健康老龄化视角下我国医养整合性体系优化研究

According to WHO, the aging of population is rapidly accelerating worldwide; the consequences for health, health systems, their workforce and budgets are profound. For older people, the promotion and maintenance of functional ability has the higher importance rather than absence of disease. The international conception of healthy aging was continually being improved. Policy-makers and service-providers in many foreign countries have been transformed to perceive healthy aging and made the most of it. China has the largest elderly population in the world. Facing with the serious separation between health care system and long-term care system, it is urgent to build an age-friendly world, requiring a transformation of health systems away from disease-based curative models and towards the provision of integrated care that is centered on the needs of older people. Based on international experience, this study aims to introduce new conception on healthy aging, comprehensively use Scientific Procedure of Policy-making, Health System Macroscopic Model, Game Theory and System Dynamics, combine typical case analysis with large-scale sample survey, integrate cross-sectional survey with system dynamics simulation, then attempt to establish ideal framework of system integrating long-term care with health care in China. Accordingly, based on large-scale cross-sectional survey results, the gap between the ideal framework and the realistic system is to be normatively analyzed, and the existing problems is to be discovered. Thus, we is to explore the deep-seated causes and formation mechanism of the resulting problems in the integrated systems, also try to establish the theoretical and mathematical models of mechanism among key interest groups under Game Theory. In order to improve the allocation of resources and achieve the goal of healthy aging, we would explore sustainable developing strategies and supporting measures to improve Chinese system integrating long-term care with health care.

WHO指出，全球范围内不断加速的人口老龄化将对全球产生深远的影响。健康老龄化国际理念日趋完善，国外不少国家已实现健康老龄化。我国是世界上老年人口最多的国家，医养分离问题严重。优化医养整合性体系，以健康老龄化视角满足不断增长的长期照护与医疗卫生服务需求，可谓任重道远。汲取国际经验，弥补国内研究不足，研究引入最新健康老龄化理念，综合运用政策制定科学程序、卫生系统宏观模型、博弈论、系统动力学等方法，将典型案例分析与大规模抽样调查相结合，横断面研究与系统动力学前瞻仿真模拟相结合，尝试构建健康老龄化下医养整合性体系的理想框架；结合大规模横断面调研现况，规范差距分析我国医养整合性体系存在的差距与问题，探索我国医养整合性体系“系统结果”表象问题产生的深层次原因及形成机制，构建关键利益团体博弈机制理论和数学模型；以优化体系资源配置，实现健康老龄化为目的，研制优化我国医养整合性体系的可持续发展策略及措施。

WHO指出，全球范围内不断加速的人口老龄化将对全球产生深远的影响。我国是世界上老年人口最多的国家，医养分离问题严重。优化医养整合性体系，以健康老龄化视角满足不断增长的长期照护与医疗卫生服务需求，任重道远。.本研究通过引入WHO健康老龄化理念，将典型案例分析与大规模抽样调查结合，横断面研究与SD模型前瞻仿真模拟结合，探索了医养分离形成机制，研制了优化长期护理体系、促进医养结合的可持续发展策略，包括：（1）通过多次大规模横断面调查和典型案例研究，收集了医养结合各利益相关方的第一手真实数据；（2）引入系统动力学方法，预测了在不同政策干预点下医疗卫生与长期照护服务供需的发展趋势；（3）基于WHO整合性照护模型的要素需求，提出搭建以“互联网+”为基础的社区居家医养整合平台；（4）科学评估并优化长期护理保险制度试点，为促进“医”与“养”的有效结合提供合理的筹资与支付手段。.SD模型结果提示，医养分离的现状下，随着老龄化的加深，2025年上海市医疗护理床位缺口将达5400余张，且养老床位大量闲置。而当医养整合性体系服务模式建立后，随着平均住院日逐渐下降，可有效缓解医疗护理床位的供需窘境；另一方面，随着长护险制度的建立和完善，可作为实现医养结合服务有效的筹资与支付手段，加上“互联网+”技术的引进，将最大程度整合医护康养及相应的社会保险资源，为不同养老场景中老人提供医疗、护理、康复、生活照料、辅具租赁等全方位、一体化的服务。以上研究成果共计发表中文核心期刊论文21篇，SCI论文3篇，出版专著一本。.因此，面对逐渐深化的老龄化，面对资源利用不合理的现实问题，相比于不断增长和加速资源供给，积极推进医养整合性体系服务模式则更为重要。现阶段还需积极引入数字化、智能化手段，同时发挥长护险的经济杠杆作用，有序推进服务按需利用。