长期护理保险制度下定点专护机构运行模式探讨

发布时间：2019-02-28 14:05

【摘要】：长期护理保险制度是我国老龄化背景下应对家庭照护资源不足、社会保障支持欠缺的重要政策。该制度在我国尚处起步阶段,需要进一步总结试点地市的实践经验。通过对青岛市、潍坊市和聊城市6个定点专护机构16位被访者进行实地访谈,探讨医疗专护制度的运行模式特征。结果表明,定点专护机构以基层单位为主;除青岛市外,试点地市的目标人口仅覆盖职工医疗保险,且均存在户籍限制;服务项目排除生活护理,抑制了照护服务需求;生活护理管理模式影响专护服务质量;结算标准比例与不断变动的医疗服务价格不吻合。探讨生活护理员的管理模式、筹资机制的顶层设计以及政府多部门协同是解决上述问题,确保长期护理保险制度可持续运行的根本点。
[Abstract]:The long-term nursing insurance system is an important policy to deal with the shortage of family care resources and the lack of social security support under the background of aging in China. This system is still in its infancy in our country, so it needs to summarize the practical experience of the pilot city. Through on-the-spot interviews with 16 interviewees from 6 fixed-point special care institutions in Qingdao, Weifang and Liaocheng, this paper discusses the characteristics of the operation mode of medical special care system. The results show that the designated special care institutions are mainly grass-roots units, except Qingdao, the target population of pilot areas only covers medical insurance for workers, and all of them have household registration restrictions, and the service items exclude life care and restrain the demand for care services. The management mode of life nursing affects the quality of special care service, and the proportion of settlement standard is not consistent with the changing price of medical service. Probing into the management mode of life nurses, the top-level design of financing mechanism and the coordination of government departments are the root points for solving the above problems and ensuring the sustainable operation of the long-term nursing insurance system.
【作者单位】：潍坊医学院公共卫生与管理学院;
【基金】：山东省人文社会科学课题:不同“医养”模式下养老机构老年人医疗服务评价研究(15-ZC-SH-02) 教育部人文社科项目:基于空间统计的农村公共卫生服务资源优化配置研究(13YJAZH094);教育部人文社科基金项目“基本药物制度背景下乡村医生队伍稳定性及发展策略研究”(14YJA630098)
【分类号】：F842.6

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