社区居家医养结合服务公私合作模式的影响因素——基于H市的扎根理论研究

Influencing factors of Public-Private-Partnership Model of community-home-based medical and elderly care services:A Grounded Theory research based on H City

为探讨社区居家医养结合服务公私合作模式的影响因素,本研究运用扎根理论法,通过三级编码构建出社区居家医养结合服务公私合作模式的影响因素理论模型。结果发现,社区居家医养结合服务公私合作模式的影响因素包括制度环境、合作管理和主体能力三个维度,制度环境因素包括医养结合管理体制障碍、医养结合公私合作的法律法规不健全、医养结合支付制度不完善、社区居家医养结合服务标准缺失;合作管理因素包括合作目标有冲突、合作契约不规范、合作机制不完善、合作关系缺乏信任;主体能力因素包括政府方的协调不力和财力有限,社会资本方的缺乏社会责任感和资金来源,服务提供方的人才短缺问题,以及老年人的养老观念落后和养老消费能力有限。

To explore the influencing factors of the public-private-partnership(PPP)model of community-home-based medical and elderly care services,this study applies grounded theory into constructing a theoretical model of influencing factors of the PPP model of community-home-based medical care and nursing services with three-level coding.Results show that influencing factors of the PPP model of community-home-based medical care combined services include three dimensions:institutional environment,cooperation management and subject capacity.Institutional environmental factors include institutional obstacles in the management of the combination of medical and elderly care,imperfection of laws and regulations concerning PPP in the combination of medical and elderly care,defective payment systems supporting this combination,and incomplete criteria for its assessment.Factors of cooperation management include divisive objectives,non-standard contracts,imperfect mechanisms,and lack of trust in cooperative relationships.Subject capacity factors include poor coordination and limited financial support from the government,lack of social responsibility and funding of the social capital resources,shortage in skillful people needed from service providers,and outdated understanding about elderly care of the senior as well as their limited consumption capacity.