| In order to explore an elderly care service supply model suitable for the characteristics of super-large cities and to open up the elderly care service links with different functions under the "9073" layout,Shanghai has gradually built a community-embedded elderly care service pattern since 2013.The preferred mode,and it is planned to achieve basic service coverage of the city by the end of 2020.However,in practice,the existing service agencies have the problem that the supply of various services cannot fully match the demand,which restricts the further promotion and operation effect of this service model,and the targeted adjustment of public policies.Therefore,this paper takes Songjiang District,Shanghai as an example,by drawing on the "accessibility" research paradigm of systematic evaluation in the field of public services,to scientifically measure and evaluate the accessibility status of community-embedded elderly care services in Songjiang District,Shanghai,and analyzes.The main reasons affecting accessibility are proposed,and targeted accessibility optimization countermeasures are proposed.Using Penchansky’s five-dimensional model of accessibility to measure the accessibility of embedded elderly care services in Songjiang District,Shanghai.By issuing questionnaires to service users of embedded elderly care institutions in Songjiang District,221 valid questionnaires were recovered,and first-hand information and data were obtained through interviews with service providers and demanders.The key performance indicator method and the Delphi method are used to determine the indicators,and the weight of the indicators is determined by the analytic hierarchy process,and the accessibility scores at all levels are obtained by combining the fuzzy comprehensive evaluation method.The results show that the accessibility score of community-embedded elderly care services in Songjiang District,Shanghai is58.68,which is at the "general" level,while in the accessibility sub-indices,availability and accessibility have higher weights,but the scores are lower,at 57.17 respectively 57.95,all at the “average” level.Among the five sub-indicators,affordability is the lowest at 57.09.Although acceptability and adaptability are at the“good” level,the scores are not high,at 63.03 and 61.77 respectively..Further,through the correlation analysis,starting from the service recipients themselves,the correlation between the factors at the individual level of the service recipients and the accessibility evaluation was explored.The availability of services is significantly correlated;the existence of a spouse,the availability of elevators,the elderly’s self-care ability,health status and accessibility are significantly correlated;and in terms of affordability,gender,household registration,work unit nature,income level and children’s age are significant Relevant factors;in terms of acceptability,the elderly’s self-assessment of life satisfaction and their preference for pension are significant related factors;while gender,age,self-psychological status,self-assessment of life satisfaction,frequency of child care,and child’s recommended pension There is a significant correlation between mode and adaptability.Through the evaluation of the service availability of the service provider and the analysis of the individual related factors of the service demander,combined with the interviews,it is found that the following problems exist in the community-embedded elderly care service in Songjiang District,Shanghai:(1)In terms of availability,institutional service personnel do not sufficiency,insufficient service utilization,there is a gap between what should be and what is,and cannot meet diverse needs,and the acquisition of services is constrained by household registration and insurance policies;(2)In terms of accessibility,insufficient services lead to cross-community and insurance policies.The phenomenon of seeking services across regions has increased,and the accessibility has been reduced,the inconvenience of domicile facilities and the dispersion of institutions have reduced accessibility;(3)In terms of affordability,the price of elderly care services with professional services and core functions is unaffordable to a certain extent.There are differences between different groups,lack of relevant social insurance or non-Shanghai household registration groups are more unaffordable,there are difficulties and preferences in institutional operations,and it is difficult to balance personal and social benefits;(4)In terms of acceptability and adaptability On the one hand,there are problems with specific service activities,the elderly have certain dissatisfaction or even resistance,and some social characteristics of service personnel are not compatible with the elderly.In response to the problem,we provide countermeasures and suggestions from the perspective of supply and demand:(1)In terms of availability,integrate and share information,conduct differentiated layout and setup of elderly care institutions according to elderly care needs,dynamically adjust service supply,and provide the most in-demand and most urgent services.Such as expanding the construction of disability and dementia care services,making full use of primary medical care,and combining with comprehensive prevention and control of chronic diseases.At the same time,make efforts in insurance policy,learn from Japan’s experience,lower the entry threshold for long-term care insurance,etc.;(2)In terms of accessibility improvement,deploy institutions and services according to the needs of the elderly,gather and use idle public land and public use according to local conditions.Housing,from "street centralization" to "community grid".Secondly,carry out aging-appropriate renovation of residences and facilities,such as elevator installation,renovation of living facilities,etc.,to get through the last "tens of meters".Carry out free or low-cost pick-up and drop-off services,create information-based processes,and facilitate services such as calling and booking.(3)In terms of affordability improvement,measures such as flexible government subsidies,access to relevant insurance,and improvement of the charging mechanism of elderly care institutions are needed at the same time.(4)In terms of acceptability and adaptability improvement,on the one hand,it is necessary to improve service procedures,collocation,standards and personnel arrangements,increase talent team construction,effectively improve personnel supply,and strengthen professional and technical training and evaluation.mechanism.On the other hand,it is necessary to start with the elderly and their families to realize the embedded elderly care services in family elderly care,so that the elderly can understand,accept,enjoy and actively participate in the services,and at the same time,encourage their children to participate in the construction of embedded elderly care services,such as regular ”,“visit” and put forward suggestions,etc.,to promote service quality improvement and prevent moral hazard. |
