Problems faced in the work and countermeasures of the integrated medical and elderly care in China
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摘要:
目的 分析我国医养结合工作开展现状，总结现有医养结合工作中存在的问题并进行深入剖析，并提出针对性改进策略。 方法 以“医养结合/医养融合”“发展”“问题”“效果”“现况”为中文检索词；以“integrated medical and elderly care/integrated medical and nursing care/integrted care”“development”“problems”“effect”“current situation”为英文检索词，检索PubMed、Web of Science、中国知网(CNKI)、维普网、万方数据知识服务平台等数据库，Google学术及百度学术等搜索引擎，检索时间为2018年1月—2023年10月。对纳入文献进行整理分析，按照文献提及率梳理目前医养结合存在的主要问题；并通过德尔菲专家咨询法，按照重要性和严重程度将医养结合模式存在的问题进行排序；通过文献提及率进行排名和专家访谈进行的排名数值相加从低到高得出综合排序。 结果 提炼出顶层设计制度不健全、服务主体能力不足、供需失衡、养老经济负担沉重、信息平台建设不足、知晓度不够、缺乏长效激励机制、监督机制不完善、机构联动松散、区域差异明显与创新力度不足等十大核心问题。 结论 构建中国特色的医养结合模式高质量发展应以建立健全制度保障为支撑、供需双方平衡、深化信息化建设、供给主体协同合作等，实现医疗资源有效利用，达到健康、有序、稳定的发展模式。 Abstract:Objective This paper analyzes the current situation of the integrated medical and elderly care work in China, summarizes the existing problems in the integrated medical and elderly care work and makes an in-depth analysis, and puts forward some suggestions for improvement. Methods The Chinese search and English search terms were "integrated medical and elderly care/integrated medical and nursing care" "development" "problems" "effect" and "current situation". Retrieve PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, WanFang Data Knowledge Service Platform and other databases, Google Scholar, Baidu Scholar, and other search engines. The retrieval time was from January 2018 to October 2023. The included literature was sorted out and analyzed, and according to the literature mention rate, the main problems existing in the current integrated medical and elderly care are sorted out. Through the Delphi expert consultation method, the problems existing in the integrated medical and elderly care mode are sorted according to importance and severity. A comprehensive ranking is obtained by adding the ranking values from low to high through the literature mention rate and the ranking values from expert interviews. Results Ten core problems are extracted, such as imperfect top-level design system, insufficient capacity of service subjects, the imbalance between supply and demand, the heavy burden of pension economy, insufficient construction of information platform, insufficient awareness, lack of long-term incentive mechanism, imperfect supervision mechanism, loose institutional linkage, obvious regional differences, and insufficient innovation. Conclusion The high-quality development of the integrated medical and elderly care model with Chinese characteristics should be supported by the establishment of a sound system guarantee, the balance between supply and demand, the deepening of information construction, and the coordination and cooperation of supply subjects, to realize the effective utilization of medical resources and achieve a healthy, orderly and stable development model. -
Key words:
- Integrated medical and elderly care /
- Development /
- Problem /
- Countermeasures
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表 1 我国医养结合政策发展历程
Table 1. The development process of integrated medical and elderly care policy in China
政策名称 时间 类型 关键点 部门 《关于加快发展养老服务业的若干意见》 2013年9月 意见 首次提出“医养结合”概念 国务院 《关于促进健康服务业发展的若干意见》 2013年9月 意见 推进医疗与养老机构合作 国务院 《关于推进医疗卫生与养老服务相结合指导意见的通知》 2015年11月 通知 初步建立医养结合政策体系、标准规范和管理制度 国家卫生和计划生育委员会 《关于确定第一批国家级医养结合试点单位的通知》 2016年6月 通知 确定第一批国家级医养结合试点单位 国家卫生和计划生育委员会 《“健康中国2030”规划纲要》 2016年10月 通知 医疗服务延伸至社区、家庭 国务院 《“十三五”国家老龄事业发展和养老体系建设规划》 2017年2月 通知 健全养老保险制度、养老服务体系 国务院 《国家积极应对人口老龄化中长期规划》 2019年11月 通知 坚持供给侧结构性改革 国务院 《关于建立健全养老服务综合监管制度促进养老服务高质量发展的意见》 2020年12月 意见 深化养老服务体制改革，促进养老服务的高质量发展 国务院 《关于印发“十四五”国家老龄事业发展和养老服务体系规划的通知》 2022年2月 通知 构建和完善兜底性、普惠型、多样化的养老服务体系 国务院 《关于进一步推进医养结合发展的指导意见》 2022年7月 意见 强调完善多部门协同机制，推动医养有机衔接 国家卫生健康委员会 
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表 2 目前医养结合发展模式面临的核心问题
Table 2. Main key problems of the resistance of integrated medical and elderly care development models at present
核心问题 属性 具体内容 文献提及率(%) 文献提及排序 专家论证排序 综合排序 顶层设计 机制 政府多头管理，政策碎片化，落实难 94.7(108/114) 1 1 1 供给能力 机构 医疗资源配置不足，服务形式雷同化 93.8(107/114) 2 3 2 供需失衡 供需 多样性、多层次的需求与服务单一化的错配 92.1(105/114) 3 2 3 养老经济 需求 老人经济收入偏低；医保报销制度不完善 91.2(104/114) 4 5 5 信息平台 信息 信息“孤立化”，数据共享平台缺失 90.4(103/114) 5 4 4 知晓程度 需求 医养结合养老服务模式知晓途径匮乏 89.5(102/114) 6 8 7 缺乏激励 机制 缺乏长效激励政策支持，供给积极性差 87.7(100/114) 7 6 6 监督机制 机制 缺乏监督管理制度，法律法规保障不健全 86.8(99/114) 8 7 8 联动松散 机构 “医”与“养”联动松散，分离现象明显 83.3(95/114) 9 9 9 区域差异 机制 城乡差异明显，养老资源利用不足问题突出 78.9(90/114) 10 10 10
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