我国居家社区医养结合服务筹资政策分析

Analysis of the financing policy about community-dwelling integrated medical and elderly care services in China

目的:对2013年以来国家层面发布的居家社区医养结合服务筹资相关政策进行分析。方法:以“医养结合”“居家社区”等为关键词检索国家卫生健康委、民政部等相关政府部门官方网站2013年1月—2021年9月发布的政策文件;对纳入政策文本进行编码和主题框架分析。结果:共纳入28项相关政策,国家卫生健康委参与发文最多(19项),其次为民政部(14项)。纳入政策涉及的筹资主题包括财政经费支持(14项)、保险制度(基本医疗保险、长期护理保险和商业保险)(19项)、社会资本(10项)、投融资和财税价格政策(5项)以及其他(福利彩票和社会捐赠)(3项)五类主题。现有居家社区医养结合服务筹资政策的资金筹集和风险分摊功能亟待提高。结论:国家应从顶层设计层面进一步明确国家、社会和个人在居家社区医养结合服务筹资的责任,加强资金风险分摊原则,以实现充足、可持续的筹资目标;加强对不同举办主体机构筹资政策安排的均衡性,确保社会资本和公立基层医疗机构的有效参与;同时注意加强政策内容的可操作性和具体化,促进政策落地与实施。

Objective: To analyze the national policies regarding the financing of community-dwelling based integrated medical and elderly care services since 2013. Methods: Policy documents published by official websites of related government departments including National Health Commission and Ministry of Civil Affairs from January 2013 to September 2021 were searched with the key words “integrated medical and elderly care” “community-dwelling” etc. Codirg and thematic framework analysis were used to analyze the included policy texts. Results: A total of 28 policies were included in this study, which included a maximum of 19 from National Health Commission followed by 14 from Ministry of Civil Affairs. The included policies covered a total of 5 financing themes, including financial support(14 policies), insurance policy(basic medical insurance, long-term medical care insurance and commercial insurance)(19 policies), social capital(10 policies), investment and tax price policy(5 policies), and others(welfare lottery and social donation)(3 policies). The revenue collection and risk pooling function of the current financing policy of community-dwelling based integrated medical and elderly care services needs to be improved. Conclusion: Chinese government should use top-level design to further clarify the responsibilities of government, society and individuals in the financing of community-dwelling based integrated medical and elderly care services, and strengthen the principle of risk pooling, to achieve sufficient and sustainable financing goals. The government should strengthen the balance of financing policy arrangement among different related institutions to ensure the efficient engagement of social capital and public primary healthcare institutions. In the meanwhile, the operability and specificity of policy contents need to be strengthened, to promote the implementation of the policies in practice.