摘要
本文以2017年全国养老服务业医养结合典型案例为对象,运用扎根理论方法,探索医养结合养老模式实践逻辑。研究发现,医养结合养老模式具有主体互动逻辑与生产过程逻辑两条主线,两条逻辑线交叉融合,"基于主体互动、实现价值共生"的主体互动逻辑贯穿医养结合全过程。医养结合养老模式的运行由适应性主体的互动产生,其生产过程为医养服务的共同生产,包括共同设计、共同提供与共同评估,以及贯穿这三个环节的共同管理。该结论对于破解医养结合实践中关键环节缺失、机制不健全、运行不顺畅等问题与推广其有益经验具有启发意义,实现路径包括重塑医养结合实践逻辑、发挥老年人主观能动性、优化医养结合战略协同策略和创新医养服务方式。本研究将医养结合养老模式的实践逻辑从服务提供延伸到服务设计、服务评价、服务管理的全过程,并扩展和丰富了共同生产理论的范围与内涵,对实现健康中国战略目标具有重要的理论价值与实践意义。
The objective of this paper is to explore the practical logic of the integration mode of medical care and endowment.An exploratory multi-case study,involving eight cases about the integration mode of medical care and endowment,from the 2017 national elderly service typical case database,was conducted in this paper.The practical logic of the integration mode of medical care and endowment has two clues,including the logic of subject interaction and the logic of production process.And these two lines are cross and fuse.The logic,based on subject interaction and value symbiosis,runs through the whole process.The mode is generated by adaptive subject interaction.The production process is the co-production of medical care service and aging service,including co-design,co-provision,co-evaluation and co-management through the first three links.The key limitation of the study is that it focuses solely on good national cases,selected from the 2017 national aging service typical cases database,which is representative to some extent.However,the scale of case selection needs to be further expanded and the richness of cases needs to be further improved.The conclusion is important for solving the problems of missing key links,imperfect mechanism and unsmooth operation of the integration mode of medical care and endowment,and it is beneficial to spread the experience of the mode.Based on the results,several approaches are proposed to optimize the mode,including reconstructing co-production process of the elderly service,promoting the initiative of the elderly,optimizing the strategy and innovating the service patterns.The study extends the practical logic of the integration mode of medical care and endowment from the service delivery to the whole process,including service design,service delivery,service evaluation and service management.The study explores the main logic line running through the mode-"realizing value symbiosis based on subject interaction".In addition,the study also extends the scope and enriches the connotation of the co-production theory.
作者
封铁英
南妍
Feng Tieying;Nan Yan(School of Public Policy and Administration,Xi’an Jiaotong University,Xi’an,710049,China)
出处
《公共管理学报》
CSSCI
北大核心
2020年第3期113-125,173,共14页
Journal of Public Management
基金
国家社会科学基金重点项目(17AJL015)。
关键词
医养结合
养老模式
实践逻辑
路径选择
扎根理论
Medical Care Integrated with Endowment
Aging Service Mode
Practical Logic
Path Selection
Grounded Theory