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Ni, Z.; Xi, Y. Welfare Pluralism. Encyclopedia. Available online: https://encyclopedia.pub/entry/23935 (accessed on 26 April 2024).
Ni Z, Xi Y. Welfare Pluralism. Encyclopedia. Available at: https://encyclopedia.pub/entry/23935. Accessed April 26, 2024.
Ni, Zhiping, Yong-Qin Xi. "Welfare Pluralism" Encyclopedia, https://encyclopedia.pub/entry/23935 (accessed April 26, 2024).
Ni, Z., & Xi, Y. (2022, June 11). Welfare Pluralism. In Encyclopedia. https://encyclopedia.pub/entry/23935
Ni, Zhiping and Yong-Qin Xi. "Welfare Pluralism." Encyclopedia. Web. 11 June, 2022.
Welfare Pluralism
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This entry is adapted from the peer-reviewed paper 10.3390/su14116849

Under the background of an accelerating population aging process, China is facing the issues of a weakening household pension function and an insufficient social pension service supply. It is urgent to establish a perfect diversified pension service supply model. The theory of welfare pluralism advocates the participation of multiple subjects in social old-age services and emphasizes that social organizations play an important role in the provision of old-age services.

welfare pluralism endowment service 116 endowment service supply model

1. Introduction

According to the results of the seventh national census, on 11 May 2021, the number of people aged 60 and over has reached 264 million in China, accounting for 18.70 percent of the total population, among which 190 million were aged 65 and over, accounting for 13.5 percent of the total population. In order to effectively address this issue, endowment service departments in China have arranged a total investment of 13.4 billion CNY within the central budget during the 13th Five-Year Plan period, providing more than 7.61 million nursing beds for the elderly. The state-led multi-level endowment service supply model, based on households, supported by communities and supplemented by institutions, has begun to take shape. At present, there are more than 34,000 endowment institutions in China, among which those funded by social capital account for more than 50 percent of the total and even account for more than 80 percent in Beijing, Shanghai and other places [1]. Numerically, social forces are relatively high. However, in fact, social organizations in China are generally weak, and their participation in elderly care services is quite finite in depth and breadth [2]. From the perspective of welfare pluralism, social organizations should play an important role in the whole endowment service supply model. Nevertheless, due to the insufficiency of a systematic overall plan from a macro perspective, social organizations have suffered from issues such as overlapping functions, unclear tasks, low efficiency and so on. Therefore, under the guidance of welfare pluralism theory, it is very necessary to form a well-structured and clearly divided old-age service supply model.

2. Spiritual and Family Support

In recent years, many scholars have focused on the spiritual and family support aspects of the endowment service supply and explored how to improve the facilities for the elderly in their twilight years or at the end of life at the spiritual level. Evandrou and Glaser proposed that the Employer Expansion Scheme can contribute to the balance between paid work and family responsibilities, better engagement of caregivers in service work and motivating low-income caregivers by extending the secondary endowment deduction to caregivers who work more than 16 h per week and earn less than the minimum [3]. Meredith suggested that the Health Promotion Programme plays a vital role in improving the health and quality of life among elderly people in nursing homes. By developing an alternative nursing home placement program for frail elderly people, they can access better services in a favorable environment [4]. Ervin and Cross pointed out that for the elderly with dementia-related cognitive deficits, the participation of nursing home staff and family members in the elderly life-storytelling process can enable the elderly to obtain positive experiences, which is conducive to the alleviation of symptoms [5]. Bjrk et al. discussed the impact of environmental factors on the health and well-being of the elderly. Environmental variables are most strongly correlated with the health and felicity of the elderly, and a positive social and psychological environment seems to play an important role in promoting the health and longevity of the elderly [6]. Thimm et al. pointed out that it is difficult for the elderly with intellectual disability to benefit from ordinary supportive residential life. Therefore, nursing institutions should provide diversified services and accommodation arrangements according to the demands of the elderly with dementia rather than merely a place to spend the whole senectitude [7]. Hunt et al. pointed out that “when asked where they would prefer to meet with their death, no one said they would like to die in a nursing home, whereas, many people, in reality, would rather spend their last moments there”. Palliative therapy would be a nice choice to improve the quality of life of the elderly at the end of life in a nursing home [8]. Frewer and Susanne’s survey pointed out that palliative therapy aims at aiding sufferers with fatal diseases to achieve the highest quality of life, and this study explored how to alter the concept and capacity of hospice care in nursing homes through cooperation with the outpatient hospice department [9]. In addition, Arensberg and Beth pointed out that a healthy aging process requires national actions and policy formulation. Simultaneously, governments should consider involving enterprises in the formulation of sustainable policies and the provision of old-age products for the elderly [10].

3. Diverse Endowment Modes

Huang pointed out that the top-level system design should be strengthened for home-based care services, and multiple forces should be actively mobilized to participate in home-based care services, so as to build a home-based care service system with multi-agent participation [11]. Wang et al. proposed that the elderly themselves should be involved in the endowment service system and the concepts of “mutual endowment” and “mutual service” should be implemented, which can provide a new mentality for perfecting the diversified providers of an endowment service [12][13]. Chen et al. proposed that in order to further innovate the endowment service supply mode, a new mode with a “combination of medical care and nursing care” should be introduced based on institutional endowment, which solves the efficiency dilemma and legitimacy crisis to some extent [14]. Xu et al. surveyed 210 aged citizens in Guangdong Province. Guo and Hao carried out a study depending on the statistics of the same batch of urban elderly from a follow-up survey on influencing factors of health among the elderly in 2005, 2008 and 2011. According to the survey results, they pointed out that the significant elements affecting aging people to favor a home endowment service consist of personal care capacity, community service delivery and insurance ability. Apparently, it is necessary to concentrate on setting up a home care needs assessment and to establish long-term care insurance and to adjust community service delivery [15][16].

4. Social Forces’ Engagement in Endowment Service

Sheng emphasized that exploring the public–private partnership (PPP) model, simplifying administrative procedures and establishing a “green channel” are required with the purpose of attracting social capital into the endowment service industry [17]. Ling and Song pointed out that the government should create a fair, open and equal competitive environment and strengthen the dominant position of social organizations in the provision of old-age services through government support and strengthening publicity [18]. Zhong and Zhang proposed that the ways for social organizations to participate in endowment services include raising funds, offering diversified endowment services and participating in the formulation of endowment policies [19]. Kang and Lu pointed out that there are three ways to introduce social capital into endowment services, including a voucher purchase service (aiming at a certain category of person), government allocation or subsidy, public–private cooperation and public–private operation [20]. Although these measures can expand the scale of endowment service supply to a certain extent, there still exists numerous problems, which can be alleviated by drawing on the experience of foreign endowment services. Li pointed out that more than 80 percent of home care services in Japan are provided by various social organizations, and developed countries provide an impartial market atmosphere, sufficient government funds, scientific evaluation system and perfect talent training mechanism for social organizations to participate in home care services [21]. The Australian government has ripe experience in encouraging social enterprises to undertake government-outsourced endowment services. Although the government implements strict qualification examination procedures for social enterprises to participate in endowment service supply, it vigorously supports social enterprises to participate in endowment services through active actions and incentive policies [22]. Cao introduced the multi-organization linkage system of the third sector community endowment service in Scotland. In order to satisfy the personalized needs of the elderly, the Scottish government advocates the model of providing the elderly service through multi-agent cooperation, realizing the cooperation between the government and the third sector through community empowerment and the decentralization of delegation, giving full play to the role of the platform and truly realizing the elderly as the center of the elderly service supply [23].

5. A New Model to Tackle the Issues in China’s Endowment Service Supply

Under the view of welfare pluralism, it is not realistic to rely on a single subject to provide old-age services, so multi-forces have to be taken advantage of to accomplish this task. According to the quadrilateral welfare theory, the social dimension involves multiactors, among which the folk society, workplaces, schools and other organizations have played an irreplaceable role in the practice of the old-aged services at home and abroad. Therefore, in view of the existing problems in China’s current endowment service supply, based on the multiple theories of welfare and previous research results, the paper proposes to build the “116 endowment service supply model”, namely one policy subject, one leading subject and six implementation subjects. The policy subject is the National People’s Congress, responsible for establishing and improving the system of laws, regulations and policies. The leading subject is the Government of the State Council, which is responsible for education and publicity, funding, information services and supervision and inspection. The implementation subjects include families, communities, workplaces, folk society, markets and schools, responsible for the implementation of specific tasks according to the division of labor. The National People’s Congress (NPC) and the government play the role of ensuring the bottom line, top-level design and resource integration, and the six suppliers provide corresponding services according to their own characteristics. Based on the unified national endowment service platform established by the government, all parties will realize intelligent management, integrate various forces, jointly promote the improvement of endowment service supply mode and solve the dilemma in the current endowment service. See Figure 1 for the specific model.
Sustainability 14 06849 g001
Figure 1. The 116 endowment service supply model.

References

  1. Xinhuanet. Available online: http://www.xinhuanet.com/fortune/2020-10/15/c_1126614326.htm (accessed on 14 February 2021).
  2. Li, C.-Y. Typical Experience and Reference of Foreign Social Organizations Participating in Domestic Care Services. J. Ocean. Univ. China (Soc. Sci.) 2015, 6, 94–99.
  3. Evandrou, M.; Glaser, K. Combining work and family life: The pension penalty of caring. Ageing Soc. 2003, 23, 583–601.
  4. Minkler, M. Health Promotion in Long-Term Care: A Contradiction in Terms? Health Educ. Behav. 1984, 11, 77–89.
  5. Ervin, K.E.; Cross, M.; Koschel, A. Working together in lifestory telling for residents in aged care facilities: A qualitative study of staff/family collaboration in aged care. J. Nurs. Educ. Pract. 2013, 3, 102–110.
  6. Bjrk, S.; Lindkvist, M.; Lvheim, H.; Bergland, Å.; Wimo, A.; Edvardsson, D. Exploring resident thriving in relation to the nursing home environment: A cross-ectional study. J. Adv. Nurs. 2018, 74, 2820–2830.
  7. Thimm, A.; Dieckmann, F.; Haler, T. In welchen Wohnsettings leben ltere Menschen mit geistiger Behinderung? Z. Gerontol. Geriatr. 2019, 52, 220–227.
  8. Hunt, L.J.; Stephens, C.E.; Smith, A.K. Palliative Care in the Nursing Home—Shifting Paradigms. JAMA Intern. Med. 2020, 180, 243–244.
  9. Susanne, F.G. Enhancement of hospice philosophy and palliative care competence in nursing homes for seniors through cooperation with an outpatient hospice care service: A practical example. Z. Gerontol. Geriatr. 2021, 54, 13–19.
  10. Arensberg, B.M. Population aging: Opportunity for business expansion, an invitational paper presented at the Asia-Pacific Economic Cooperation (APEC) International Workshop on Adaptation to Population Aging Issues, July 17, 2017, Ha Noi, Viet Nam. J. Health Popul. Nutr. 2018, 37, 7.
  11. Huang, C.-M. Analysis on Issues and Countermeasures on Home Based Care Service from the Perspective of Welfare Pluralism. Soc. Welf. (Theor. Version) 2018, 5, 3–7.
  12. Wang, H.; Han, J.-F. New Model of Mutual Support for the Elderly Aiming at Establishing High-quality Old Age. People’s BBS 2017, 12, 78–79.
  13. Jin, H.-B. “Using Old Service”: A New Way to Solve the Dilemma of China’s Pension. Acad. J. Zhongzhou 2015, 11, 78–83.
  14. Chen, Y.; Huang, S.-Y.; Chen, Y.; Zhang, W. The Predicament of Institutional Endowment in the New Era and the Mechanism Innovation of Medical and Nursing Integration. Reform Strategy 2018, 34, 97–103.
  15. Xu, X.-Y.; Liang, H.-Y.; Zhu, H.-Q. Investigation and Analysis on the Demands of Home Based Endowment services in Guangzhou. China’s Health Serv. Manag. 2017, 34, 537–540.
  16. Guo, L.-N.; Hao, Y. Individual Health, Family Care and Social Provision: Which Side Has a Greater Impact on the Home Care Services Demands of the Senior Citizens. Northwest Popul. 2019, 40, 36–49.
  17. Sheng, Y. Analysis of Countermeasures to Improve the Elderly Service System Led by Hangzhou Urban Area and participated Coordinately by Multiple Entities. Econ. Res. 2017, 19, 124.
  18. Ling, D.-Z.; Song, Q.-L. Issues and Countermeasures on Social Forces Participating in Endowment Service Industry in Guangxi Zhuang Autonomous Region from the Perspective of Aging. Chin. J. Gerontol. 2017, 37, 5479–5481.
  19. Zhong, W.; Zhang, Z.-J. The Path and Optimization of Social Organizations Participating in Old-age Service in Ethnic Areas. J. Anhui Univ. Technol. (Social Sci. Ed.) 2018, 35, 26–29.
  20. Kang, R.; Lv, X.-J. Investigation on the Present Situation of Social Capital Participation in Home Care Service: A Case Study of Beijing. Urban Issues 2018, 3, 89–96.
  21. Li, C.-Y.; Zhang, J.-G. Construction of old-age service system from the perspective of enabling government: International experience. J. Tianjin Inst. Adm. 2014, 16, 106–111.
  22. Lei, Y.-R. Experience and Inspiration of Australian Social Enterprises Undertaking Government Pension Service Supply–Based on A Case Study of Social Enterprise. New Horiz. 2017, 4, 111–115.
  23. Cao, M.-Y. Analysis on Multi-organization Linkage System of the Third Sector Community Elderly Care Service in Scotland. China Adm. 2020, 1, 142–148.
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