政府主导型老年人陪诊服务的地方政策比较研究

A Comparative Study of Local Policies on Government-Led Chaperone Service for the Elderly

摘要: 伴随我国人口老龄化加剧，老年人就医陪伴需求日益凸显。陪诊服务作为新兴的社会服务形态，分为政府主导型和非政府主体主导型，已有研究缺乏对前者的关注。运用吉尔伯特等人的社会福利政策分析框架，从分配对象、供给内容、递送方式、筹资方式四个维度，对上海市、合肥市庐阳区、浙江省舟山市和重庆市两江新区四地的陪诊服务政策或项目进行比较分析。研究发现四地在四个维度上呈现较大差异，形成了以养老服务机构为抓手型、基层医疗机构内嵌型、政府民政救助延伸型、大型医疗机构社志协同型的差异化做法，地区福利方式有混合型、补缺型和制度型。这些政策探索给其他地方政府的重要启示是应重视加强对困难老年人就医陪同的分层保障、明确陪诊服务人员的资质标准、推进社会工作者与志愿者协同服务和服务的风险防控。

Abstract: With the population aging in China, the demand for chaperone service for the elderly has become increasingly prominent. As an emerging form of social service, chaperone service can be categorized into government-led and non-government-led types, yet existing research has paid insufficient attention to the former. Employing Gilbert et al.’s social welfare policy analysis framework, this study conducts a comparative analysis of chaperone service pilot policies or projects in four locations: Shanghai, Luyang District of Hefei City, Zhoushan City of Zhejiang Province, and Liangjiang New Area of Chongqing City. The analysis is structured across four dimensions: who is served, what is supplied, how it is provided and how it is funded. It is found that the four locations exhibit considerable differences across the four dimensions, resulting in differentiated approaches: taking elderly care institutions as a key lever, embedded services within primary healthcare facilities, government civil affairs assistance extended to elderly care, and collaborative social work with large medical institutions. Local welfare can be categorized into mixed, residual, and institutional types. These policy explorations offer important insights for other local governments. They should prioritize enhancing multi-tiered support for the disadvantaged elderly requiring accompaniment for medical care, clarify qualification standards for chaperone service workforce, promote the integration of social workers and volunteers as well as risk prevention and control of services.