上海市中心城区长期护理保险服务质量调查

摘要: 目的评估长期护理保险服务对象的需求和满意度, 了解长期护理保险服务推广后是否达到预期。方法研究对象来自上海市中心3个社区，每个社区于2021年1—12月从通过评估失能程度为2~6级且享受相应的长期护理保险待遇的居民中，各抽取80名居民。调查内容分为2个部分，(1)个人基本情况；(2)长期护理服务质量评价：基于SERVPERF(Service Performance)模型，构建移情性、可靠性、响应性、保证性、感知性5个评价维度，每个维度对应设计3~5个评价指标，共20个指标对长期护理服务质量进行评价。结果 240名服务对象中, 男性78名(32.50%)，女性162名(67.50%)；其中90.42%(217/240)为70岁及以上的老人；已婚122人(50.83%)、丧偶106人(44.17%)；服务的地点主要为社区居家；健康状况和自理能力以一般(49.58%)和不健康(33.75%)、自理有困难(42.08%)和基本自理(34.17%)为主；需求2~3级护理占58.75%。本次调查的长期护理服务质量的整体评价总分为4.408分，处在比较好和非常好的范围内。5个维度的得分从高到低依次是：响应性、可靠性、感知性、保证性和移情性。结论服务对象对长期护理服务质量的整体评价是满意的，但不能满足不同等级服务对象的护理需求。
- 长期护理服务 /
- 长期护理保险 /
- 服务质量
Abstract: Objective To evaluate clients' needs and satisfaction with long-term care insurance, and understand whether or not the desired target is achieved after the long-term care insurance service promotion. Methods The research subject came from three communities located in the centre of Shanghai from January to December 2021, and a total of 80 residents who were involved in the corresponding long-term care insurance were randomly selected from each community. The outcomes rank from levels 2 to 6 by evaluating their disabilities. The survey involves two parts: (1) personal information; (2) quality evaluation from long-term care services: based on SERVPERF (Service Performance) model, five dimensions of empathy, reliability, responsiveness, assurance and perception were constructed, and each dimension was designed with 3-5 evaluation indicators, and a total of 20 indicators were used to evaluate the quality of long-term care services. Results A total of 240 people were involved, including 78 males (50.83%) and 162 females (67.50%); among them, 90.42% (217/240) were 70 years old or above; 122 were married (50.83%) and 106 were widows (44.17%); the service location was mainly community home; health situations and self-care ability were mainly including general (49.58%), unhealthy (33.75%), with disability (42.08%) and ability with self-care (34.17%); 58.75% of them were required for level 2-3 care. The overall evaluation score of long-term care service quality in this survey was 4.408, which was in a relatively good and very good range. The five aspects ranked from top to the bottom were responsiveness, reliability, perception, assurance and empathy. Conclusion The overall evaluation outcome stays positive. However, it cannot satisfy the needs of different disability levels of the elderly.
- Long-term care service /
- Long-term care insurance /
- Quality of service

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表 1 240名长期护理保险服务对象的基本情况调查[人(%)]

Table 1. Basic situation survey of 240 long term care insurance clients [cases (%)]

项目	类别	人数	老西门社区	淮海社区	南东社区
性别	男性	78	30(38.46)	25(32.05)	23(29.49)
	女性	162	50(30.86)	55(33.95)	57(35.19)
年龄(岁)	60~69	23	7(30.43)	14(60.87)	2(8.70)
	70~79	78	14(17.95)	30(38.46)	34(43.59)
	80~89	88	32(36.36)	30(34.09)	26(29.55)
	≥90	51	27(52.94)	6(11.76)	18(35.29)
文化程度	从未上过学	13	4(30.77)	2(15.38)	7(53.85)
	小学	80	28(35.00)	26(32.50)	26(32.50)
	初中	94	35(37.23)	37(39.36)	22(23.40)
	高中	28	9(32.14)	7(25.00)	12(42.86)
	大专及以上	25	4(16.00)	8(32.00)	13(52.00)
婚姻状况	未婚	8	3(37.50)	1(12.50)	4(50.00)
	已婚	122	48(39.34)	43(35.25)	31(25.41)
	离婚	4	2(50.00)	2(50.00)	0
	丧偶	106	27(25.47)	34(32.08)	45(42.45)
居住方式	独居	72	21(29.17)	20(27.78)	31(43.06)
	两老同住	88	37(42.05)	38(43.18)	13(14.77)
	单独与子女同住	58	14(24.14)	14(24.14)	30(51.72)
	两老与子女同住	11	4(36.36)	5(45.45)	2(18.18)
	其他	11	4(36.36)	3(27.27)	4(36.36)
退休前职业	企业工人	99	33(33.33)	32(32.32)	34(34.34)
	个体或私营企业主	34	9(26.47)	10(29.41)	15(44.12)
	公务员或事业单位人员	41	16(39.02)	13(31.71)	12(29.27)
	其他	66	22(33.33)	25(37.88)	19(28.79)
月收入(元)	＜3 000	2	1(50.00)	1(50.00)	0
	3 000~＜4 000	70	31(44.29)	29(41.43)	10(14.29)
	4 000~＜5 000	132	36(27.27)	42(31.82)	54(40.91)
	≥5 000	36	12(33.33)	8(22.22)	16(44.44)
生活来源^a	养老金	220	71(32.27)	73(33.18)	76(34.55)
	子女供养	116	48(41.38)	64(55.17)	4(3.45)
	配偶供养	4	1(25.00)	1(25.00)	2(50.00)
	房租利息存款	74	26(35.14)	44(59.46)	4(5.41)
健康状况	非常健康	3	0	1(33.33)	2(66.67)
	健康	22	0	14(63.64)	8(36.36)
	一般	119	29(24.37)	56(47.06)	34(28.57)
	不健康	81	43(53.09)	8(9.88)	30(37.04)
	非常差	15	8(53.33)	1(6.67)	6(40.00)
生活自理能力	完全自理	12	1(8.33)	7(58.33)	4(33.33)
	基本自理	82	15(18.29)	36(43.90)	31(37.80)
	自理有困难	101	45(44.55)	26(25.74)	30(29.70)
	不能自理	30	12(40.00)	5(16.67)	13(43.33)
	完全不能自理	15	7(46.67)	6(40.00)	2(13.33)
从哪里获得长期护理服务	社区居家	225	77(34.22)	77(34.22)	71(31.56)
	养老机构	15	3(20.00)	3(20.00)	9(60.00)
护理需求	2~3级	141	49(34.75)	60(42.55)	32(22.70)
	4级	45	14(31.11)	9(20.00)	22(48.89)
	5级	30	6(20.00)	2(6.67)	22(73.33)
	6级	24	11(45.83)	9(37.50)	4(16.67)
注：^a调查显示居民生活来源多样化。

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表 2 评语集隶属度

Table 2. Membership degree of comments set

维度		指标	评语集
维度		指标	非常差	比较差	一般	非常好	比较好
感知性	A1	护理服务内容丰富	< 0.001	< 0.001	0.025	0.429	0.546
	A2	服务人员热情礼貌	< 0.001	< 0.001	0.013	0.496	0.492
	A3	服务态度认真耐心	< 0.001	< 0.001	0.054	0.650	0.296
	A4	护理人员细心周到	< 0.001	< 0.001	0.042	0.333	0.625
保证性	B1	能够按时获得服务	< 0.001	< 0.001	0.058	0.450	0.492
	B2	服务能够满足需求	< 0.001	< 0.001	0.050	0.438	0.513
	B3	服务时间足时充裕	< 0.001	0.063	0.175	0.363	0.400
	B4	服务价格适当合理	< 0.001	< 0.001	0.025	0.450	0.525
响应性	C1	老人有需要能及时响应	< 0.001	< 0.001	< 0.001	0.546	0.454
	C2	基本生活照料细致到位	< 0.001	< 0.001	0.025	0.604	0.371
	C3	服务人员工作熟练可靠	< 0.001	< 0.001	0.042	0.392	0.567
可靠性	D1	服务设备先进齐全	0.025	0.013	0.025	0.504	0.433
	D2	定期检查询问身体	< 0.001	< 0.001	0.063	0.546	0.392
	D3	服务人员专业水平高	< 0.001	< 0.001	0.050	0.379	0.571
	D4	身体健康状况有所改善	< 0.001	< 0.001	0.058	0.508	0.433
	D5	医疗护理费用有所减少	0.004	0.021	0.113	0.546	0.317
移情性	E1	主动关心帮助老人	< 0.001	< 0.001	0.025	0.463	0.513
	E2	经常与老人交流聊天	< 0.001	< 0.001	0.125	0.421	0.454
	E3	根据老人自身情况提供服务	< 0.001	< 0.001	0.104	0.442	0.454
	E4	根据老人需要调整服务时间	< 0.001	0.046	0.088	0.392	0.475

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表 3 240名长护险服务对象对长期护理服务质量评价结果(分)

Table 3. Evaluation results of long-term care service quality of 240 long-term care insurance clients (points)

目标层	得分	准则层	得分	指标层	得分
		感知性	4.371	护理服务内容丰富	4.521
				服务人员热情礼貌	4.479
				服务态度认真耐心	4.242
				护理人员细心周到	4.583
		保证性	4.366	能够按时获得服务	4.433
				服务能够满足需求	4.463
				服务时间足时充裕	4.100
				服务价格适当合理	4.500
		响应性	4.461	老人有需要能及时响应	4.454
长期护理服务质量	4.408			基本生活照料细致到位	4.346
				服务人员工作熟练可靠	4.525
		可靠性	4.430	服务设备先进齐全	4.308
				定期检查询问身体	4.329
				服务人员专业水平高	4.521
				身体健康状况有所改善	4.375
				医疗护理费用有所减少	4.150
		移情性	4.351	主动关心帮助老人	4.488
				经常与老人交流聊天	4.329
				根据老人自身情况提供服务	4.350
				根据老人需要调整服务时间	4.296

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