Henrard J C
Hôpital Ste Périne, Université René Descartes, Paris.
Rev Epidemiol Sante Publique. 1987;35(3-4):298-308.
The social welfare policy, adopted in the 1970s, of devising ways to help the aged to remain in their homes and adapting institutions to the problems of the very old was instituted without being integrated into the incentive programs of such other sectors as public health and housing. The result has been a patchwork of services and centers whose organization, financing, and allowances are fragmented among a multitude of agencies. In addition, there is an imbalance of resources among the different sectors providing medical care and social welfare assistance. This makes for substantial difficulties in coordinating the activities of service providers and in financing some of the services. Moreover, inflexibility is apparent in adjusting types of services to varied and evolving needs. These problems explain the gaps, disjointed character of care, and faulty guidance in the system of distributing assistance that constitute so many blockages of the pathways used by the elderly. Such blockages cannot be usefully examined by analyzing the overall system, but must be studied at local points of convergence among clients, services and institutions. Such research is presently being conducted by the Concerted Action Committee of the European Community's Health Service Research.
20世纪70年代采取的社会福利政策，旨在想方设法帮助老年人居家养老，并使机构适应高龄老人的问题，但该政策在制定时并未纳入公共卫生和住房等其他部门的激励计划。其结果是，服务和中心拼凑而成，其组织、资金和津贴分散在众多机构之中。此外，提供医疗保健和社会福利援助的不同部门之间资源分配不均。这给协调服务提供者的活动以及为某些服务提供资金带来了巨大困难。此外，在根据多样化且不断变化的需求调整服务类型方面明显缺乏灵活性。这些问题解释了援助分配体系中存在的差距、护理的脱节特征以及错误引导，这些构成了老年人使用的众多途径中的诸多障碍。通过分析整个系统无法有效地审视这些障碍，而必须在客户、服务和机构的地方交汇点进行研究。目前，欧洲共同体卫生服务研究协调行动委员会正在开展此类研究。
