医养结合机构养老模式创新研究①.doc

“医养结合”机构养老模式创新研究① Research on Innovation of Medical-Nursing Combined Institutional Care Mode 摘 要 随着失能老人养老问题日益突出，服务整合和养老机构转型已是必然趋势。本文从实践中凝练出“医养结合”机构养老的创新模式，以失能老人为目标群体，以养老机构内设医疗机构、养老与医疗机构合作等创新方式提供服务，重点强调区别于传统机构养老服务的专业医疗服务。为突破这一新型模式的发展困境，本文提出“按人计价”的政策设计，直接向医养结合养老机构提供资金，并创新性地运用健康生命表设定支付标准和入住比例，通过将年龄、自理程度因素纳入制度设计，有助于改善当下的老年补贴制度绩效，具有一定的创新性和实践性。结果显示，平均支付标准从 2012 年的 45.85 元/天上升到 2030 年的 361.45 元/天；覆盖人群总人数从 24.35 万逐渐增加到 231.77 万；政府年资金支持总额从 42.67亿逐渐增加至 3728.34 亿。最后，对政策发展进行展望，包括引导机构提高医疗层次、农村地区推广、资金来源方式等，为政策设计提供参考。 Abstract In order to solve elders’ survival problem service integration and innovation ofinstitutional care are inevitable.Based on investigation in several areas this researchsummarized the innovation of medical-nursing combined institutional care modewhich aims at disabled elders provides service in innovative ways and emphasize onprofessional medical services that differs from traditional institutional care. To helpthe new mode develop this research proposes a policy design that “pay by person“sets payment standards based on health life table. Institutions are directly financed to① 本文是国家科技计划课题“劳动保障政策仿真模型平台与决策支持系统_专业模型开发（2012BAK22B02）”，教育部哲学社会科学研究重大课题攻关项目“社会养老服务体系建设研究（No.12JZD035）”，国家社会科学基金重点项目“建立和完善我国新型农村社会养老保险制度研究（09AZD031）”，国家社会科学基金重点项目“加快覆盖城乡居民的社会保障制度体系研究（07ASH009）”阶段性成果的一部分。。make flexible use of the money to pay medical and nursing fees. Results show that theaverage payment criteria rises to 361.45 RMB/d in 2030 from 45.85 in 2012. Thepayment criteria of urban elders aged 80 is 2.7 times that of elders aged 60 indicatingthe policy support for the vulnerable aged population covered rises from 243500 in2012 to 2.31 million the total amount of financial support from government risesfrom 4.26 billion to 372.83 billion. Finally future policy support including expansionto rural areas region-specific payment criteria especially source of governmentfinancial support is discussed to provide reference for government policy design.关键词：医养结合；机构养老；失能老人；政策创新Key words: Medic