合肥市公立医院推进医养结合的问题和对策研究

发布时间：2018-05-11 12:19

本文选题：医养结合 + 公立医院　；参考：《安徽大学》2015年硕士论文

【摘要】：在人口老龄化不断加剧的社会背景下,患病老人的养老问题显得尤为突出和迫切。近年来,全国各地陆续探索出了“医养结合”这种新型的养老服务模式,它将“医疗”与“养老”相结合,更加强调医疗服务的突出重要性,成为解决患病老人养老问题的重要途径。本文以合肥市人口老龄化程度高、发展速度快、未富先老为背景,结合合肥市人口健康状况的紧迫形势,搜集整理了合肥市目前养老机构的发展现状,指出这些机构存在设施较差、服务水平参差不齐、医疗服务跟不上、人员配备不足、护理人员专业性不强等诸多问题。为了有效应对目前的老龄化形势,合肥市滨湖医院在国内较早地探索了“医养结合”养老服务。2010年该医院开设236张“医养结合”床位,对入住老人实行“医保住院”和“托护养老”两种管理路径,根据老人病情变化,在不挪床位的情况下实现两者之间的轻松转换。文章对滨湖医院医养结合病区的收费标准、成本与收益情况、满意度情况进行了的调查和分析,结果显示医养结合确实为缓解患病老人的养老问题提供了一种比较理想的解决路径,但由于床位紧张、成本较高、收费较贵等多种原因,目前滨湖医院医养结合病区只能解决部分患病老人的养老问题,尤其是经济条件较好的、失能程度较高的老人。2013年,合肥市滨湖医院所属的合肥市第一人民医院集团将“医养结合”在其旗下的体保中心进行了有效复制,这为我国部分定位不明确、效益产出不明显的医疗机构转型提供了有效参考,同时,体保中心对医养结合的范畴进行了扩充,重点开始探索公立医院推行居家养老和临终关怀两种“医养结合”服务。公立医院在开展医养结合服务上有其优越性,尤其是能够实现医疗与养老的无缝对接,还有国家医保作支撑。但在医养结合服务上,实践走在了政策之前所以在公立医院推行医养结合服务中面临的突出问题多集中于顶层设计方面,如政府多头管理、人才后备力量不足等。为保障公立医院推行医养结合服务的健康良性发展,首先应构建一体化的行政协调机制,做好顶层设计。同时,卫生行业在统筹规划时,应考虑在新建医院内配比增设医养结合床位,或将部分医疗机构转型为医养结合型机构,以缓解公立医院医养结合床位不足的问题。在应对人才不足的问题上,应将专业教育与职业教育相结合,以区域内成熟的医养结合服务提供机构为平台,建立专业人才培养基地。人口老龄化不是中国一个国家的问题,它是世界性难题,而美国、德国、日本在养老问题上的已经较为成熟的做法值得中国借鉴,尤其是日本的“介护养老”中对于“介护人才”的培养,值得成为我国医养结型人才培养的重要参考模式。
[Abstract]:Under the background of the aging of the population, the problem of aging for the sick elderly is particularly prominent and urgent. In recent years, various parts of the country have gradually explored the "combination of medical care and support", a new mode of old-age care services, which combines "medical care" with "old-age care" and places more emphasis on the prominent importance of medical services. It has become an important way to solve the problem of elderly care for the sick. In this paper, with the background of high aging population, rapid development speed and old age before becoming rich in Hefei, and combining with the urgent situation of population health in Hefei, this paper collected and sorted out the current development situation of pension institutions in Hefei. It is pointed out that there are many problems in these institutions, such as poor facilities, uneven service level, poor medical services, inadequate staffing, and poor professionalism of nursing staff, and so on. In order to effectively cope with the current aging situation, Hefei Binhu Hospital explored the "combination of medical care and nursing" old-age service earlier in the country. In 2010, the hospital opened 236 beds of "combination of medical care and nursing". The two management paths of "medical insurance hospitalization" and "care for the aged" are carried out for the elderly. According to the changes of the elderly's condition, the transition between the two can be realized easily without moving the beds. This paper investigates and analyzes the charge standard, cost and income, satisfaction degree of the medical and nursing ward in the Binhu Hospital. The results show that the combination of medical care and nursing does provide an ideal way to solve the problem of the elderly who are sick. However, because of the shortage of beds, the higher cost and the higher fees, and so on, there are many reasons, such as the shortage of beds, the higher costs and the higher fees. At present, the combination of medical and nursing care in Binhu Hospital can only solve the problem of providing for the aged of some sick elderly people, especially those with better economic conditions and higher degree of disability. In 2013, Hefei City first people's Hospital Group, which belongs to Hefei Binhu Hospital, effectively duplicated the "combination of medical care and nourishment" in its health care center, which is unclear for some of our country's positioning. At the same time, the health care center expanded the scope of the combination of medical care and support, and began to explore the implementation of the home care and hospice care in public hospitals two types of "combination of medical care and maintenance" services. The public hospital has its superiority in developing the combination of medical and nursing services, especially to realize the seamless docking between medical treatment and old-age care, and the state medical insurance as the support. However, in the practice of the combination of medical services and support services, practice before the policy, so in public hospitals in the implementation of the combination of medical and maintenance services faced by the outstanding problems focused on the top-level design, such as government multi-head management, lack of talent reserve, and so on. In order to ensure the healthy and benign development of medical and nursing service in public hospitals, we should first construct an integrated administrative coordination mechanism and do a good job of top-level design. At the same time, in the overall planning of the health industry, consideration should be given to increasing the proportion of beds in new hospitals or transforming some medical institutions into medical and nursing institutions, so as to alleviate the problem of insufficient beds in public hospitals. To deal with the problem of shortage of talents, we should combine professional education with vocational education, take the mature medical and nursing service providers in the region as the platform, and establish the training base of professional talents. The aging of the population is not a national problem in China. It is a worldwide problem. However, the mature practices of the United States, Germany and Japan on the issue of old-age support are worthy of China's reference. In particular, the training of nursing talents in Japan is worthy of becoming an important reference model for the cultivation of medical and nursing talents in China.
【学位授予单位】：安徽大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：D669.6

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