1976, Tokyo began to provide home-based care for the elderly who have been ill in bed all the year round, and the Ministry of Health and Welfare extended this service to the whole country in 1978. 1980, Kyoto established the "Home for Alzheimer's Patients", which has branches in 4/kloc-0 prefectures and counties all over the country.
65438-0986 The state amended the law on health care for the elderly and set up "health care facilities for the elderly" between hospitals and families. Those elderly people who have completed treatment and need to recover their physical functions can take advantage of the day service of community health care facilities for the elderly and receive regular training.
In order to promote the training of professionals engaged in home care services for the elderly, the Japanese government promulgated the Law on Social Welfare and Elderly Nurses 65438-0987.
However, due to the rapid increase of the elderly population and the deterioration of economic conditions such as the oil crisis during this period, maintaining the welfare policy completely implemented by the state encountered financial difficulties. Therefore, in the third period, the policy of expanding welfare was revised, and the reform of welfare infrastructure (such as the change from facility service to family service) was carried out simultaneously with the financial reform.
Social welfare practice period (from1early 1990s to present)
At this stage, the infrastructure established in the first two periods has been greatly reformed, and the concept of "local welfare" has begun to take shape in the field of elderly welfare.
The purpose of welfare has changed from "preventing poverty" to improving the quality of life. The welfare model has expanded from simple money distribution to spiritual care. The welfare target has expanded from poor and neglected specific groups to all elderly people and their families. Service providers have expanded from the state to private individuals and institutions, and the welfare objects have finally gained the right to choose and decide the services they enjoy.
Corresponding to these changes, the Japanese government has issued a series of filing plans, such as 1989 10 strategy to promote the health care and welfare of the elderly (golden plan), 10 new10 plan to promote the health care and welfare of the elderly (new golden plan) and 1999. The Social Welfare Law not only changed the name of the previous Social Welfare Law, but also revised the purpose and concept of social welfare. The Social Welfare Law stipulates that the purpose of social welfare is to promote local welfare and give necessary support to individuals' daily life. Residents who enjoy social welfare should have the opportunity to participate in social, economic, cultural and other social exchanges; The formulation of welfare plans should reflect the opinions of residents, social welfare undertakings and interested parties.
1997 formulated and implemented in 2000, the "nursing insurance system" combines the welfare system and medical care system of the elderly into one, and expands the coverage from specific groups to all the elderly. The life help you can get by joining insurance includes: nursing insurance facilities and services for the insured to stay in various nursing facilities, as well as more and more attention to home care, day care, short-term care and other home services. After the implementation of the nursing insurance system, for-profit legal persons and non-profit legal persons have also joined the elderly welfare industry and become the main body of welfare undertakings together with the administrative department. The services of for-profit legal persons are mainly limited to the scope stipulated in the Nursing Insurance Law, or areas where certain benefits can be obtained, as well as spiritual support for the elderly. Non-profit organizations and volunteers have made great contributions. As mentioned above, the relationship between the insured and the welfare institution was unequal in the past. After the implementation of this system, the elderly can freely choose nursing providers and nursing projects. More importantly, the nursing insurance system enables local governments to change the nursing insurance plan according to the specific changes. In April, 2006, the Ministry of Health and Welfare revised the nursing insurance, introduced a new nursing medical system which attached importance to prevention and community service, and thoroughly implemented the concept of "local welfare".
Third, the Japanese welfare measures to deal with aging and its enlightenment to China.
As a post-capitalist country, Japan's experience in promoting economic development and improving social security is worth learning, especially in the field of social welfare for the elderly.
In the past, the Japanese government mainly adopted a state-led security policy for certain elderly people, and it was mainly the responsibility of family members, especially women, to take care of most elderly people. However, with the progress of aging, the population in need of care has increased sharply, the financial burden of the country has increased, the traditional social concept has gradually weakened, and it is gradually impossible to meet the needs only by the strength of the family. Therefore, the "nursing insurance system" is introduced, and the welfare of the elderly follows the universal laws of major developed countries in the world and develops in the direction of marketization and socialization. Japan is unique in that it gives full play to the role of family, market and citizen organizations (volunteers, non-profit organizations and traditional regional organizations) outside the country, and makes flexible use of welfare resources on the basis of the public welfare system. Japan's experience can be used for reference by many Asian countries with similar cultural backgrounds.
As the most populous country in the world, China's huge population base makes the future aging scale and speed no less than that of Japan. According to the results of the fifth population census, in June 2000, the population over 65 in China reached 88 1 1000, accounting for more than 7% of the total population, and also entered the ranks of aging countries. Compared with other countries, China's aging has the characteristics of large scale, rapid development, large regional differences, unbalanced population aging and economic development, weakened family support ability, and insufficient institutional preparation to deal with aging. Facing the enormous pressure of aging, China is similar to other countries in social security for the elderly. The first is to pay full attention to the law, which clearly stipulates the rights and social participation of the elderly in the basic national laws such as the Constitution and the Law of the People's Republic of China on the Protection of the Rights and Interests of the Elderly (promulgated by 1996). Under the current system, the main implementers of social security for the elderly are government agencies such as civil affairs departments, and deliberation and coordination institutions such as China National Working Committee on Ageing (1995 changed to China Association on Ageing) and National Working Committee on Ageing (1999 was established). Because there is no mature welfare insurance system and annuity system for the elderly like Japan, and the influence of the dual structure of urban and rural areas in China, the welfare security for the elderly is basically oriented to specific groups. For example, the old-age insurance system mainly covers employees of urban enterprises and institutions and flexible employees, as well as a small number of insured persons in rural areas, while medical insurance currently only covers employees of urban enterprises and institutions and flexible employees. The elderly care project is similar to other countries in the world, including facility services and family services. Urban facilities and services for the elderly are relatively sound, including welfare homes, nursing homes, apartments and service centers for the elderly. At present, nursing homes in rural areas can only accommodate some elderly people who are unable to fulfill their maintenance obligations, have no ability to work and have no source of income. As for home service, the community service represented by the "National Community Elderly Welfare Service Starlight Plan" which was implemented on 200 1 has gradually taken shape, but it is not yet mature.
Although the degree of aging in China is not as serious as that in Japan, the absolute number of elderly people ranks first in the world, so it is necessary to plan ahead for the welfare of the elderly. We can learn from Japanese and other aging countries, and explore and improve welfare policies that are in line with China's national conditions and can achieve practical results.
(A) market-oriented nursing services, diversified service subjects.
Similar to Japan, in terms of welfare for the elderly, in China, in addition to the security system established by the state according to the financial situation, the traditional customs of caring for the elderly such as family members and blood ties are still continuing. Because kinship can not only satisfy the physical care of the elderly, but also satisfy the psychological comfort of the elderly, which can not be achieved by other nursing methods, so the role of the family continues to dominate. However, with the miniaturization of families, the increase of only-child families, the widespread employment of women, the extension of the life span of the elderly and the increase in the proportion of nursing, the government's guarantee ability and the family's nursing ability can not meet the actual needs gradually. Therefore, giving full play to the flexibility of the market and relying on social forces to develop diversified welfare resources such as volunteers and non-profit organizations are effective ways to solve the aging problem.
Give full play to the role of non-governmental organizations, establish an effective communication bridge between residents and administrative organs, reflect the needs of the elderly to relevant departments in a timely manner, and then adjust the policies and services being implemented in a timely manner according to needs.
(2) Strengthen home-based care services and establish a convenient, fair and efficient rescue system.
At present, in view of China's current level of economic development, the government's financial investment is limited, and the plan of establishing large-scale medical and health care facilities for the elderly and guiding the elderly to service facilities to realize medical care and nursing cannot be realized in a short time, so it is more suitable to give priority to decentralized home-based care for the elderly. The civil affairs department can set up a home visit service team mainly composed of medical institutions and volunteers, which can regularly impart and coach health care knowledge not only to the elderly and disabled elderly, but also to all retired elderly people, attach importance to the construction of prevention system, and separate the elderly who only need life care from the medical system, so that the medical insurance system can play its due role and save valuable medical resources. At the same time, the state has invested a certain amount of financial resources to establish special nursing facilities, and the elderly who are not suitable for home care are concentrated in the facilities, and the way to enjoy nursing is determined by specialized institutions.
(3) Improve the legal system and form a welfare security service network for the elderly.
The Welfare Law for the Elderly enacted in Japan 1963 includes not only facilities welfare measures and home welfare measures for the elderly, but also the survival value of the elderly, which has become the basic basis for the establishment of the welfare system for the elderly. At the same time, laws related to health care, medical treatment, housing, education and labor have been gradually promulgated, which has provided a guarantee for Japan to calmly deal with the social problems brought about by aging. Although China has enacted a large number of laws and regulations on the welfare of the elderly, the basic law of the social security system for the elderly, the Welfare Law for the Elderly, has not yet taken shape. Therefore, in today's increasingly serious aging problem, China urgently needs to improve the legal system suitable for social security for the elderly.
Encourage social funds to set up pension institutions through preferential policies, and the civil affairs department will formulate special regulations for management. At the same time, the employees of community welfare centers for the elderly are strictly trained to improve the service quality. Finally, the most fundamental thing is to reform the old-age insurance and medical insurance system in a planned way, expand the scope of participation, strengthen personal awareness of old-age care through the establishment of personal account system, and establish a multi-level financing model to strive to achieve the sustainable development of welfare security services for the elderly.
The above has introduced some enlightenment of Japanese welfare security measures for the elderly to China. It should also be emphasized that Japanese aging is a natural product of social and economic development with rapid post-war economic development, while China's aging problem is accelerated when the economy is not very developed. Therefore, when considering the social security of the elderly population in China, we need to take into account the particularity of China's "getting old before getting rich" compared with other countries. It is also very important to emphasize the sustainability of economic development, build a labor market system suitable for China's national conditions, and establish relevant supporting reforms while paying attention to the welfare security of the elderly.
According to "Research Report on Prediction of Population Aging Development Trend in China", the middle of 20th century will be the most severe period of population aging in China. Before the peak of aging comes, we must make full preparations and take strong countermeasures to improve the social security system for the elderly and ensure the healthy and stable development of society.