| With the aging population and the transformation of the disease pattern in China,although the progress of medical science and technology is conducive to the decline of the mortality rate and the extension of the average remaining life of the population can achieve today,the increase of the morbidity rate of chronic diseases and the natural aging caused by the prolongation of life span have increased the length of disability and mental retardation of the elderly.In order to cope with the risk of ageing,government proposed to establish a long-term care insurance system in 2016 and carried out pilot work.However,by analysising the policies of the pilot cities in China,it is found that the definition of the target population,the level of care needs and the level of care services in the long-term care insurance system are unclear,fragmented and rough,especially in the start of long-term care services,i.e.the assessment system of care needs.There are many problems.Therefore,under the guidance of the concept of "healthy aging",it is of great significance to explore accurate and multi-dimensional disability assessment tools for assesing disabled elderly,financing for long-term care insurance,payment for long-term care benefits and service content,as well as long-term care welfare and even salvation.Based on the realistic background and practical significance,this paper systematically combs the experience and literature research of the assessment system for disabled elderly at home and abroad,innovates and draws lessons from Amartyasen's "capability" theory and analysis framework,and also tries to construct disabled elderly by referring to the "double boundary" lessoned from Alkire-Foster method.In the end,this paper constructs multidimensional disability assessment index and calculates the multidimensional disability assessment index.Based on CLHLS data in 2014 and STATA14.0 statistical software,this paper chooses three aspects to study and analyze,i.e.individual,social and resource.At the individual level,this paper chooses the ability of daily living and the ability of daily living,instrumental daily living ability,communication ability,perceptual function,mobility ability and cognitive function.The resource level includes home care environment dimension,and social level includes social activity participation ability dimension.There exists 8 dimentions and 31 direcions.They are evaluated by one-dimensional disability measurement,multi-dimensional disability measurement and multi-dimensional disability index respectively.Group decomposition and other data analysis as well as sensitivity analysis of threshold dimension threshold of indicators.Through multi-dimensional disability measurement,the study finds that:(1)31.4% of the elderly over 60 years old had more than two dimensions of disability,and 27.5% of the elderly had any three dimensions of disability in eight dimensions.After sensitivity analysis,18.2% of the elderly still had multi-dimensional disability if a more rigorous standard assessment was adopted;(2)The multi-dimensional disability rate of female elderly,elderly and rural elderly is higher;(3)As for the contribution rate of each dimension to disability index,the proportion of IADL,mobility and social participation barriers of the elderly is higher.Based on the above conclusions,this paper puts forward the following countermeasures and suggestions:Firstly,we can explore and construct a multi-dimensional composite disability assessment index system of long-term care insurance in China by using the feasible competency theory and international experience for reference,and carry out comprehensive needs assessment for disabled elderly people;secondly,we can develop a nationwide standardized assessment process(SOP),care management system and electronic assessment system;finally,based on multi-dimensional disability level and care needs assessment,the "demand side" drives the "supply side" and promotes the development of diversified community home care resources. |
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