基于“供需–整合”二维框架的养老服务体系重构

Reconstructing the Elderly Care Service System Based on a Two-Dimensional Framework of “Supply-Demand Fit and System Integration”

摘要: 本文聚焦我国养老服务面临的供需失衡与体系碎片化双重困境。基于福利多元主义与整合照护理论，本文搭建起“供需匹配度–体系整合度”二维分析框架，经梳理研判发现当前养老服务深陷“低匹配–低整合”的困境。研究发现，我国供给侧资源过度向机构倾斜，与“9073”格局规划背离；需求侧正从生存型向发展型升级；医养康护分离、管理多头分割加剧体系碎片化。通过借鉴日本统一评估与英国社区枢纽经验提出多维度优化思路：以供给侧改革将资源向社区居家集聚，建立全国统一评估体系破解协同难题，以社区为整合节点构建“照护枢纽”，同时审慎推进数智赋能，实现人技协同。唯有打破制度壁垒，推动系统性整合，方能跨越碎片化困境，构建高质量养老服务体系。

Abstract: This paper focuses on the dual dilemma of supply-demand imbalance and system fragmentation facing China’s elderly care services. Drawing upon welfare pluralism and integrated care theory, this study constructs a two-dimensional analytical framework of “supply-demand fit degree and system integration degree,” which reveals that the current elderly care system is trapped in a vicious cycle of low matching and low integration. The findings indicate that: supply-side resources are overly concentrated in institutional care, deviating from the “9073” policy orientation; demand-side needs are upgrading from subsistence-oriented to development-oriented patterns; and the separation of medical care, nursing care, rehabilitation, and health management, coupled with fragmented multi-department governance, exacerbates systemic fragmentation. Drawing on Japan’s unified assessment system and the UK’s community hub experience, this paper suggests redirecting resources toward community-based and home-based care through supply-side reform, establishing a national unified assessment system to address coordination challenges, constructing community-based “care hubs” as integration nodes, while cautiously advancing digital empowerment to achieve human-technology synergy. Only by breaking down institutional barriers and promoting systematic integration can we overcome the fragmentation dilemma and build a high-quality elderly care service system.