“十四五”期间中国老年人长期照护政策的量化评价：基于PMC指数模型分析

doi:10.3969/j.issn.1006-9771.2024.08.009

Abstract

Abstract:

Objective To quantitatively evaluate the structure and content of the long-term care policy for the older people in the 14th Five-Year Plan in China.

Methods The primary indicators were constructed based on multi-source flow model, using Policy Modeling Consistency (PMC) model, and the secondary indicators were constructed based on World Health Organization reports Long-term care for older people: Package for universal health coverage and Decade of healthy ageing: Plan of action. An evaluation system was formed, containing nine primary indicators and 35 secondary indicators. A total of eight policies issued by the nation between November, 2021 and January, 2024 were included. High-frequency words were extracted using ROSTCM 6.0, a semantic network map of keywords was created using Gephi, and the policies were analyzed using the evaluation system.

Results The policies mainly focused on nursing, community, rehabilitation and nursing home, etc. The average PMC index was 6.77. For the policy content coverage, one policy was perfect, five were excellent and two were acceptable. In the dimension of policy content, the indexes of three primary indicators of policy function, policy receptors and infrastructure construction were 0.85 or more; while the indexes of three primary indicators of caregiver assistance, support for the elderly and human resources building were 0.7 or less.

Conclusions The content of long-term care policies for the older people issued in the 14th Five-Year Plan in China covers well in policy functions, policy recipients and infrastructure, and needs to be upgraded in the three dimensions of caregiver assistance, support for the elderly and human resource building. It is important to strengthen the policy content and measures in three areas, namely, the comprehensive care support network, the creation of an age-friendly environment and support for informal care.

Key words: aging, long-term care, policy evaluation, Policy Modeling Consistency index model

CLC Number:

R197

ZHOU Lifang, LANG Zihan, WU Yixuan, XU Na, XU Lingfeng, CHEN Zhongming, YIN Wenqiang, YU Qianqian. Quantitative evaluation of long-term care policies for older people in the 14th Five-Year Plan in China: based on Policy Modeling Consistency index model[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 939-947.

Figures/Tables 6

Table 1

Table 2

PMC evaluation indicator system and contents"

一级指标	二级指标	二级指标评价内容	指标来源或依据
老年人支持(X₁)	ADL和IADL(X_1.1)	政策是否涉及支持和协助老年人ADL和IADL等内容	WHO^[12](2023)
	社会参与(X_1.2)	政策是政策否涉及支持老年人社会参与等内容
	无障碍建设(X_1.3)	政策是否涉及提升环境和交通无障碍程度等内容
	辅助器具提供(X_1.4)	政策是否涉及发展嵌入式康复辅助器具销售和租赁网点等内容
照护者援助(X₂)	心理社会(X_2.1)	政策是否涉及对照护者提供社会参与、心理教育、咨询、休闲和体育活动等内容
	临时照护(X_2.2)	政策是否涉及短期照护、日间照料、邻居或志愿者辅助照料等临时照护相关内容
基础建设(X₃)	信息化平台建设(X_3.1)	政策是否涉及建立老年健康数据收集和发布机制等信息化建设	基于文本挖掘及政策内容确定
	辅助器具研发(X_3.2)	政策是否涉及发展辅助搬运、翻身、巡检机器人等辅助器具研发
	标准规范建设(X_3.3)	政策是否涉及老年人长期照护标准规范建设
	示范点建设(X_3.4)	政策是否涉及老年人长期照护示范点建设
人力资源建设(X₄)	保证供给(X_4.1)	政策是否涉及培养现有和新兴正式照护劳动力	WHO^[13](2020)
	培训和认证(X_4.2)	政策是否涉及护理人员培训和资格认证
	非正式照护(X_4.3)	政策是否涉及为非正式照护者提供帮助
政策受体(X₅)	政府(X_5.1)	政策作用对象是否为政府及其相关下级部门	基于文本挖掘及政策内容确定
	医疗机构(X_5.2)	政策作用对象是否为医疗机构
	养老机构(X_5.3)	政策作用对象是否为养老机构
	企业(X_5.4)	政策作用对象是否为长期照护相关企业
	社区(X_5.5)	政策作用对象是否为失能老人所在社区
	家庭(X_5.6)	政策作用对象是否为失能老人所在家庭
激励约束(X₆)	财政投入(X_6.1)	政策是否涉及长期照护财政资金、金融保障等财政投入内容	薛惠元^[14] (2023)
	政府购买(X_6.2)	政策是否涉及政府购买长期照护服务相关内容
	法律规范(X_6.3)	政策是否包含长期照护法律或制度保障相关内容
	监督考核(X_6.4)	政策是否涉及监督考核相关内容
政策性质(X₇)	预测(X_7.1)	政策是否涉及预测性质的描述，如制度框架基本确立、增强、健全	Ruiz Estrada^[15] (2011)
	建议(X_7.2)	政策是否对老年人长期照护服务发展提出意见或建议
	反馈(X_7.3)	政策是否存在相应问题的反馈渠道
	描述(X_7.4)	政策是否涉及养老机构建设、社区设施配置等相关细节性描述
	引导(X_7.5)	政策是否涉及引导长期照护服务发展相关内容
政策功能(X₈)	宏观设计(X_8.1)	政策是否涉及老年人长期照护政策总体架构相关内容	薛惠元^[14] (2023)
	鼓励激励(X_8.2)	政策是否涉及鼓励激励老年人长期照护服务相关内容
	规范引领(X_8.3)	政策是否涉及规老年人长期照护服务规范引领相关内容
	制度完善(X_8.4)	政策是否涉及老年人长期照护制度完善相关内容
政策设计(X₉)	依据充分(X_9.1)	政策是否依据相关法律法规、中央文件制定	张永安^[16] (2017)
	目标明确(X_9.2)	政策是否具有明确、可量化的指标
	规划详实(X_9.3)	政策内容是否详实

Table 2

Table 3

Figure 1

Table 4

Figure 2

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编号	名称	发文时间	发文部门
P1	国家卫生健康委办公厅关于开展老年医疗护理服务试点工作的通知	2021年11月	国家卫生健康委员会办公厅
P2	中共中央国务院关于加强新时代老龄工作的意见	2021年11月	中共中央、国务院
P3	“十四五”国家老龄事业发展和养老服务体系规划	2021年12月	国务院
P4	“十四五”健康老龄化规划	2022年2月	国家卫生健康委员会等15部门
P5	“十四五”国民健康规划	2022年4月	国务院办公厅
P6	全国护理事业发展规划(2021-2025年)	2022年4月	国家卫生健康委员会
P7	民政部财政部关于组织开展中央财政支持经济困难失能老年人集中照护服务工作的通知	2023年10月	民政部、财政部
P8	国务院办公厅关于发展银发经济增进老年人福祉的意见	2024年1月	国务院办公厅

词汇	n	词汇	n	词汇	n	词汇	n	词汇	n	词汇	n
老年人	421	社区	121	健全	89	疾病	74	重点	66	安宁	54
养老	355	能力	106	制度	84	经济	74	照护	64	救助	54
护理	348	质量	102	试点	83	评估	73	护士	63	基层	52
机构	272	康复	101	需求	82	事业	73	引导	62	企业	51
医疗	196	保障	100	创新	80	行动	72	困难	58	安全	50
体系	146	规划	98	标准	79	失能	71	规范	57	推广	49
管理	136	技术	95	医院	78	设施	71	资源	56	服务能力	47
机制	130	养老机构	93	培训	78	监测	70	地区	56	预防	47
社会	129	老龄化	90	家庭	76	居家	70	医疗卫生	56	中医药	46
鼓励	125	教育	89	保险	76	医疗机构	69	人才	55	环境	45

指标	P1	P2	P3	P4	P5	P6	P7	P8	均值
老年人支持(X₁)	0.25	1.00	1.00	0.25	0.75	0.50	0.25	1.00	0.63
照护者援助(X₂)	0.00	0.00	0.50	1.00	0.00	0.50	0.00	0.50	0.31
基础建设(X₃)	0.75	1.00	1.00	0.75	1.00	1.00	0.50	1.00	0.88
人力资源建设(X₄)	0.67	0.67	1.00	0.67	1.00	0.67	0.00	0.67	0.67
政策受体(X₅)	1.00	1.00	1.00	0.60	1.00	1.00	0.60	1.00	0.92
激励约束(X₆)	0.50	1.00	1.00	0.50	0.50	0.75	0.75	0.75	0.72
政策性质(X₇)	0.80	0.80	1.00	0.80	0.60	1.00	1.00	0.80	0.85
政策功能(X₈)	1.00	1.00	1.00	1.00	1.00	1.00	1.00	0.75	0.97
政策设计(X₉)	0.67	0.67	1.00	1.00	1.00	1.00	0.67	0.67	0.84
PMC指数	5.63	7.13	8.50	6.63	6.85	7.42	4.83	7.13	6.77
政策等级	可接受	优秀	完美	优秀	优秀	优秀	可接受	优秀	—

Quantitative evaluation of long-term care policies for older people in the 14th Five-Year Plan in China: based on Policy Modeling Consistency index model

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