安宁疗护、善终与社会保障制度——概念厘定与理论分析  

Hospice Care,Respectful End-of-life and Social Security and System

作　　者：张跃华[1,2] 阎文溯 卢倞 杜晓雪 ZHANG Yue-hua;YAN Wen-su;LU Liang;DU Xiao-xue

机构地区：[1]浙江大学公共管理学院、长三角智慧绿洲创新中心 [2]浙江大学民生与保障研究中心 [3]浙江大学公共管理学院 [4]爱达荷大学

出　　处：《保险研究》2025年第2期3-13,共11页Insurance Studies

基　　金：中国保险学会委托项目:安宁疗护、生命质量与保险制度设计,国家社科基金重大项目(23&ZD045);浙江大学长三角智慧绿洲创新中心2025年度攻坚计划,中央高校基本科研业务费专项资金。

摘　　要：临终痛苦、因病返贫以及医疗资源配置优化等老龄化社会的几个重要社会问题,皆可以通过安宁疗护制度进行一定缓解。安宁疗护是一种尊重临终患者自主权、致力于减轻患者临终痛苦、提高患者生命质量、为患者和家属提供相关社会支持的整体医护方案。适当的社会保障制度安排可以促进安宁疗护发展,降低因病返贫的可能并实现医疗资源优化。本研究围绕理论模型中个体效用的假设,对安宁疗护在医学实践中的相关概念进行厘定和衔接,分析不同医护模式对患者效用产生的作用。在此基础上,构建简化的个体临终医疗决策模型,探讨患者临终医疗决策选择和相应的社会成本收益,揭示了为患者提供安宁疗护选择存在促进个人和社会福利改进的空间,提出通过政策性保险作为筹资机制,以实现社会保障制度的帕累托改进,并进一步厘清社会保障体系中安宁疗护的边界,为患者、家属的合意选择与安宁疗护相关制度的规范实施提供分析框架。Pain at the end of life,poverty due to illness,and optimization of medical resources are several important social issues in an aging society,which can all be alleviated to a certain extent through hospice care.Hospice care is a holistic care that respects the autonomy of terminally ill patients,and is committed to alleviating pain at the end of life,improving the quality of life of patients,and providing relevant social support for patients and their families.Proper social security system arrangements can effectively promote the development of hospice care,reduce the possibility of poverty due to illness,and optimize medical resources.In the applicability issues of individual utility,decision-making time,medical costs,etc.,the study focuses on the assumptions of individual utility in the model,analyzes the relevant concepts of hospice care in medical practice,and the room for welfare improvement of the effects of different medical care models on patient utility.On this basis,this paper constructs a simplified individual terminal medical decision-making model to explore the choice of terminal medical decision-making plans and the corresponding social cost-benefit of patients.It reveals that there is room for promoting individual and social welfare improvements by providing patients with hospice care options,and proposes to achieve the Pareto improvement of the social security systems through policy-based insurance.It further clarifies the boundaries of hospice care in the social security system,and provide a conceptual framework for the appropriate choice of patients and their families and the standardized implementation of hospice care-related systems.

关 键 词：安宁疗护 缓和医疗 临终关怀 社会保障 安宁疗护社会保障 

分 类 号：F840.684[经济管理—保险]