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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Page,42,关于完善老年服务和长期护理制度的思考与建议,李 珍,2018-2-27,Reflection,and,Reccommendation,for,Improving,Old,-Age,Service,and,LTC,Li,Zhen,2018-2-27,1.,前言,2.,中国养老服务制度的发展及长期护理筹资制度的探索,3.,关于完善老年服务和长期护理体系的思考与建议,Index,Preface,2.,Development,of,Old,-Age,Service,in,China,and,Exploration,of,Establishing,LTC,Financing,System,3.,Reflection,and,Reccommendation,for,Improving,Old,-Age,Service,and,LTC,Index,1.,前言,养老服务体系早在上世纪,90,年代开始建设，,2006,年就关注到老年人长期护理服务递送体系的建设，中国政府是有远见的。经过十几年的建设，以,家庭为基础，社区为依托、机构为补充、医养结合,的多元利体系已经建成。,随着人口寿命的延长，长期护理的需求会日益增长，而另一方面，少子化、家庭小型化、医疗护理的专业化等等原因，老年人长期护理需求在家庭内部得不到满足时，这种需求就会,外溢为社会需求,，社会供给养老服务是必然的。,就高收入国家和地区的实践而言，第一，,筹资模式的选择取决于许多因素,，经济发展水平和家庭制度、长期护理的责任归属、人们对政府作用的认识是几个非常重要的因素；第二，无论筹资制度如何，,越依赖机构递送服务花费就越高，家庭的作用越大则总体费用越小,。花费越高则家庭对外部的依赖程度也越高。即需求产生供给，供给的扩张反过来推动或拉动需求。,1.,Preface,Chinese,OA,Service,system,starts,in,1990s,and,in,2006,the,focus,was,moved,to,LTC,delivery,which,represents,far,sight,of,Chinese,government,.,After,about,2,decades,China,has,basically,built,up,a,multi,-,tier,LTC,system,based,on,home,care,supported,by,community,care,with,supplement,of,institutional,care,and,in,combiniation,with,medical,care,.,As,life,expectancy,extends,LTC,needs,increase,.,However,sub-repleacement,fertility,small,-scale,family,and,specialization,of,medical,care,cannot,satisfy,LTC,demand,in,family,and the,demand,therefore,becomes,a,social,need,outside,family,which,necessarily,requires,social,OA,services,provided,.,Practices,in,high,-income,countries,and,regions,tell,us,:,(1,),funding,model,of,LTC,depends,on,many,factors,among,which,economic,development,family,structure,responsibility,distribution,role,of,government,are,the,most,important,;,(2),no,matter,what,the,funding,model,is,services,delivered,by,institutions,cost,higher,than,thouse,from,family,.,Higher,cost,cause,family,to,rely,on,external,service,forming,a,demand,to,which,supply,and,production,must,respond,to,.,The,expansion,of,supply,can,in,turn,drive,or,drag,demand,.,2.,中国养老服务制度的发展及长期护理筹资制度的探索,2.1,中国养老服务递送体系政策的演变,1994,年以前，中国家庭一直是养老服务的唯一提供者，政府只对没有子女且没有经济能力的老年人负责。,1994,年以后，养老服务递送主体的政策发生了变化，除了家庭，“社会养老保障制度”被引入，这里的“社会”是指社区和机构。自此,，,中国养老服务递送进入多元化时代。,进入,21,世纪后，养老服务递送主体的政策,一直是在调整家庭、社区和机构的不同主体的权重和三者之的协同关系,，同时失能、半失能老年人的养老问题被提出，长期护理体系的建设受到重视。,2.,Development,of,Old,-Age,Service,in,China,and,Exploration,of,Establishing,LTC,Financing,System,2.1,Evolution,of,OA,service,policy,in,China,Before,1994,family,has,been,the,only,provider,of,OA,service,while,the,government,only,take,responsibility,of,old,people,without,child,and,ecocomic,support,.,Since,1994,in,addition,to,family,Social,OA,Security,system,was,introduced,of,which,the,word,“,social,“,refered,to,community,and,instituion,.,Then,OA,service,in,China,started,to,diversify,.,After,2000,delivery,of,OA,services,is,characterized,by,adjustment,and,balance,of,roles,of,family,community,and,institution,and,at,the,same,time,for,the,issue,of,fully,and,partially,disabled,old,people,LTC,becomes,one,of,the,focuses,in,policy,discussion,.,2.1,中国养老服务递送体系政策的演变,2006,年，,关于加快发展养老服务业的意见,提出“发展养老服务业要按照政策引导、政府扶持、社会兴办、市场推动的原则，逐步建立和完善以,居家养老为基础、社区服务为依托、机构养老为补充,的服务体系。”,2011,年发布的老龄事业“十二五” 规划强调了机构的作用，政策修正为“,居家为基础、社区为依托、机构为支撑,”；同年，民政部发布,社会养老服务体系建设“十二五”规划,，首次提出“解决失能、半失能老年群体养老问题”是“加强社会养老服务体系建设，促进社会和谐稳定的当务之急”。社会资本快速进入养老服务市场，政府也给予养老机构大量补贴，导致养老机构过剩。,而养老服务“十三五”规划的政策是要使“,居家为基础，社区为依托，机构为补充，医养结合的养老服务体系更加完善,”，这样在服务递送的主体方面，回归到,2006,年的表述，在服务递送的内容上适应长期护理的需求，提出了医养结合。,2.1,Evolution,of,OA,service,policy,in,China,In,2006,the,governments,Opinion,on,Developing,OA,Service,Industry,was,made,which,set,the,objective,of,LTC,as,to,be,a,system,based,on,home,care,supported,by,community,care,and,supplemented,by,institutional,service,with,guide,of,policy,support,of,government,practice,of,social,participants,and,promotion,by,the,market,.,In,2011,the,12,th,F,-Y-Plan,on,OA,service,emphasized,the,role,of,institutions,for,which,the,2006,objective,was,changed,to,be,that,of,being,“,backed,by,institutional,services,“,.,In,the,same,year,MOCA,issued,its,12,th,F,-Y-Plan,on,Social,OA,Service,which,proposed,to,solve,the,problem,derived,from,fully,or,partially,disabled,old,people,viewing,it,as,the,urgent,issue,for,the,harmony,of,Chinese,society,.,Capital,entered,the,OA,service,market,rapidly,at,the,same,time,for,which,the,government,gave,substantial,subsidies,to,OA,institutions,resulting,in,oversupply,of,OA,services,.,In,the,13,th,F,-Y-Plan,the,objecive,of,LTC,was,changed,to,be,that,of,to,improve,the,system,based,on,home,care,supported,by,community,care,supplemented,with,institutional,services,and,in,combination,of,medical,services,which,is,a,return,to,the,2006,policy,with,the,combination,with,medical,services,as,the,addition,.,2.2,城乡养老服务及长期护理体系的现状,家庭是长期护理服务的主要提供者。,社区为依托的养老服务递送尤其是针对失能半失能老年人、高龄老年人、低收入空巢老年等特殊群体的服务递送体系得到了快速发展。,信息化服务系统为依托的社区居家养老服务平台基本健全。,机构养老床位数快速增长，长期护理、康复、临终关怀等等服务受到重视。,2.2,OA,Service,and,LTC,in,Urban,and,Rural,China,Family,is,the,main,supplier,of,LTC,services,.,OA,services,supported,by,communit,care,is,developing,rapidly,especially,those,provided,to,disabled,old,people,very,-old,people,and,low,-income,old,people,without,child,.,Digital,Community,OA,sercive,platform,is,generally,established,across,China,.,Beds,for,OA,services,in,institutions,increase,rapidly,and,policy,makers,pay,more,attention,to,services,for,LTC,rehabilitation,and,hospice,care,.,老龄委“四调”：,需要护理服务的城乡老年人中，,91%,的老人实际获得了照料护理服务，城镇为,93.46%,，高于农村的,89.43%,。只有约,10%,的老年人不能获得所需要的照料护理服务。 在照料护理服务的主要提供者中，仍然以家庭成员为主：配偶（,43.48%,）、儿子（,28.64%,）、儿媳（,10.08%,）、女儿（,10.35%,）这四个主要提供者就占到了约,93%,。,2016,年底，注册登记的养老服务机构,2.9,万个，各类养老床位合计,730.2,万张，（每千名老年人拥有养老床位,31.6,张，包括社区留宿和日间照料床位）。根据青连斌,2014,年底和,2015,年对,421,家养老机构的调查，,84.6%,的养老机构设置了失能老人床位，平均每家设置失能老人床位,91,张，占平均床位数的,42%,，,61.8%,的养老机构设置了多功能护理床，平均每家机构设置多功能床位,53,张。,According,to,the4th,survey,by,Chinas,Aging,Committee, 91%,of,old,people,in,need,of,care,service,got,the,services,. 93.46%,of,urban,old,people,in,need,receive,the,services,while,89.43%,of,thouse,from,rural,area,got,the,services,.,Only,10%,of,old,people,couldnt,receive,cares,they,needed,.,Families,were,still,the,major,supplier,of,service,:,spouse,(43.48%),son,(28.64%),sons,wife,(10.08%),daughter,(10.35%),totally,accounting,for,93%,of,all,the,service,suppliers,.,As,of,the,end,of,2016,there,were,29,000,OA,institutions,registered,7.3,million,beds,provided,(31.6,beds,per,1000,old,people,including,beds,in,community,services,and,daytime,centers,).,According,to,Qing,Lianbins,report,on,421,OA,institutions,in,the,ends,of,2014,&,2015,84.6%,of,the,instituions,had,beds,for,disabled,old,persons,with,averagely,9,beds,in,each,accounting,for,42%,of,all,the,beds,.,In,61.8%,of,the,institutions,there,were,multi,-function,al,beds,for,care,with,averagely,53,in,each,.,2.3,老年人长期照护服务体系发展的主要问题,长期护理服务及递送体系的问题既有供求关系总量也有供求结构性错配的问题。,居家养老来看，有几个问题需要关注：,第一，农村老年人在健康状态、收入状态等方面较城镇老年人更弱势，长期护理服务供求矛盾比城镇更突出，而公共政策对城镇老年人关照更多，加剧了这种不平衡。（,第一代农民工,）,第二，现有的政策已经关注到高龄老人、空巢老人、低收入老人的养老服务和长期护理需求问题，一些多代同居的家庭可能是既没有能力提供长期护理服务也没有能力购买服务的，“两代老人”家庭（老人与老老父母同居）长期护理能力也是有限的。,第三，城镇家庭医疗护理需求可及性不强。,第四，老年人利用互联网能力不足。,2.3,Major,problems,in,developing,LTC,Problems,of,LTC,and,its,service,delivery,system,are,resulted,from,both,the,relation,between,total,supply,and,demand,and,the,structure,of,supply,.,For,home,care,problems,include,:,(,1),rural,old,persons,are,weaker,than,those,urban,in,terms,of,health,and,income,.,Controdiction,between,supply,and,demand,in,rural,area,is,much,obvious,than,that,in,urban,area,.,Public,policy,covers,more,for,urban,people,which,enlarge,the,U,&R,imbalance,(affecting,the,first,generation,of,migrant,peasant,-workers),(2),Todays,policy,has,paid,attention,to,LTC,needs,of,and,services,for,very,-old,people,no,-child,old,people,low,-income,old,people,.,Some,families,composed,of,several,generations,would,be,those,without,capacity,to,provide,LTC,and,without,purchase,power,for,buying,the,services,.,In,families,with,two,generations,of,parents,the,capacity,of,LTC,is,also,limited,.,(,3),accessibility,of,urban,family,medical,care,is,weak,.,(,4),Old,peoples,capacity,of,accessing,to,internet,is,insufficient,for,getting,the,services,.,2.3,老年人长期照护服务体系发展的主要问题,社区和机构养老总体情况是,供给与需求的错配,社区长期护理服务供给与需求的错配：,一是社区养老床位的供给与需求的错配，,二是政府通过社区递送的服务与多样化需求的错配。,养老机构供给与需求的错配的主要表现是,:,一是机构养老床位总供给在数量上与总需求错配。,二是养老机构供给与需求存在空间上的错配。,三是财政补供方使得资源错配。,2.3,Major problems in developing LTC,For,community,and,institutional,cares,the,general,problem,is,the,mis,-match,between,supply,and,demand,:,In,communities,the,problems,are,:,1,mis,-match,of,beds,in,community,services,2,mis,-match,bewteen,types,of,community,services,provided,by,the,government,and,diversified,demand,of,old,people,In,institutions,the,problems,are,:,1,mis,-match,of,beds,2,mis,-match,of,space,3,.,mis,-match,of,subsidies,provided,by,public,finance,beds (10,000),being,cared,(10,000,persons),beds (10,000),being,cared,(10,000,persons),institutions (100),beds (10,000),2.4,长期护理筹资体制的探索,一是政府供给的补残模式,；,二是社会保险模式,；,三是相互保险模式。,2.4,Exploring,establishment,of,LTC,funding,system,1,Government,Subsidy,Model,2,Social,Insurance,Model,3,Mutual,Insurance,Model,2016,年,8,月，全国,26,个省（区、市）出台了高龄津贴补贴政策，,20,个省（区、市）出台了养老服务补贴政策，,17,个省（区、市）出台了长期护理补贴政策。享受高龄补贴的老年人,2355.4,万人，比上年增长,9.3 %,；享受护理补贴的老年人,40.5,万人，比上年增长,52.8%,；享受养老服务补贴的老年人,282.9,万人，比上年增长,9.7%,。,2016,年月，人力资源社会保障部办公厅出台关于开展长期护理保险制度试点的指导意见，选择,15,个城市试点，先行先试，探索长期护理社会保险的模式。,In August 2016, 26 provinces made subsidy polices for very-old,persons,allowance;,20,provinces,made,subsidy,policy,for,OA,services,provision,;,17,provinces,made,subsidy,policy,for,LTC,services,.,Compared,with,the,previous,year,beneficiaries,of,very,-old,persons,allowances,were,23.55,million,increased,by,9.3%;,those,of,LTC,subsidy,were,405,thousand,increased,by,52.8%;,and,those,of,OA,service,subsidy,were,2.82,million,increased,by,9.7%,。,I,n,July,2016,General,Office,of,MOHRSS,issued,the,Guidelin,for,Piloting,LTC,Insurance,and,chose,15,cities,as,pilot,sites,.,3.,关于完善老年服务和长期护理体系的思考与建议,3.1,政府在长期护理领域的首要责任是“兜底线，织密网”,3.1.1,老年人长期生活照料是私人事务，,个人和家庭是第一责任人,；,3.1.2,现阶段,长期护理社会保险,不适应中国国情,；,3.1.3,在长期照料领域政府的首要责任是“,兜底线，织密网,”,3.,Reflection and recommendation on improving OA service and LTC system,3.1,The,principal,responsibility,of,government,in,the,field,of,LTC,should,be,“,guaranteeing,the,minimum,livelihood,and,strengthening,the,safety,net,for,the,people,“,.,3.1.1,LTC,for,old,peoples,life,is,private,affair,for,which,individual,and,familty,should,be,primarily,responsible,.,3.1.2,In,the,current,stage,the,LTC,insurance,is,not,suitable,in,Chinese,context,.,3.1.3,The,principal,responsibility,of,government,in,the,field,of,LTC,is,“,guaranteeing,the,minimum,livelihood,and,strengthening,the,safety,net,for,the,people,“,.,3.1.1,老年人长期护理包含两个内容，一是与医疗护理有关的筹资与服务，一是与日常生活照料有关的筹资与服务。与医疗有关的服务应该是基本医疗保险基金来购买，而不是另建一个险种来解决老年人的医疗费用问题；从经济理论和社会伦理的角度看，与日常生活照料有关的服务属于私人事务，就像婴幼儿和其他家庭成员的生活照料是私人事务一样，应该由私人来供给，私人可以自由决策是自己提供服务或者是购买服务，购买老年人长期生活照料服务的费用，可以自付也可以通过保险的方式来转移，但决定权力在私人。正因为赡养和照料家庭成员的私人事务，所以中国的老年人权益保障法和婚姻法都规定了夫妻之间、父母子女之间经济上和生活上相互照料的权力与义务。中国没有遗产制度，老年人的财富下传，从社会伦理的角度子女理应赡养父母。从个人和家庭的经济能力看，除了退休金外，多半个人和家庭是有一定经济能力的。 中国学者主张建立长期护理社会保险制度的理由之一是老年人长期住院浪费了医疗资源，并以日本、荷兰等国为学习对象。其实日本的案例并没有证明设立长期护理保险能有效解决“社会性住院”问题，荷兰,2015,年的改革将与医疗有关的护理重新纳入医疗保险。,3.1.1,LTC,includes,two,elements:,1,funding,and,service,related,to,medical,care;,2,funding,and,services,related,to,daily,life.,Medical-related,LTC,service,should,be,purchased,with,funds,of,the,Basic,Medical,Insurance,but,not,with,funds,from,a,new,insurance.,Economically,and,ethnically,LTC,service,for,daily,life,should,is,private,issue.,Therefore,family,and,members,should,provide,it,to,old,people,just,like,family,members,provide,cares,to,babies,or,other,members.,An,individual,can,also,decide,freely,that,who,should,be,the,provider,or,what,sort,of,service,should,be,purchased.,For,purchasing,LTC,services,funds,can,be,provided,through,insurance,but,this,should,be,decided,by,the,person,that,needs,the,services.,Since,support,to,and,care,for,family,members,are,private,affairs,the,PRCs,Law,on,Protecting,Old,Peoples,Rights,and,Marriage,Law,regulates,that,parents,and,children,have,the,right,to,receive,mutual,supports,from,each,other,and,under,the,obligation,of,providing,supports,to,each,other.,There,is,no,(western),heritage,system,in,China.,Assets,of,old,people,would,be,inherited,by,their,next,generation.,Therefore,ethnically,children,should,support,their,old,parents.,From,the,perspective,of,personal,and,family,economy,in,addition,to,pension,income,most,individuals,and,families,have,more,economic,resources,to,support,old,members.,The,reason,why,Chinese,scholars,propose,to,establish,social,LTC,insurance,is,that,long-term,medical,cure,for,old,people,in,hospital,would,waste,medical,resources,and,therefore,China,should,learn,from,Japan,and,Netherlands.,However,in,Japan,case,there,is,no,evidence,that,LTC,insurance,can,effectively,solve,the,problem,of,“social,hospital,stay”.,The,Netherlands,have,on,the,contrary,re-included,medical,-,related,LTC,into,medical,insurance.,3.1.2,中国的家庭制度是社会保护制度中的正式制度安排,中国的社会保障制度定位于“保基本”，“保基本”含义是保障基本风险和基本保障水平，长期照料费用不是基本风险，甚至不是纯粹风险,中国人均,GDP,仍然处于中等偏上水平，且中国的人均可支配收入呈偏态分布，通常收入水平较高者对保险资金的利用率较高，而收入水平较低者利用率较低，从福利归属看，社会保险具有逆向再分配的作用，这一问题在大病医保和公积金制度中都存在,中国经济结构和就业结构呈明显二元化状态，,2016,年户籍城镇化率仅为,41%,，,8,亿多劳动力，,参加职工医疗保险的只有,2.9,亿人口,供给侧改革，政府要求降低企业税费,3.1.2,Chinese,family,is,a,formalized,system,for,social,protection.,Chinese,SP,is,for,protecting,the,minimum,livelihood,which,means,providing,basic,insurance,and,basic,protection.,Costs,for,LTC,are,not,basic,risk,and,even,not,pure,risk,.,Chinas,GDP,per,capita,ranked,at,the,middle,and,slightly,upper,level,in,the,world,and,the,disposable,income,per,capita,is,abnormally,distributed.,Usually,higher,income,receiver,uses,insurance,funds,more,efficiently,while,lower,income,receiver,does,not.,Thus,in,terms,of,benefits,ownership,social,insurance,functions,reversely,in,income,redistribution.,This,is,a,common,problem,in,the,Insurance,for,Disastrous,Disease,and,Housing,Credit.,In,China,the,economic,and,employment,structure,is,characterized,by,the,urban-rural,dualism,.,In,2016,only,41%,people,possessed,the,urban,Hukou,while,the,working,people,were,800,million,of,which,only,290,million,participated,in,the,Medical,Insurance,for,Employees.,In,China,the,government,is,conducting,the,supply-side,reform,and,reducing,tax,and,fees,for,enterprises.,strong,family,support,weak,family,support,poor,rich,Dibao,Low,income,weak,support,Low,income,strong,support,High,income,Weak,support,High,income,strong,support,Classification,of,disabled,old,people,and,policy,target,四调：有效样本：,215577,个,失能定义：吃饭、穿衣、上厕所、室内走动、上下床、洗澡，,ADLS,六项只要一项做不了则为完全失能，有困难和不费力为自理，,1-2,项做不了为轻度失能，,3-4,项做不了为中度失能，,5-6,项做不了为重度失能,四调：,4.2%,为失能老人（,2.2,亿老年人口，失能,924,万）,轻度：,2.3%,中度：,0.5%,重度：,1.3%,The 4,th,Survey,：,Effective,samples:,215577,Definition,of,disability,：,eating,dressing,toileting,moving,in,house,moving,in,and,off,bed,bathing,(,ADLS),disabled,in,these,6,points,=,full,disability,having,problem,but,managing,to,overcome,it:,OK,disabled,in,1-2,points:,light,disability;,disabled,in,3-4,points:,medium,disability,disabled,in,5-6,points:,serious,disability,The,4,th,Survey,：,4.2%,old,people,are,disabled,（,Of,220,million,old,people,9.24,million,are,disabled,）,Light,Disability,：,2.3%,Medium,Disability,：,0.5%,Serious,Disability,：,1.3%,失能老年人按收入、居住安排分的分布,%,（,2016,年,最低生活保障线,城市,5928,元，农村,3744,元）,Distribution,of,Disabled,Person,according,to,income,and,living,pattern,(,Minimum,Dibao,2,016,for,urban,area:,5928,Yuan,for,rural,area,3744,Yuan),贫困家庭,Poor,Family,非贫困家庭,Non-Poor,Family,不与子女同住,Living,without,children,19.4,25.4,与子女同住,Living,with,children,28.2,26.9,3.,关于完善老年服务和长期护理体系的思考与建议,3.2,建议财政支出政策由,“,补供方,”,为主转向以,“,补需方,”,为主,3.2.1,老年人长期照料以补需方为主,3.2.2,改政府直接购买服务为服务券补贴,3. Recommendations,3.2,Transforming,public,subsidy,from,supporting,supplier,to,supporting,demander,3.2.1 Subsidy,should,be,mainly,provided,to,support,demanders,3.2.2 Direct,governmental,purchase,of,services,should,be,changed,into,service,coupon,3.,关于完善老年服务和长期护理体系的思考与建议,3.3,构建“支持和维护家庭”的政策体系,3.3.1,利用现有电视网络或者其他资源联通老年人家庭的互联网；社区养老服务机构可以为老年人及其家庭成员提供相关培训，使互联网的便利惠及老年人、特别是社会失能老年人；,3.3.2,推进家庭医生签约并将长期护理内容纳入家庭医生服务内容，允许医务人员上门服务，解决家庭长期护理中最急迫的需求；,3.3.3,支持适老住房改造。目前长期护理需求高的人群主要集中在老老人，其中城镇多数人的住房为上世纪,80,年代建造，没有电梯等设施是居家养老的困难之一，因而住房的改造很重要；,3.3.4,对提供长期护理服务的家庭成员进行所得税减免；,3.3.5,对提供长期护理服务的家庭成员提供喘息服务或者津贴；,3.3.6,未来的城市住房设计应该将人口老龄化与家庭小型化考虑在内，使代际既有独立空间又能相互照顾；,3.3.7,通过税惠政策鼓励子女居住在老年父母的“一碗汤”距离内,。,3. Recommendations,3.3,Making policy system in favor of family,3.3.1 Using,TV,or,other,networks,to,connect,old,people;,community-based,old,age,service,institutions,can,provide,relevant,training,to,old,people,and,their,families,especially,on,how,to,use,internet,to,get,benefit,(for,those,disabled).,3.3.2 Promoting,GP,contraction,and,including,LTC,into,service,inventory,of,GP;,allowing,medical,doctor,to,provide,in-home,service,in,order,to,solve,the,most,urgent,needs,of,LTC.,3.3.3 Supporting,house,adaptation.,Currently,LTC,needs,are,concentrated,in,old,people.,Urban,houses,are,almost,built,in,1980s,which,are,without,elevators,and,therefore,results,problem,to,old,people,.,Therefore,house,adaptation,is,important.,3.3.4 Deducting,income,tax,for,LTC,provider,from,the,same,family.,3.3.5 Provide,allowance,and,“rest-taking”,service,to,family,LTC,provider.,3.3.6 Urban,house,design,should,reserve,space,for,old,people,to,enjoy,their,privacy,.,3.3.7 Making,incentives,to,encourage,children,to,live,within,the,distance,that,they,can,provide,daily,care,to,their,parents.,3.,关于完善老年服务和长期护理体系的思考与建议,3.4,完善健康养老、积极养老政策降低失能概率,3.4.1,普及积极养老、健康养老的理念,；,3.4.2,采取积极措施，降低失能概率,；,3.4.3,加强康复训练减轻失能程度。,3.5,城市和社区规划中为家庭养老和社区养老留有空间。,3.6,开放机构养老市场，变前置审批为事中和事后监督，监管的标准一定要与当地经济发展水平相一致。,3. Recommendations,3.4,3,.4,Perfecting policies for healthy and active old-age life, and reducing probability of becoming disable,3.4.1 Promoting,the,concepts,of,healthy,and,active,aging.,3.4.2 Adopting,active,approach,
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