医养结合模式下养老机构发展现状及驱动因素研究——以武汉市为例

左梦利

摘要

随着1999年以后老年人数量的快速增长，21世纪我国面临着严峻的人口老龄化问题。 老年人的医疗服务需求推动了我国养老服务模式的持续发展，于是我国在2013年首次提出要“推动医养融合发展”。在政策的推动下，养老机构开始探索养老服务和医疗服务相结合的途径，来顺应市场的转变。基于此，本文从养老机构运营管理的角度出发，研究医养结合的驱动因素及发展策略。

本文首先介绍了养老机构医养结合的相关概念和理论基础，接着以企业生态理论和社会系统理论为依据，分析养老机构生态系统的要素和结构，并构建养老机构医养结合生态循环模型，为后续研究驱动因素提供理论基础。然后以武汉市作为研究地区，基于诱因理论从政府引导、社会组织助推、市场需求、市场竞争四个方面提出养老机构医养结合的外部驱动因素；基于需求层次理论从生存意识、关系意识、自尊意识、转换意识、和谐意识、总体意识和服务意识七个层次提出养老机构医养结合的内部驱动因素。通过调研武汉市城区养老机构医养结合现状及驱动因素，采用因子分析法提取养老机构医养结合的关键驱动因子，分别是医疗养老服务顶层设计和功能配置、养老机构医养结合自身定位和内部管理、构建医疗养老服务市场环境、养老机构提高医养结合市场竞争力、养老机构提升管理效能和服务质量、养老机构健全服务和制度以及养老机构加强与外界战略合作，再利用逐步回归分析找出养老机构医养结合的重要驱动因素。最后本文提出促进养老机构医养结合发展的策略如下：从政府支撑的角度，重点是完善顶层设计和推进标准化建设；从机构引领角度，主要在于强化医疗服务和重视人才储备；从市场推动的角度，则是发挥公益优势和引进社会资本。

本文构建养老机构生态系统理论并分析养老机构医养结合驱动因素，可为养老机构医养结合健康发展提供理论基础和理论方法。研究成果可为养老机构以及政府、行业协会等各方主体制定医养结合发展战略提供参考。

关键词：医养结合，机构养老，企业生态理论，驱动因素

Abstract

With the rapid growth of the number of the elderly since 1999, China is facing a serious problem of population aging in the 21st century. The medical service demand of the elderly promoted the sustainable development of the service mode for the aged, and China first put forward policy about "promoting the integrated development of medical and nursing" in 2013. Driven by the policy, elderly care institutions began to explore ways to integrate pension and medical care to adapt to market change. Based on this, this paper studies the driving factors and promoting countermeasures of the combination of medical care and pension, from the perspective of the operation and management of the institutions.

This paper first combs the related concepts and theories about the combination of medical care and pension. Based on the enterprise ecological theory, this paper analyzes the elements and structure of the ecological system of the elderly care institutions, and constructs the ecological cycle model of the combination of medical care and pension, providing theoretical support for the identification of driving factors. Then taking Wuhan as an example, this paper puts forward the external driving factors of the combination of medical care and pension from four aspects: government guidance, social organization promotion, market demand and market competition based on the incentive theory, and puts forward the internal driving factors from seven levels: existence consciousness, relationship consciousness, self-esteem consciousness, transformation consciousness, harmony consciousness, overall consciousness and service consciousness based on the demand level theory. Through investigating the current situation and driving factors of the combination of medical care and pension in the elderly care institutions in Wuhan City, this paper identifies the key driving factors by factor analysis, namely designing top level and allocating function, self positioning and internal management, constructing market environment, improving market competitiveness, improving management efficiency and service quality, improving services and systems, and strengthening strategic cooperation, and then stepwise regression analysis is used to pick up the important driving factors of the combination of medical care and pension in the elderly care institutions. Finally, this paper puts forward the following development strategies for the elderly care institutions: from the perspective of government support, it focuses on improving the top-level design and promoting standardization construction; from the perspective of institutional guidance, it mainly lies in enhancing medical service and paying attention to talent reserve; from the perspective of market promotion, government should take advantage of aging association in public welfare and encourage social capital to actively participate in.

This paper constructs the ecosystem theory of the elderly care institutions and analyzes the driving factors of the combination of medical care and pension, which can provide the theoretical basis and method for the healthy development of the combination of medical care and pension. The research results can provide a reference for the elderly care institutions, the government, the associations and other parties to formulate the development strategy of the combination of medical care and pension.

Keywords: Medical-nursing combined old-age care, Institutional care for the elderly, Enterprise ecology theory, Driving factor