我国医养结合工作面临的问题与对策研究

Problems faced in the work and countermeasures of the integrated medical and elderly care in China

目的分析我国医养结合工作开展现状,总结现有医养结合工作中存在的问题并进行深入剖析,并提出针对性改进策略。方法以“医养结合/医养融合”“发展”“问题”“效果”“现况”为中文检索词;以“integrated medical and elderly care/integrated medical and nursing care/integrted care”“development”“problems”“effect”“current situation”为英文检索词,检索PubMed、Web of Science、中国知网(CNKI)、维普网、万方数据知识服务平台等数据库,Google学术及百度学术等搜索引擎,检索时间为2018年1月—2023年10月。对纳入文献进行整理分析,按照文献提及率梳理目前医养结合存在的主要问题;并通过德尔菲专家咨询法,按照重要性和严重程度将医养结合模式存在的问题进行排序;通过文献提及率进行排名和专家访谈进行的排名数值相加从低到高得出综合排序。结果提炼出顶层设计制度不健全、服务主体能力不足、供需失衡、养老经济负担沉重、信息平台建设不足、知晓度不够、缺乏长效激励机制、监督机制不完善、机构联动松散、区域差异明显与创新力度不足等十大核心问题。结论构建中国特色的医养结合模式高质量发展应以建立健全制度保障为支撑、供需双方平衡、深化信息化建设、供给主体协同合作等,实现医疗资源有效利用,达到健康、有序、稳定的发展模式。

Objective This paper analyzes the current situation of the integrated medical and elderly care work in China,summarizes the existing problems in the integrated medical and elderly care work and makes an in-depth analysis,and puts forward some suggestions for improvement.Methods The Chinese search and English search terms were"integrated medical and elderly care/integrated medical and nursing care""development""problems""effect"and"current situation".Retrieve PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),VIP,WanFang Data Knowledge Service Platform and other databases,Google Scholar,Baidu Scholar,and other search engines.The retrieval time was from January 2018 to October 2023.The included literature was sorted out and analyzed,and according to the literature mention rate,the main problems existing in the current integrated medical and elderly care are sorted out.Through the Delphi expert consultation method,the problems existing in the integrated medical and elderly care mode are sorted according to importance and severity.A comprehensive ranking is obtained by adding the ranking values from low to high through the literature mention rate and the ranking values from expert interviews.Results Ten core problems are extracted,such as imperfect top-level design system,insufficient capacity of service subjects,the imbalance between supply and demand,the heavy burden of pension economy,insufficient construction of information platform,insufficient awareness,lack of long-term incentive mechanism,imperfect supervision mechanism,loose institutional linkage,obvious regional differences,and insufficient innovation.Conclusion The high-quality development of the integrated medical and elderly care model with Chinese characteristics should be supported by the establishment of a sound system guarantee,the balance between supply and demand,the deepening of information construction,and the coordination and cooperation of supply subjects,to realize the effective utilization of medical resources and achieve a healthy,orderly and stable development model.