消费水平、就医关注与养老模式偏好——论医养结合制约因素的破解

Consumption Levels,Medical Concerns and Preferences for Pension Models——The Discussion on Breaking the Restrictive Factors of the Combination of Medical Care and Elderly Care

中国医养结合面临的最主要制约因素是医疗服务与养老服务体系相互割裂、服务链断裂,老年人养老照料和医疗服务需求无法同时得到满足,医养结合有“名”无“实”。基于2018年C市老年人调查的万份数据,以消费水平作为中间变量,探讨“医”(就医关注)与“养”(养老模式偏好)的关系。实证结果显示,随着月消费水平的不断提高,老年人越关注医疗费用和医疗水平,且对医疗水平关注度更高。就医关注的侧重点不同影响养老模式偏好:相对于就医渠道,对医疗费用越关注,老年人越倾向社区居家养老;对医疗水平越关注,老年人越倾向机构养老,且消费水平在就医关注对养老模式偏好选择上具有促进作用。因此,应探索建立“家庭医生+养老机构+医疗机构”的“融合—联动式”医养结合差异化供给模式,即对关注医疗费用且偏好社区居家养老的老年人,构建“首诊在家庭医生+转诊经社区+大病转诊医院”模式;对关注医疗水平且偏好机构养老的老年人,构建“首诊在医养机构+转诊经社区+大病转诊医院”模式。

The main restrictive factor facing the combination of medical care and elderly care in China is that the medical service and elderly care service system are separated from each other and the service chain is broken.The demand of the elderly for care and medical services cannot be met at the same time,and the integration is only a formality.Based on more than 10,000 data from the 2018 survey of the elderly in City C,this paper takes the consumption level as an intermediate variable to explore the relationship between “medical care”(medical concerns)and “elderly care”(preferences for pension models).The empirical results show that,firstly,with the continuous improvement of monthly consumption level,the elderly are more concerned about the medical expenses and medical level,and pay more attention to the latter.Secondly,the different focus on medical care affects the preference of pension models:compared with medical channels,the more concerned about medical expenses,the more the elderly prefer community-based and home-based care;the more concerned about the medical level,the more the elderly prefer institutional care.Moreover,the consumption level has a promoting role in the influence of medical concerns on pension model preference.Therefore,this paper proposes to explore the establishment of a “integration-linkage” differentiated supply model of “family doctor +elderly care institution+medical institution”:construct the model of “first diagnosis in family doctor+referral through community+referral hospital for serious illness”,for the elderly who are concerned about medical expenses and prefer community-based and home-based care;build a model of “first diagnosis in a medical and elderly care institution+referral through community+referral hospital for serious illness”,for the elderly who are concerned about the medical level and prefer institutional care.