Analysis and Strategy Research on the Mode of Medical Care Service for the Aged in Urban and Rural Areas of Guangzhou

doi:10.12114/j.issn.1007-9572.2018.00.232

Abstract

Abstract: The nursing issue is under enormous pressure with a growing aging population in China.The aging level of Guangzhou is obviously higher than the national average level.There is a serious problem of medical care service for the elderly in urban and rural areas in Guangzhou.Facing this reality，we must have a in-depth analysis of the present situation of medical care service for the elderly in Guangzhou to study and discuss coping strategies，establish a basic mode of medical care，pay attention to the relationship of medical care services，and properly handle the relationship between the state and the private，the collective and the individual，the top and the grass-roots level.We need to realize the benign operation of medical care services for the aged in urban and rural areas of Guangzhou by integrating public resources，strengthening the infrastructure and management，formulating policies and regulations，and establishing and improving the operation mechanism of medical care services.

Key words: Aged, Integrating medical and nursing care, Strategy, Institutional mechanism

摘要： 随着国内老龄化进程的加剧，养老问题面临巨大压力，广州市老龄化程度明显高于全国平均水平，广州市城乡老年人医养服务问题严峻。本文深入分析广州市老年人医养服务现状，探讨应对策略，从分级养老的视角出发，提出构建广州市医养服务模式的思路，应注重医养服务的关系调节，妥善处理国营与民营、集体与个体、顶层与基层的关系，整合广州市城乡老年人医养服务的公共资源，加强软硬件建设，制定政策法规，建立健全医养服务运作机制，实现城乡老年人医养服务的良性运作。

关键词: 老年人, 医养结合, 策略, 制度机制

LIAO Shengwu,TAN Bihui,LI Wenyuan, et al. Analysis and Strategy Research on the Mode of Medical Care Service for the Aged in Urban and Rural Areas of Guangzhou　[J]. Chinese General Practice, 2019, 22(2): 188-193. DOI: 10.12114/j.issn.1007-9572.2018.00.232.
廖生武,谭碧慧,李文源等. 广州市城乡老年人医养服务模式探析与策略研究[J]. 中国全科医学, 2019, 22(2): 188-193. DOI: 10.12114/j.issn.1007-9572.2018.00.232.

References

［1］邓敏，杨莉，陈娜.医养结合下老年人医疗消费行为影响因素分析——以南京市为例［J］．中国卫生政策研究，2017，10（1）：52-57．DOI：10.3969/j.issn.1674-2982.2017.01.009.
DENG M，YANG L，CHEN N．An analysis on influencing factors of elders' medical consumption behavior under the back-ground of pension combined with medical service：a case study of Nanjing［J］．Chinese Journal of Health Policy，2017，10（1）：52-57．DOI：10.3969/j.issn.1674-2982.2017.01.009.
［2］决胜全面建成小康社会，夺取新时代中国特色社会主义伟大胜利——在中国共产党第十九次全国代表大会上的报告［EB/OL］．（2017-10-28）［2018-03-12］．http：//paper.people.com.cn/rmrbhwb/html/2017-10/28/content_1813142.htm.
［3］李洪心.人口老龄化与现代服务业发展关系研究［M］．北京：北京师范大学出版社，2012：3.
LI H X.Research on the relationship between aging of population and the development of modern service industry ［M］．Beijing：Beijing Normal University Press，2012：3.
［4］广州市统计局.广州市2016年国民经济和社会发展统计公报［EB/OL］．（2017-05-05）［2018-03-12］．http：//www.tjcn.org/tjgb/19gd/35077.html.
Guangzhou Municipal Statistical Bureau.2016 statistical bulletin of national economy and social development in Guangzhou
［EB/OL］．（2017-05-05）［2018-03-12］．http：//www.tjcn.org/tjgb/19gd/35077.html.
［5］国家卫生计生委办公厅，民政部办公厅.关于确定第二批国家级医养结合试点单位的通知［EB/OL］．（2016-09-22）［2018-03-12］．http：//www.nhfpc.gov.cn/jtfzs/s7872/201609/46bad905688f403c8eae4ca56fbb7d84.shtml.
General Office of the National Health and Family Planning Commission，General Office of the Ministry of Civil Affairs.Notice on the second batch of national pilot units for medical and health care［EB/OL］．（2016-09-22）［2018-03-12］．http：//www.nhfpc.gov.cn/jtfzs/s7872/201609/46bad905688f403c8eae4ca56fbb7d84.shtml.
［6］成秋娴，冯泽永.美国PACE及其对我国社区医养结合的启示［J］．医学与哲学，2015，36（17）：78-80，88.
CHENG Q X，FENG Z Y.The program of all inclusive care for the elderly and its implications to develop medical-nursing combined community support mode in China［J］．Medicine & Philosophy，2015，36（17）：78-80，88.
［7］周霞，廖生武，易松，等．分级诊疗背景下社区老年冠心病患者医养结合健康管理模式研究［J］．中国全科医学，2017，20（26）：3232-3238．DOI：10.3969/j.issn.1007-9572.2017.00.017.
ZHOU X，LIAO S W，YI S，et al．Mode of healthcare management services delivered by medical and elderly care institutions for community-dwelling elderly patients with coronary heart disease under the situation of the implementation of hierarchical medical system in China［J］．Chinese General Practice，2017，20（26）：3232-3238．DOI：10.3969/j.issn.1007-9572.2017.00.017.
［8］佘瑞芳，谢宇，杨顺心，等．医养结合服务发展的国际经验研究［J］．中国医院管理，2016，36（6）：79-80.
SHE R F，XIE Y，YANG S X，et al．Research on international experience of the development of health care and pension service［J］．Chinese Hospital Management，2016，36（6）：79-80.
［9］唐志红，于卫华，饶晓岚，等．医养结合-四元联动整合照护模型的实践［J］．中华护理杂志，2017，52（1）：40-43．DOI：10.3761/j.issn.0254-1769.2017.01.008.
TANG Z H，YU W H，RAO X L，et al．The building of the “treatment-care and four linkage combination” integrated care model［J］．Chinese Journal of Nursing，2017，52（1）：40-43．DOI：10.3761/j.issn.0254-1769.2017.01.008.
［10］国务院办公厅.国务院办公厅关于印发全国医疗卫生服务体系规划纲要（2015—2020年）的通知［EB/OL］．（2015-03-30）［2018-03-12］．http：//www.gov.cn/zhengce/content/2015-03/30/content_9560.htm.
General Office of the State Council.Circular of the general office of the state council concerning the issue of the outline of the national medical and health service system（2015—2020）［EB/OL］．（2015-03-30）［2018-03-12］．http：//www.gov.cn/zhengce/content/2015-03/30/content_9560.htm.
［11］卫生计生委，民政部，发展改革委，等．关于推进医疗卫生与养老服务相结合的指导意见［EB/OL］．（2015-11-20）［2018-03-12］．http：//www.gov.cn/zhengce/content/2015-11/20/content_10328.htm.
Health and Family Planning Commission，Ministry of Civil Affairs，Development and Reform Commission，et al．Guiding opinions on promoting the combination of health care and pension services［EB/OL］．（2015-11-20）［2018-03-12］．http：//www.gov.cn/zhengce/content/2015-11/20/content_10328.htm.
［12］田锐，杨林，林全艺，等．新疆维吾尔自治区四市医养结合调研分析［J］．中国全科医学，2018，21（12）：1451-1455．DOI：10.3969/j.issn.1007-9572.2018.00.095.
TIAN R，YANG L，LIN Q Y，et al．Integrated medical and nursing care delivery status in four pilot cities in Xinjiang，China［J］．Chinese General Practice，2018，21（12）：1451-1455．DOI：10.3969/j.issn.1007-9572.2018.00.095.
［13］广州市民政局.2018年养老机构明细表［EB/OL］．（2018-02-24）［2018-03-12］．http：//www.gzmz.gov.cn/gzsmzj/fljgb/201802/3ad6067725ac47788c9f882f60771155.shtml.
Bureau of Civil Affairs of Guangzhou Municipality.List of pension institutions in 2018［EB/OL］．（2018-02-24）［2018-03-12］．http：//www.gzmz.gov.cn/gzsmzj/fljgb/201802/3ad6067725ac47788c9f882f60771155.shtml.
［14］张曼婕，黄海，王嘉雯，等．广州市医养结合养老服务现状分析［J］．现代医药卫生，2016，32（18）：2934-2937．DOI：10.3969/j.issn.1009-5519.2016.18.064.
ZHANG M J，HUANG H，WANG J W，et al．Analysis of the status quo of Guangzhou medical service and pension service［J］．Modern Medicine & Health，2016，32（18）：2934-2937．DOI：10.3969/j.issn.1009-5519.2016.18.064.
［15］韩杨，李红玉.锦州市老年人医养结合机构养老意愿及其影响因素分析［J］．中国全科医学，2018，21（12）：1456-1460．DOI：10.3969/j.issn.1007-9572.2018.00.087.
HAN Y，LI H Y.Analysis of the willingness of elderly people in Jingzhou City to choose medical-nurse combined care institutions and of associated influencing factors［J］．Chinese General Practice，2018，21（12）：1456-1460．DOI：10.3969/j.issn.1007-9572.2018.00.087.
［16］吴宏洛.论医疗保险制度设计对失能老人的救助功能—基于医养结合长期照护模式的考察［J］．福建师范大学学报（哲学社会科学版），2014，59（2）：23-29.
WU H L.On the relief function of medical insurance system design for disabled elders—based on the investigation of the long-term care model of combining medical care and nursing care［J］．Journal of Fujian Normal University（Philosophy and Social Scienecs Edition），2014，59（2）：23-29.
［17］郭东，李惠优，李绪贤，等．医养结合服务老年人的可行性探讨［J］．国际医药卫生导报，2005，11（21）：43-44．DOI：10.3760/cma.j.issn.1007-1245.2005.21.013.
GUO D，LI H Y，LI X X，et al．Discussion on the feasibility of medical service combined with service for the elderly［J］．International Medicine & Health Guidance News，2005，11（21）：43-44．DOI：10.3760/cma.j.issn.1007-1245.2005.21.013.
［18］郝丽，张伟健.基于大数据的“医疗－养老－保险”一体化智慧社区养老模式构建［J］．中国老年学杂志，2017，37（1）：226-228．DOI：10.3969/j.issn.1005-9202.2017.01.099.
HAO L，ZHANG W J.The construction of pension model of “healthcare-pension-insurance” integrated intelligent community based on big data［J］．Chinese Journal of Gerontology，2017，37（1）：226-228．DOI：10.3969/j.issn.1005-9202.2017.01.099.
［19］郭文君，欧雅琴，叶永茵.国营与民营结合是今后医养服务的发展趋势［N］．南方日报，2017-01-10（9）．
GUO W J，OU Y Q，YE Y Y.The combination of state-owned and private-owned enterprises is the development trend of medical care and pension services in the future［N］．Nanfang Daily，2017-01-10（9）．
［20］刘波，杨雪莲.城市社区居家养老的困境及对策思考——以广州市为例［J］．特区经济，2014，32（11）：96-99.
LIU B，YANG X L.The predicament and countermeasures of home care in urban communities：a case study of Guangzhou［J］．Special Zone Economy，2014，32（11）：96-99.
［21］黄佳豪，孟昉.“医养结合”养老模式的必要性、困境与对策［J］．中国卫生政策研究，2014，7（6）：63-68．DOI：10.3969/j.issn.1674-2982.2014.06.011.
HUANG J H，MENG F.Integrating pension service with medical service for the elderly：necessity，dilemmas and solutions［J］．Chinese Journal of Health Policy，2014，7（6）：63-68．DOI：10.3969/j.issn.1674-2982.2014.06.011.

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