目标、机制和评价:以整合为焦点的医养结合分析框架

Target,Mechanism,and Evaluation:An Analytical Framework of Integrated Medical Treatment and Rehabilitation Focusing on Integration

医养结合中的重点不在医和养的地位比较上,关键应放在“结合”上。我国养老服务体系建设必须进行社会结构和制度再造,打破原有政策碎片化、管理部门化、医养资源分割、照护功能不连续的局面,从整体上建构集“预防保健、疾病治疗、康复护理、生活照料”一体化的整合照护体系。在澄清现有关于医养结合概念争论的基础上,从整合的背景和目标、整合的层次和机制以及整合评估三个方面给出了医养结合研究的分析框架。认为应借鉴发达国家整合照护的成熟经验并结合中国医养结合的政策实践,以“整合”为基本立足点,从服务、组织(社区)和政策三个维度建构从微观到中观再到宏观的整合照护体系。

The point of medical treatment and rehabilitation integration is not the comparative status of one over the other but the combination.China’s construction of the old-age services system must reshape the social structure and system,solving the problems including the fragmentation of policy,the departmentalization of management,the segmentation of medical and rehabilitation resources,and the discontinuity of nursing functions.An integrated nursing system should be established as a whole to cover prevention and healthcare,treatment of disease,rehabilitation and nursing,and daily care.Arguments over the concept of medical treatment and rehabilitation integration are clarified,based on which an analytical framework for the study of medical treatment and rehabilitation integration is formed from the following three aspects:the background and target of integration,the levels and mechanism of integration,and the evaluation of integration.It is suggested that with integration the basic standpoint,an integrated nursing system can be constructed on the three dimensions of service,organization(community),and policy;during the process,the mature experience of developed countries in integrated nursing can be referred to in combination with China’s policy and practice of medical treatment and rehabilitation integration.