According to the arrangement of the annual work points of the Standing Committee of the County People's Congress, recently, the Education, Culture, Health and Work Committee of the Standing Committee of Feixi County People's Congress conducted an in-depth investigation on the pilot work of combining medical care with nursing care in the county: it listened to the work reports of the county health planning commission, the county civil affairs bureau, the county finance bureau and other departments, went deep into the five-guarantee support center of Yandian Township to investigate the situation, held a symposium attended by relevant personnel, and listened to opinions and suggestions. On this basis, a research report is formed.
I. Basic information
Since the national, provincial and municipal documents on promoting the combination of medical and health care and old-age services were issued, the county * * * and relevant functional departments have actively responded to the trend of population aging, conscientiously implemented the spirit of relevant documents, integrated old-age care and medical resources, actively explored the combination of medical care and nursing, and initially explored a feasible combination model of medical care and nursing for the elderly with five guarantees, which has better solved the problem of centralized support for the elderly with five guarantees. For example, since the establishment of the special care area for the elderly in Yandian Township from May 2065438 to May 2005, more than 2,600 elderly people with five guarantees have been treated in time, effectively solving the problems of untimely treatment and unattended care for the elderly with five guarantees. At present, the county 15 five-guarantee centers have set up special care medical areas.
Second, the problems existing in the pilot work
The aging population calls for the combination of medicine, nursing and insurance. At present, this work is being piloted, but there are still some difficulties and problems. For example, during the investigation of the Five Guarantees Support Center in Yandian Township, it was learned that the lack of operating funds and medical personnel in the medical area for the entitled groups affected and restricted the effective development of the pilot project of combining medical care with nursing care, and needed more support and care from the county and its related functional departments and all walks of life.
Three. Countermeasures and suggestions
(1) Strengthen policy guarantee. According to the spirit of the national, provincial and municipal documents on the combination of medical care and nursing care, based on the actual situation and pilot work experience in our county, especially in view of the problems existing in the pilot work, we will clarify the solutions, implement incentive measures, and guide the orderly and accelerated development of the combination of medical care and nursing care institutions. According to the medical service demand of the elderly and the distribution of medical resources for the aged in the county, we should make overall plans and rational layouts of all kinds of medical and nursing institutions, realize the effective allocation and organic connection of resources between medical institutions and pension institutions, and improve the utilization efficiency of public service resources for special groups such as the elderly. It is necessary to increase financial input, study and introduce policies to promote private investment, and stimulate the enthusiasm of private investment. On the basis of in-depth investigation, the boundary between "medical care" and "nursing care" should be divided, especially to solve the problem that medical services in old-age care institutions concerned by the broad masses of the people should be included in the medical insurance policy. It is necessary to seriously study, do a good job in policy convergence, and support the old-age care institutions that combine medical care with nursing care to gradually enter a virtuous circle.
(2) Strengthen resource integration. It is necessary to seriously study and establish a daily cooperation and business cooperation mechanism between medical institutions and pension institutions, coordinate pension resources, promote the effective integration of resources between medical institutions and pension institutions, and promote the "pairing" between "hungry" township medical institutions and "dissatisfied" pension institutions, improve the efficiency of resource utilization, and promote the benign interaction between medical resources and pension resources. Township hospitals should gradually integrate the medical resources of village (neighborhood) clinics with the health diagnosis and treatment of the elderly, and maximize the social and economic benefits of public medical resources. We should conscientiously implement relevant policies, provide convenient services for social forces to set up pension institutions, and especially leave room for private medical institutions to develop the combination of medical care and nursing.
(3) Promote integrated development. According to the requirements of national, provincial and municipal documents, combined with the distribution of medical resources for the aged in our county, we urge all kinds of old-age care institutions in the county to establish an agreement and cooperation relationship with medical institutions at all levels to ensure that more than 50% of old-age care institutions can provide medical and health services for the elderly in different forms by the end of 20 17, and achieve full coverage by 2020. It is necessary to make full use of the existing medical and health service resources, establish rehabilitation centers, hospitals and nursing homes for the elderly, and support some county and township hospitals and specialized hospitals with too many idle places to transform into nursing homes for the elderly and carry out old-age services; Encourage and support township medical and health institutions to provide quality medical services for the community and home-based care for the elderly, and meet the growing demand for healthy care for the elderly.
(4) Highlight talent support. It is necessary to continuously strengthen the talent guarantee for the development of the combination of medical care and nursing, and improve the level of old-age services in the combination of medical care and nursing institutions. It is suggested that the county * * * and relevant functional departments should take gerontology, rehabilitation and nursing talents as urgently needed talents and bring them into the training plan of health technicians and the training scope of key physicians in Linyi City; Actively explore the establishment of cooperation mechanism between medical institutions and old-age care institutions in terms of technology and talents, encourage outstanding medical practitioners and practical nurse in medical institutions to provide services to old-age care institutions, and continuously improve the working ability and level of employees; Relevant incentive policies will be introduced to give professional and technical personnel engaged in medical care in old-age care institutions the same treatment as medical personnel in medical institutions in terms of professional title declaration and evaluation.
(5) Strengthen leadership over the pilot work. County * * * and relevant departments should further raise awareness, effectively put the work of combining medical care with nursing care in a higher position, seize policy opportunities, strengthen organization and leadership, increase financial input, promote fruitful pilot work in an orderly manner, jointly promote the healthy development of combining medical care with nursing care in our county, and make new contributions to building a healthy and happy new Feixi.
In order to actively respond to the increasingly serious problem of population aging, improve the health service ability of the elderly population, and meet the basic needs of "providing medical care and security for the elderly", in recent years, our district has actively explored the service model of "combining medical care with nursing care" and achieved initial results.
I. Progress and effectiveness of work
(1) Explore the construction of a combination system of medical care and nursing, and promote the complementary advantages of resources.
According to the spirit of the instructions of the State Council and the people of provinces and cities on accelerating the combination of medical care and nursing care, the * * District has formulated the Implementation Plan on Promoting the Combination of Medical and Health Care and Pension Services (Trial), which will be studied and approved by the Standing Committee of * * *. According to the plan, vigorously promote the integration of health and old-age service resources: first, support qualified medical institutions to open elderly wards and elderly nursing places; The second is to promote qualified old-age care institutions and medical institutions to hold a combination of medical care and support; The third is to encourage some hospitals in the jurisdiction to transform into nursing homes; Fourth, promote the organic combination of grassroots medical and health institutions and community home care services; Fifth, support old-age care institutions to apply for the establishment of infirmary or nursing station according to relevant regulations, and improve the ability of old-age care institutions to provide basic medical care services.
Up to now, the district civil affairs department has managed a total of 1 1 homes for the aged and set up 1 186 elderly nursing beds (including 300 elderly nursing beds approved by Xinmin Hospital). The district health department approved three community pension institutions, including nursing homes, to set up clinics and nursing stations, and the district civil affairs department took the lead in organizing six pension institutions in our district to establish a combination of medical care and nursing, initially achieving full coverage of basic medical and health services for pension institutions.
(2) Innovate the service mode of combining medical care with nursing care, and build a solid foundation for home-based aged care services.
Relying on the advantages of grass-roots community health service institutions, a "peer-to-peer" health service system with family doctors as the main body is established. The family doctor service team actively goes deep into the community and families, and implements classified health management for the elderly in the community through the implementation of "points system", "health savings bank", "fans signing" and health clubs for the elderly. By the end of May this year, 57 family doctor service teams had been set up in the whole region, with more than 38,000 households and 78,000 people, including more than 43,000 elderly people over 60.
Establish a "personalized" health service system supported by "medical association" Each community health service center has established a "medical association" with the First Hospital of the City and the Provincial Acupuncture Hospital respectively, integrating medical experts and Chinese medicine rehabilitation experts into the family doctor service team, and carrying out "personalized" contract services. In April this year, Shuanggang Center innovatively set up a "2+2" professional service team for family doctors, set up four professional service teams for elderly health management, hypertension, diabetes and stroke rehabilitation, and signed paid contract service packages with 56 elderly people at home to meet diversified service needs.
(3) Enrich the service connotation of combining medical care with nursing care, and establish an institutional pension service mechanism.
In order to strengthen the health protection of the elderly in the old-age care institutions, since June this year, the community health service centers under the jurisdiction of this district have established a fixed service relationship with the old-age care institutions under their jurisdiction: First, they take the initiative to hold 1 health education lectures for the old-age care institutions every quarter, conduct routine health checks for the elderly and guide rehabilitation treatment. The second is to establish a 24-hour service hotline with the old-age care institutions to make on-site diagnosis and treatment of common diseases and frequently-occurring diseases at any time. The third is to receive the elderly who are hospitalized for rehabilitation and transfer them back to the old-age care institution in time according to the rehabilitation situation. Fourth, the elderly enjoy free treatment of chronic diseases such as selective drugs and other health policies that benefit the people. Since 20 12, the number of free drugs for hypertension and type 2 diabetes in our district has reached 89,000 and 43,000 respectively, and the free amount has reached more than 3,654.38+million yuan, of which the proportion of drugs for the elderly accounts for more than 98%.
Second, there are difficulties and problems.
With the continuous development of the aging population, the health and old-age care of the elderly is a major issue facing today's social development, and the most effective means to solve the problem of health and old-age care is the combination of medical care and old-age care. From a national perspective, the combination of medical care and nursing is a new topic, which is being actively explored. There are mainly the following difficulties and problems in practical work:
(A) the combination of health care service demand and carrying capacity is asymmetric. According to statistics, in 20 15 years, the proportion of elderly people over 60 years old in the total population exceeded 16. 1%, and it showed an upward trend every year; It is expected to exceed 20% in 2024, 30% in 204 1 year, and nearly 34% in 2050. In 20 15, there were 84,000 elderly people over 60 years old in our district, accounting for 17% of the registered population in the whole district, and the aging trend was synchronized with the whole country. There are less than 800 old-age care institutions in our district, which are basically elderly people who need long-term medical care, nursing, rehabilitation and life care, such as illness, disability and dementia. Most elderly people, including "independence" and "disability", choose to live at home for the elderly. The huge demand of the elderly for old-age care and medical services has brought severe challenges to the current old-age health system and become an unavoidable problem for the whole society.
(2) The management system of combining medical care with nursing care is not perfect. At present, old-age care institutions are set up, approved and managed by civil affairs departments, community-based care and home-based care services are the responsibility of street residents, medical services are the responsibility of the Health Planning Commission, and medical insurance payment policies are formulated by human and social departments. Due to the system, administrative functions, the division of funds and other factors, there are some problems in the implementation of the combination of medical care and nursing, such as industry barriers, overlapping responsibilities and business interweaving. The pattern of divide and rule will inevitably lead to mutual barriers between medical care and nursing resources, and it is difficult to achieve the same goal, complementary advantages, coordination and horizontal integration, and it is difficult to effectively guarantee the unity of medical care and nursing for the elderly.
(C) The qualitative positioning of the combination of medical and nursing institutions is not clear. In terms of practical services, a fully functional institution combining medical care with nursing care can neither completely replace the old-age care institution nor completely replace the medical institution, but should have its distinctive characteristics and needs. It is necessary to further clarify the standard system and examination and approval department in the establishment and examination and approval. According to the current policy, the ownership of the examination and approval authority of the fully integrated medical and nursing institutions is not clear. Even if the same investor obtains the approval of the health and civil affairs departments respectively when setting up medical institutions and pension institutions, the operating mechanism is relatively independent, which does not solve the problem of whether the combination of medical care and nursing is "medical care" or "nursing care".
The policy of combining medical care with medical insurance payment is still conservative. The current medical insurance payment policy, which focuses on disease treatment, has not introduced the relevant payment standards for health management, disease prevention, early diagnosis and treatment, family doctor contract service, family ward and other medical and health services for the elderly. Even the latest medical insurance payment method that combines medical care and treatment due to illness has clear provisions on the diseases of the elderly, and there are fewer diseases. It can be said that the current medical insurance payment policy has inhibited the development of the service industry of combining medical care with nursing care to varying degrees, and it needs to be further liberalized.
Three. Countermeasures and suggestions
In view of the current population development situation, aging development trend and existing problems, developing the combination of medical care and nursing will be an important livelihood project. At present, on the basis of active practice and exploration, the main tasks of * * * are to basically establish the system and mechanism of combining medical care with nursing care, improve the policy and regulation system of combining medical care with nursing care, form a diversified and multi-channel service network of combining medical care with nursing care, and provide affordable public services for the elderly at all stages of their lives. To this end, the following opinions and suggestions are put forward:
(1) Give play to the leading role of * *, and do a good job in the top-level design of the combination of medical care and nursing.