Study On The Accessibility Of Home-based Care Services For Urban Seniors From The Perspective Of Welfare Pluralism

As the basic content of the social elderly service system,home-based elderly care services are the core and focus of the current state's support for the development of the elderly service industry.Since the implementation of the 13th Five-Year Plan,the coverage and protection level of the home-based care service system has been continuously upgraded.However,the system's ability to meet the needs of the target population is still low,and the overall needs of the urban elderly in multiple service items cannot be effectively met.This reflects the unsatisfactory degree of "accessibility" of home-based elderly care services,and the inability to provide potential service targets with adequate access to the service system.The inaccessibility of services is mainly related to the obstacles set by the local social service network to the population.Improving the accessibility of services is a supplier's responsibility,it is necessary to discuss the dilemma and causes of service accessibility from the perspective of service supply.However,Chinese domestic researchers currently have few theoretical interpretations and empirical studies on the accessibility of home-based elderly care services,lack theoretical guidance in answering questions such as what is the accessibility of home-based elderly care services in policy practice,how to measure the accessibility of home-based elderly care services,and how to determine the factors affecting service accessibility.The main purpose of this research is to supplement the domestic theoretical research in related fields,analyze the current status and causes of the accessibility of home-based elderly care services from the perspective of service supply,and provide a reference for improving the results of related policy implementation in practice.This research attempts to answer the question "How does the organizational structure affect the accessibility of home-based care services for urban seniors?".The research questions are specifically divided into four sub-questions,including "Who are the main providers of home-based care services for urban seniors,and what are their roles in service financing,delivery and regulation?" "What is the current status of the accessibility of home-based care services for urban seniors under the current supply model?" "How does the participation mode of supply subjects affect the accessibility of home-based care services for urban seniors?" "How to adjust the existing multi-subject supply structure to improve the accessibility of services?".The research strategy is to borrow the analysis framework of the Welfare Pluralism Theory to describe and analyze the organization and behavior of multiple supply entities in the supply of home-based elderly care services,as well as the current status and problems of service accessibility under the existing supply model;to explore the structural causes of problems affecting service accessibility from the organizational structure of service supply,so as to provide references for improving the structure,process and results of relevant policy implementation in practice.This study takes Jinan City,Shandong Province in China as an empirical research case,mainly collects data through in-depth interviews,and uses the three-level coding data analysis method of qualitative research to answer the research questions.The main findings of this research are as follows:(1)The main supply subjects of home-based elderly care services includes government departments,market organizations and non-profit organizations,among which government departments are responsible for service financing and regulation,and social entities mainly participate in service delivery.(2)The overall accessibility of home care services is poor.From the perspective of the four evaluation dimensions of Availability,Spatial Accessibility,Accommodation and Acceptability,this problem is prominent in two aspects;The limited scope of servicetargets,the low level of service items lead to weak service availability;The lack of professional needs assessment methods and the lack of classification and grading standards for service objects lead to insufficient accommodation of the service process and content.(3)In the financing,delivery and regulation of services,the ways in which the organizational structure of service supply affects the accessibility of services have been discovered:the source of funds and the scale of financing affect the service systems'admission and treatment standards to its objects,and the social entities' enthusiasm of service delivery has an impact on the availability of services;The nature,ability and production form of the service delivery entities affect the content and quality of the services,and can have an impact on the availability,spatial accessibility,accommodation and acceptability of the service;The lack of professional demand assessment methods and precise service classification and grading service regulation methods cause insufficient service supply and waste of resources,which has an impact on the accommodation of services.Combining the findings of the above three aspects,the final conclusion of this study is that the current urban home care services mainly adopt the supply mode of public financing,social subject delivery,and public regulation;Under this supply model,the limited scale of funding,insufficient participation capabilities of service entities,and rough regulatory methods for funds and services have resulted in weak overall accessibility of services.In response to the research conclusions,this article proposes the following policy recommendations:In terms of service financing,improve the guarantee level of municipal financial funds,broaden the financing channels for service funds;In terms of service delivery,support social entities to participate in the distribution of services,enrich the government's forms of purchasing home-based elderly care services;In terms of service regulation,introduce a precise service classification and grading subsidy plan,strengthen the evaluation of service quality.This research supplements the domestic basic theoretical research on the concept of service accessibility and the application research borrowing the theory of welfare pluralism in the field of elderly care services.It is of practical significance to building an effective evaluation criteria,improving the organizational structure of the service system,enhancing the sense of acquisition of the elderly group the equal distribution of basic public elderly service resources.This research puts forward several issues that need further study,including the connection between the long-term care insurance system and the home-based elderly care service system,the multiple supply of welfare for community elderly service facilities,and the multiple subjects and accessibility status of service users to the supply of services,the problems of evaluation of "accessibility" and the establishment of refined "accessibility" quantitative indicators,etc.,these problems need to be resolved by further follow-up research.