老年友好照护环境对优化长期护理保险服务效果的协同作用  

Effect of age-friendly social and family care environment on the long-term care services for the disabled elderly people

作　　者：蔡菁菁 姜敏敏 李鲁 CAI Jingjing;JIANG Minmin;LI Lu(Institute of Modern Services,School of Public Affairs,Zhejiang Shuren University,Hangzhou 310015,China;Shulan International Medical College,Zhejiang Shuren University,Hangzhou 310015,China;School of Public Health,Zhejiang University School of Medicine,Hangzhou 310058,China;Zhejiang Urban Governance Research Center,Hangzhou 310000,China)

机构地区：[1]浙江树人学院公共管理学院现代服务业研究院,浙江杭州310015 [2]浙江树人学院树兰国际医学院,浙江杭州310015 [3]浙江大学医学院公共卫生学院,浙江杭州310058 [4]浙江省城市治理研究中心,浙江杭州310000

出　　处：《浙江大学学报(医学版)》2025年第1期28-38,I0022-I0024,共14页Journal of Zhejiang University(Medical Sciences)

基　　金：国家社会科学基金(21BGL235)。

摘　　要：目的:关注长期护理保险(简称长护险)政策的服务供给效果,并探索家庭和社会的友好照护环境在政策作用链条中的角色。方法:研究选取浙江省内享受长护险政策的失能老人(n=311,宁波地区)和未享受长护险政策的失能老人(n=542,杭州城区211位,衢州开化县331位),通过面访调研获得信息,探索群体间服务供给(保障日常活动、提供预防保健、满足精神慰藉)效果的差异。通过家庭功能量表和家庭内具体三项事务获得帮助(事务帮助、经济帮助、情感帮助)的情况来测量家庭友好照护环境,采用经修正的世界卫生组织推荐的老年友好城市环境框架测量社会友好照护环境(包含无障碍环境、信息传播环境、社会参与环境、经济保障环境)。控制社会人口学特征、养老状况特征、健康风险特征等协变量后,采用多元logistic回归探索长护险政策的服务供给效果,采用中介与调节效应的检验探索友好照护环境的作用及机制,并运用固定效应模型对长护险服务供给效果进行稳健性检验。结果:享受长护险政策的失能老人,预防保健和精神慰藉被满足的比重更高,且多因素分析发现享受长护险政策与精神慰藉被满足有显著的正向关联。具体而言,相较于宁波地区的失能老人,杭州城区(OR=0.45,95%CI:0.27~0.74,P<0.01)与衢州开化县(OR=0.21,95%CI:0.12~0.37,P<0.01)的失能老人更容易感到精神慰藉未满足。中介效应分析结果显示,社会友好照护环境中的无障碍环境(OR=1.22,95%CI:1.02~1.45,P<0.05)、信息传播环境(OR=1.19,95%CI:1.02~1.39,P<0.05)和社会参与环境(OR=1.40,95%CI:1.17~1.67,P<0.01)的得分与精神慰藉服务满足率呈正相关;调节效应分析结果表明,社会友好照护环境(OR=1.46,95%CI:1.16~1.84,P<0.01)能够弥补长护险试点与非试点地区之间的效果差异。最终,固定效应模型验证“是否享受长护险—社会友好照护环境—精神慰藉服�Objective:To investigate the effect of age-friendly social and family care environment on the long-term care(LTC)services for the disabled elderly people.Methods:A questionnaire-based survey was conducted among disabled elderly people in three cities of Zhejiang province from June to August 2022,involving 311 subjects from Ningbo city(LTC service insurance pilot site,insured group)and 542 subjects from Hangzhou and Quzhou cities(uninsured group).The service provisions,including ensuring daily activities,preventive healthcare,and satisfying spiritual comfort,were compared among the groups.The family friendly care environment was evaluated with the Family Function Scale and assistance of daily activities,financial support and emotional comfort.The social friendly care environment was measured with the revised WHO recommended age-friendly city environmental framework,including accessibility guarantee environment,information dissemination environment,social participant environment,and life security environment.After controlling for covariates such as sociodemographic,elderly care status,and health risk characteristics,the impact of environment on the effectiveness of service provision of LTC insurance was explored by multiple logistic regression analysis.The mediating and moderating effects were tested to explore the role of age-friendly care environment.A fixed effects model was used to test the service provision effects of LTC insurance policy.Results:Disabled elderly with LTC insurance had a higher proportion of their preventive health care and spiritual comfort needs met.Additionally,a multifactorial analysis found a significant positive association between LTC insurance and meeting the spiritual comfort needs.Compared with insured group(Ningbo city),disabled elderly people in Hangzhou urban area(OR=0.45,95%CI:0.27-0.74,P<0.01)and Quzhou rural area(OR=0.21,95%CI:0.12-0.37,P<0.01)were more likely to feel unsatisfied with spiritual comfort.The results of mediation analysis showed that the scores of accessibility gu

关 键 词：长期护理保险 失能老人 老年友好照护环境 无障碍环境 信息传播环境 社会参与环境 

分 类 号：R197.1[医药卫生—卫生事业管理] D669.6[医药卫生—公共卫生与预防医学]