日本经验提示中国长期护理的未来设计——对于“独立生活追求者”概念的政策建议

Japan's long-term care experience: policy proposals for “independence-seeking seniors” in China's future system

摘要

中国正面临老龄化加剧与劳动年龄人口减少的双重压力。2022年,65岁及以上人口已超过2亿,占总人口的14%,预计到2050年将达到约4亿。与此同时,出生率持续低迷,劳动人口急剧下降,护理人员资源短缺,机构利用率也偏低。如果长期护理期不断延长,养老制度的可持续性将陷入危机。本文以二战后日本出生群体价值观变化为参照点,引入“独立生活追求者(ILS)”的理念,以期在中国实现缩短护理期、让老年人尽可能自立生活的社会转型。在日本,婚礼中媒人参与率由20世纪70年代的70%下降到2020年的不足10%;葬礼方面,截至2022年家庭葬礼的比例为55%;经调查约35%的居民有过预先护理计划意向表达,预计2026年度护理人员缺口上升到25万人,这些数据体现出老年人对“自立”与“尊严照护”价值观的认知不断拓展。日本的经验不是答案,而是参考,中国应结合国家社会文化土壤重新设计养老制度。本文提出三层次的制度构想,同时提出结合文化价值变化与医疗护理结果的评价框架,并展示短期、中期和长期的实施场景。要实现可持续的老龄化社会运行,应以ILS理念为核心,促进老年人自立并缩短护理期。

Abstract

China is confronted with the dual pressures of deepening population aging and a shrinking working-age population. In 2022, the population aged 65 and above exceeded 200 million, accounting for 14% of the total population, and the figure is projected to reach approximately 400 million by 2050. Meanwhile, the birth rate remains persistently low, the working-age population is plummeting, there is a severe shortage of care workers, and the occupancy rate of elderly care institutions stays relatively low. A continuous extension of long-term care periods will put the sustainability of the elderly care system at risk. Taking shifts in the values of Japan's post-WWII birth cohorts as a frame of reference, this paper introduces the concept of “independence-life seeker (ILS)”, aiming to facilitate a social transformation in China that shortens caregiving durations and enables older adults to maintain self-reliant lives to the greatest extent possible. In Japan, the proportion of marriages arranged by matchmakers dropped from 70% in the 1970s to less than 10% by 2020. In terms of funerals, household funerals accounted for 55% of all funerals as of 2022. Surveys show that roughly 35% of residents have expressed intentions to formulate advance care plans, and the shortfall of care workers is expected to rise to 250,000 by fiscal year 2026. These data reflect the growing recognition among older adults of values centered on self-reliance and dignity-conserving care. Japan's experience offers reference rather than ready-made solutions, and China needs to redesign its elderly care system in light of its unique national and socio-cultural context. This paper puts forward a three-tier institutional framework, proposes an evaluation framework integrating evolving cultural values and medical and long-term care outcomes, and outlines short-term, medium-term and long-term implementation pathways. There fore,to achieve the sustainable operation of aging society, policymakers should center its policies on the ILS concept to foster elderly self-sufficiency and compress the length of long-term care utilization.

关键词

老龄化社会 / 自立支援 / 劳动人口 / 独立生活追求者

Key words

Aging society / Support for independent living / Labor force / Independence-life seeker

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