超越多重博弈的医养结合机制建构论析——我国医养结合型养老模式的困境与出路

Separation,Bureaucracy and Multiple Interactions and conflicts: Challenges to Integrated Aged Care Model in China

党的十九大阐述新时代民生和养老事业发展时强调指出,必须从体制政策诸方面着手,积极推进医养结合,加快老龄事业和产业发展。根据十九大要求检视我国养老事业可见,目前,我国养老服务体系存在显著的医养分离问题,由于医养结合涉及诸多主体之间的利益分配,我国政府部门在构建医养结合型养老服务模式过程中,面临着科层性体制造成的部门合作难度大、断裂性医保机制造成的医养对接难和孱弱性激励机制造成的专业医护人员匮乏等难题。本文以博弈论的理论逻辑,透过这些表象困境深究其原因,由此发现,我国医养结合模式中存在的多种代理关系,隐含的多重复杂博弈行为,导致协同治理关系难以构建;在这种多种代理和多重博弈关系中,作为博弈主体的政府相关职能部门、医养机构、老年群体具有各自不同的约束条件、利益诉求、动力机制和策略选择。据此,文章从结构性改革和政策制定,医疗与养老服务机构的机制衔接以及建立健全长期护理保险制度三个维度出发,探讨了我国医养结合型养老模式的构建路径,希冀有效整合养老服务与医疗资源,以最大限度满足老年人群体医养护一体化需求。

A great separation between social care and health care exists in China’s current aged care system,and China is on a path to set up an integrated aged care modelHowever,since this model involves contestation of benefits among different stakeholders,China faces many practical challengesThese challenges include the hard cooperation leaded by our current bureaucratic system,the difficult joint of social care system and health care system influenced by the discontinuous health care mechanism,and the lack of health care professionals and care workers resulted in the frail incentive mechanism.Based on the logic of interest game theory,this paper tries to seek out the underlying cause behind the appearance challengesIt is found that the deep reason is that there are multi-level agent relationships which imply multiple complicated interest interactions and conflicts in China’s integrated aged care modelAs stakeholders are different in resource constraints,preference of interests and strategic choices,it is difficult to set up a relationship of cooperation governance.Hence,this paper discusses the probable construction paths from structural reforming,policy-making,and cohesive mechanism of social care and health care,and hopes to meet the seniors’demands at the maximum through integrating aged care resources and health care resources effectively.