Supply And Demand Of Long-term Care Services For The Elderly In China

China’s aging population gradually shows the characteristics of rapid development,a large population base,and significant regional differences,and the additional effect of family planning and other policies to control population growth leads to the serious imbalance of China’s population structure.At the same time,the problem of old-age security is worsening,which mainly reflects the mismatch between the supply of resources for long-term care services and the demand for old-age care.Although China has made a series of efforts in the formulation and improvement of old-age policies and the development and optimization of the old-age industry in order to actively respond to the aging population,remarkable results have been achieved.However,as the number and life expectancy of the elderly population is increasing,the demand for care services and facilities for the aged is also on the rise.At the same time,the development trend of the family with fewer children and core,and the continuous decline of human resource supply in family care,lead to the increasing contradiction between the supply side and the demand side of endowment resources.Against this background,this paper,based on the perspective of supply and demand,selects the elderly as the research object and discusses the balance between supply and demand of long-term care services for the elderly from three aspects: the demand side of long-term care services,namely the elderly group,and the supply side of long-term care services,namely family care,community care,and institutional care.Therefore,this study follows the following logical paradigm:(Ⅰ)Based on the theory of public services and public goods and the theory of welfare pluralism,this paper divides the supply forms of long-term care services into family care,community care,and institutional care.(i)From the overall perspective,the principal component analysis method is first used to construct the evaluation system of long-term care service supply ability from the three supply subjects of family,community and institution,to analyze whether the distribution of long-term care service resources between regions is balanced and effective.(ii)The evaluation step by step,this paper first to the CLASS of database under the long-term care services for the elderly home care,community care and institutional care three services of supply and demand information mining,can comprehensively grasp and evaluation of supply and demand of the elderly in long-term care services in our country,make up the domestic supply and demand of perspectives about long-term care services overall evaluation of the blank.(Ⅱ)The logical framework of empirical analysis in this paper is a progressive and in-depth relationship.Under the effective demand theory,namely the theory that demand determines supply,it is determined that the supply of long-term care services for the elderly should be based on the demand of the elderly group.Therefore,the analysis of this paper focuses on the demand for long-term care services for the elderly.In addition,the Andersen’s behavioral model is adopted to integrate the three long-term care service modes of family care,community care,and institutional care into an empirical analysis framework,which is also the biggest innovation of this paper.In this paper,Andersen’s behavioral model is widely used in the field of health services.At the same time combined with the characteristics of long-term care service selection behavior to make a reasonable transformation.Among them,the long-term care service selection behavior(individual behavior)based on the Framework of the Andersen’s behavioral model is the result of the comprehensive influence of environmental characteristics,individual characteristics,and the endowment effect.Its theoretical model is conducive to objectively evaluate the effectiveness of the matching between supply and demand of long-term care services for the elderly in China,and also to some extent enriches the shortage of domestic research in this field.(i)In family care,the Andersen’s behavioral model is adopted to focus on the analysis of individual behavior i.e.willingness choice of long-term care mode.(ii)In community care,Andersen’s behavioral model is adopted to focus on the analysis of individual behavior 2,namely,long-term care service utilization behavior,and explore the relevant factors influencing the subjective demand of community care service for the elderly from the perspective of supply and demand,namely,supply level and objective need.(iii)In institutional care,Andersen’s behavioral model is adopted and combined with the above individual behaviors(Behavior 1: willingness choice of long-term care mode and Behavior 2: long-term care service utilization behavior)to further analyze the impact on the elderly’s care effect,namely life satisfaction.The analysis logic is helpful to relate the demand behavior and behavior result of the longterm care service for the elderly and to put forward the countermeasures and suggestions to promote the matching of the supply and demand of the long-term care service for the elderly and the sustainable development.Based on the above research,this paper draws the following conclusions:Firstly,the overall evaluation of long-term care service supply capacity:This part adopts the 2018 China statistical yearbook and China civil affairs statistics yearbook,on the basis of family care,community care and institutional care three service mode of the responsibility main body,select the ability to reflect the longterm care service regions and supply of 34 indicators,mainly using descriptive statistical analysis method and principal component analysis,which supplies ability carries on the concrete analysis to it.The findings are as follows :(I)the proportion of the elderly population in most provinces(municipalities and autonomous regions)in China has reached or approached the standard of population aging,and the comprehensive supply capacity of long-term care services in most provinces(municipalities and autonomous regions)has not yet met the overall needs of the elderly.(II)At the same time,the eastern region has the most dominant long-term care service supply capacity,while the western region has the most obvious supply disadvantage.The distribution of endowment resources among regions is also extremely uneven.(III)The above results indicate that provinces with strong regional economic strength have a relatively strong comprehensive supply capacity of long-term care services.Therefore,more attention should be paid to the skewed pre-allocation of elderly care resources in western and central regions to meet the increasingly severe long-term care service demands of the elderly in economically underdeveloped regions.Secondly,analysis of supply and demand for home care services:(Ⅰ)From the perspective of demand,influenced by traditional concepts such as Confucianism and filial piety culture,90% of the elderly in China choose their own family or their children’s family to provide for the aged,and the elderly in rural areas are more willing to choose family members to provide for the aged.To further in-depth analysis of various factors on the way of the elderly in long-term care service demand,this part adopts the 2014 CLASS survey data,at the same time based on Andersen’s behavioral model as the analytical framework,multinomial Logit regression model is established,the quantitative analysis of the tendency,enabling factors,demand factors on the decision-making behavior of the elderly home care services option,and compare the different effect of all kinds of factors.The more children the elderly have,the stronger their willingness to choose family care mode in the future.Meanwhile,the more sons they have,the stronger their tendency to choose family care mode in the future.(Ⅱ)From the perspective of supply,no matter in urban or rural areas,family members are still the internal suppliers of family care services,and they are also the primary tendency for the elderly to choose to provide care services.The role of government,community,and social organizations as the external providers of family pension services is not obvious.However,with the continuous reduction of family size,the increasing number of ’empty nest’ elderly,the prominent contradiction between their own work,raising children and taking care of the elderly,and other factors that lead to the weakening of family care function,the family care function will constantly spill over into the social care service system.With the continuous progress of economy and society and the continuous improvement of people’s living standards,the disabled elderly have higher and higher requirements on the quality of life,and their demands for long-term care services are gradually diversified and personalized.At the same time,the co-development of aging and the disablement of the elderly makes the burden of supporting the children of young adults continue to increase.Thirdly,the analysis of supply and demand of community care services:(Ⅰ)From the demand side,our country the elderly for community care services rendered ’high demand,low utilization’,one of the highest weighted demand according to the results for ’accompanied by a doctor and other health care services’,followed by ’the elderly service hotline’ and other spiritual solace class service,the last is a life to take care of such services.At present,the imbalance between supply and demand for community care services is still severe.Under nine services of life care,medical care,and spiritual consolation,the proportion of the elderly with corresponding demand but not provided is almost over 30%.The imbalance between supply and demand for spiritual consolation services is the highest,followed by medical care and life care services.Using 2014 CLASS survey data and Andersen’s behavioral model as the analysis framework,this paper specifically discusses whether the elderly’s subjective needs for community care services are generated based on their own objective needs or derived from the existing supply orientation.The quantitative influence of these factors on the demand for community care services for the elderly was explored from the perspectives of propensity factor,enablement factor and demand factor.(i)Among the predisposition factors,the older the elderly,the stronger the subjective needs of community care services.The elderly with spouses have lower subjective needs for community care services than the elderly without spouses.At the same time,the elderly in urban areas have a more significant demand for community care services than the elderly in rural areas.(ii)Among the enabling factors,the supply level of community care services is mainly investigated,and the supply level of existing community care services has a significant positive impact on the subjective demand of the elderly.(iii)Among the demand factors,the influence of the objective needs of the elderly on the community care service was specifically analyzed.Among them,the elderly with good self-rated health status had significantly lower subjective needs for community care service than the elderly with average or poor health.The higher the income,the stronger the subjective needs of the elderly for community care services are.(Ⅱ)From the perspective of supply,among the current types of community care services,the highest level of supply is life care services,followed by spiritual consolation and medical care services.On the other side,life care services are less difficult to supply,so the provision of this service in the community is relatively sufficient.However,the model of community care service in China started late,and the utilization rate of beds for the aged has been fluctuating at a low level,indicating that the development of its service usage lags far behind the investment and expansion of community pension service institutions and facilities.Moreover,in the process of development,community care service is faced with the limitations of weak hardware and software environment support base,serious structural imbalance between the quantity and quality of nursing service personnel,and poor social resource integration ability,which makes the supply of community care service seriously insufficient.Finally,the analysis of supply and demand for institutional care services:(Ⅰ)From the perspective of demand,institutional care,as an important supplementary form of family care,is generally accepted by the public at a low level.Moreover,both the elderly themselves and their families have a serious subjective bias in choosing nursing homes.This part adopts the 2014 CLASS survey data and conducts an empirical analysis of the elderly’s effect on the last link of the elderly’s long-term care service supply and demand behavior under the construction of the Andersen’s behavioral model.(i)Among the tendency factors,the life satisfaction of the elderly living in urban areas is higher.Compared with urban areas,rural areas have been suffering from adverse impacts in economy,education and medical treatment for a long time.These adverse impacts accumulate over time,making the satisfaction of the elderly in rural areas in their old age significantly more negative than that in urban areas.(ii)Among the enabling factors,the elderly with more homeownership and higher incomes reported more positive life satisfaction.The elderly with higher educational background and more self-care ability in daily life is more positive in life satisfaction.The higher the degree of social network support is,the better the mental health will be.The external inner security will make the elderly better cope with the life changes and pressures brought by the old age.(iii)Among the demand factors,the willingness of institutional care services has a negative impact on the life satisfaction of the elderly,indicating that the elderly who choose institutional care services may have a lack of intergenerational support,and at the same time feel a relatively low sense of satisfaction and fulfillment.Therefore,the primary focus to effectively promote the process of active aging is still to improve the economic situation of the elderly,the basic material needs should be satisfied first,and then to solve the spiritual needs of the elderly and the realization of self-worth and other contradictions.(Ⅱ)From the perspective of supply,first of all,the current supply of endowment facilities and institutional beds far exceeds the industry demand,and the bed utilization rate of institutional endowment beds has been decreasing year by year since 2011,indicating that there are problems of resource waste and low effective utilization rate of endowment beds.At the same time,the mismatch between the professional quality and education level of nursing staff and job demands greatly restricts the professional and professional development of the nursing service industry,and the imbalance of the gender and age structure of nursing staff seriously restricts the improvement of nursing quality.Moreover,the results of institutional care service supply efficiency in various regions show that the average comprehensive efficiency of China’s endowment institutions is 0.944,and the average pure technical efficiency is 0.964,lower than the average scale efficiency of 0.979.Among them,the provinces whose comprehensive efficiency did not reach the best are mostly located in the central and western regions.Therefore,each corresponding region should attach importance to strengthening the investment of government departments for the aged,so as to promote the scale efficiency of institutional care service supply in the central and western regions and pay attention to the balanced development of the eastern and northeastern regions.