如何促成医养结合?——英国经验与本土化启示  

How to Promote the Integration of Meclical and Elderly Care Services:Experience from the UK and Localization Enlightenment

作　　者：康蕊 KANG Rui(National Academy of Chinese Modernization,Chinese Academy of Social Sciences,Beijing 100005,China)

机构地区：[1]中国社会科学院中国式现代化研究院,北京100005

出　　处：《人口与经济》2025年第1期91-105,共15页Population & Economics

基　　金：国家社会科学基金青年项目“医养结合养老服务模式的治理体系研究”(20CRK012);中国社会科学院“青启计划”(2024QQJH161)。

摘　　要：20世纪80年代,英国为解决其医疗和养老服务的主管部门分散且界限模糊,不同机构间服务内容割裂,难以应对老年人医疗和养老混合型需求等问题,开始探索建立医疗和护理服务合作体系。英国政府首先通过健全社区医疗卫生服务解决老年人长期住院问题,以划清“医”“养”边界;其次通过立法要求部门间协同合作,明确各方责任并进行预算合并;最后以具体项目聚集资源确保整合服务下沉社区。该体系让社区在地化养老模式得到发展,医疗资源配置效率显著提升,老年人的获得感显著增强,其成功的关键在于建立了以家庭医生为中心的多学科整合型服务网络、联合评估需求并进行部门间信息共享、建立共同基金和个人账户、提供出院后短期的衔接性服务、实施来自政府和消费者的双重监管。同时,改革也面临“成本病”问题、数字化和信息化转型以及医疗和照护业务转型中的问题。这些经验和挑战对我国的本土化启示是:顶层设计和下沉社区是调动各部门合作积极性的关键,综合评估需求是构建医养结合体系的基础,健全基层医疗卫生并建立具体的合作网络能够为其提供支撑,统一预算和支付是能够实现医养结合的重要保障。未来我国应通过转诊等建立医院和基层医疗机构之间的联系,各部门应综合评估医养需求并对信息共享,应建立以家庭医生为中心的服务支撑网络,探索建立医养结合服务基金并强调个人责任。In the 1980s,the UK began to explore the establishment of a cooperation system of medical and nursing services to address issues such as dispersed and blurred regulatory authorities for medical and elderly care services,fragmented service content between different institutions,and difficulty in addressing the mixed needs of mediceal and elderly care.The British government firstly solves the long-term hospitalization problem of elderly people by improving community medical and health services in order to clarify the boundary between“medical”and“nursing”,and secondly requires inter-departmental collaboration through legislation clarifying the responsibilities of all parties and conducting budget consolidation,and finally gatheres resours through specific projects to ensure the integration of services into the community.This system has enabled the development of a localized elderly care model in the community,significantly improving the efficiency of medical resource allocation,and significantly enhancing the sense of gain for the elderly.The key to success lies in establishing a multidisciplinary integrated service network centered on GPs,jointly assessing needs and sharing information between departments,establishing mutual funds and personal accounts,fully utilizing market forces to improve service quality,and providing short-term bridging services after discharge.In the future,the integration of medical and elderly care services in the UK will also face challenges such as digital and information transformation,financial responsibility and model reform,and the transformation of medical and mursing care businesses.The inspiration from these experiences and challenges for China’s localization is that top-level design and sinking communities are the key to mobilizing the cooperation enthusiasm of various departments,and comprehensive evaluation of needs is the foundation for building a medical and elderly care services integration system,and improving grassroots health care and establishing specific cooper

关 键 词：医养结合 去机构化 社区医疗卫生 基层健康网络 

分 类 号：C913.6[经济管理]