民族地区“医养结合”耦合模式选择、层级体系构建与实践策略——基于粤北N自治县和S自治县的考察

The Selection of the Coupled Mode of“Integration of Medical Treatment with Life Maintenance”,the Construction of the Hierarchical System and Practice Strategies in Ethnic Minority Areas:An Investigation Study of N and S Autonomous Counties in Northern Guangdong

民族地区发展“医养结合”养老服务事业是政策导向和现实需求,但仍未建成覆盖农村基层和功能齐全的“医养结合”养老服务体系。基于粤北N自治县和S自治县的考察,研究农村基层组织、民族老年人家庭、镇敬老院、县城社区、县社会福利院等养老服务供给主体与乡村医生、村卫生站、镇中心卫生院、县级医院等医疗服务供给主体耦合的“医养结合”养老服务供给模式。从两县自然村、行政村、行政镇、县城社区、全县5个区域层级入手,比较分析两县各层级耦合模式的运行状况,总结“医养结合”适宜模式、待全面实施模式、不适宜模式和耦合关键点,进而构建“医养结合”养老服务供给侧层级体系,据此提出患病老年人“医养结合”养老服务决策路径。最后,针对耦合关键点和存在问题对每个区域层级提出实践策略。

It is the policy guidance and practical demand to develop the elderly care service of“integration of medical treatment with life maintenance”in ethnic minority areas of China.However,it has not yet established a comprehensive and well-functional rural grassroots system for the elderly.This field investigation of N and S autonomous counties in northern Guangdong focuses on the elderly care service model of“integration of medical treatment with life maintenance”,which is coupled with rural grassroots organizations,ethnic minority families with elderly members,township homes for the aged,county-level communities,county-level social welfare homes,etc.,as well as village doctors,village health centers,township central hospitals and county hospitals,etc.Starting from the five regional levels of natural villages,administrative villages,administrative towns,county-level communities and the whole county,it compares and analyzes the operation status of the coupled modes at different levels,and then discusses the appropriate mode,the mode to be fully implemented,the inappropriate mode and the key points of each coupled mode.Furthermore,it constructs the hierarchical system of the supply side and accordingly puts forward the decision-making path for the elderly with illness under the guidance of“integration of medical treatment with life maintenance”.Finally,aiming at the relevant key points and existing problems,it puts forward the practice strategies on the supply side at each regional level.