社区医养结合服务包运行的保障问题与对策——基于上海市普陀区的实证研究

Study on the Problems and Strategies of Integrating Pension Service with Medical Service Package Security in Community——A Case Study of Putuo District of Shanghai

目的了解上海市普陀区社区医养结合服务包运行的保障现况,剖析存在的问题并提出相应对策,为社区医养结合工作的有序开展提供指导。方法采用判断抽样法,选取上海市普陀区四类典型社区"医养结合"服务模式的试点单位,对各类模式的服务保障,成本、定价、考核和结算等资金支持情况,服务保障评价等进行调研。结果在保障内容方面,社区医养结合服务包所需的人、机、料、法和环的保障要素基本完善。在社区医养结合服务包运行的资金支持方面,除了"多点执业"模式下,养老机构需要按照全科医生半天的机会成本支付给全科医生个人常规上门查床巡诊的费用外,其他均参照中心内原有的收费体系。服务保障评价方面,试点单位对医务人员执业保障、结算办法、供需匹配和医务人员紧缺等方面表示担忧。结论社区医养结合服务包存在服务环境保障不足、服务内容供需不匹配、医务人员执业保障不健全和结算方法不便利等问题,需要政府和供方从深入挖掘老年人的医疗卫生服务需求、加强医养结合人才队伍的建设、完善医务人员多点执业相关法律制度和借助信息化改善医疗服务结算办法等方面做出努力。

OBJECTIVE To understand the prevalence of the integrating pension service with medical service package security in Putuo District of Shanghai, and to analyze the existing problems in the construction process and propose corresponding countermeasures, so as to provide peers a reference for the orderly development of integrating pension service with medical service.METHODS With the method of judging sampling method, 4 pilot units of integrating pension service with medical service were selected as research. The smwey content included service security, financial support including cost, pricing, assessment, settlement and evaluation of service security. RESULTS The results of the survey showed that the security elements that package needed included people, machines, materials, methods and environment, which were basically complete in the units in this smwey. Concerning to the financial support, the pension institution needed to pay the GP＇ s half-day opportunistic cost to the GP＇ s individual for the visits and bed check in ＂muhiple-site physician practice＂ mode, while other services got financial support refer to the original fee system in the centers： if the service was in the charge list, the service fee was settled by the individual to communily health centers. The evaluation of service security showed that, pilot units expressed concern about the medical personnel＇ s practice protection, settlement procedures, difference between supply and demand, and shortage of medical personnel. CONCLUSION There were problems such as lack of service environment protection, mismatch of service content between sup-ply and demand, unsound medical staff＇ s protection, and inconvenience of settlement methods in communily medical service package, which required the government and suppliers to dig deeper into the needs of the elderly for medical and health services, and make efforts to build a team of qualified medical personnel, as well as to improve the relevant legal systems of muhiple-site physician practice and im-prove the settlement of medical services with informtization.