摘要
当前,医疗与养老服务资源难以深度融合,导致医养结合服务模式下老年个体健康水平改善效果不明显。为了考察医养结合机构服务模式的健康产出效果,从“生理健康心理健康认知健康社会功能”四维度构建老年人多维健康绩效指标体系,并采用“久期分析”构建“多维健康绩效指数”并进行指数因素分解。基于两种典型医养结合模式,运用湖北省多地的动态追踪调查数据测度老年人健康绩效水平及组群差异发现:入住医养结合机构后,第一,老年人生理健康和认知健康总体上有小幅改善,但心理健康改善不显著,社会功能呈现一定程度负向变化。其中,医内设养模式下,老年人生理健康维度维持相对稳定、社会功能维度降幅较明显,养内置医模式下老年人生理健康和认知功能均有不同程度改善。第二,老年人健康状态稳定性有所增强,医内设养模式在健康状况维持率方面较为突出,养内置医模式在健康深度、规模变化方面也有较好表现。第三,心理健康对多维健康绩效指数贡献度最高,生理健康的贡献度最低,养内置医模式下各维度贡献率变化相对而言较小。第四,不同医养结合模式下,多维健康绩效指数具有组群差异和异质性。对此,从精准提升医养结合服务内容供需适配性、建立多方位心理慰藉和社会功能修复体系、建立多主体利益共享和激励机制、提供细分群体的靶向式医养结合服务等方面提出了相关的对策建议。
Current challenges in the deep integration of medical and elderly-care resources have resulted in limited health improvement effects under integrated medical and elderly-care service models.To investigate the health outcome of institutionally integrated medical and elderly-care models,this paper establishes a multidimensional health performance evaluation system for the elderly encompassing four dimensions:physical health,mental health,cognitive health,and social functioning.Utilizing the duration approach,this paper constructs a multidimensional health performance index(MHPI)and conducts factor decomposition.Through dynamic tracking survey data from multiple regions in Hubei Province,this paper measures health performance levels of the elderly and group heterogeneity across two typical service models.According to the outcomes:overall,the physical health and cognitive health of the elderly have improved slightly,their mental health has not improved significantly,and their social function has shown some negative changes.Medical institutions with integrated nursing care resulted in relatively stable maintenance in physical health,but the decline in the dimension of social function is relatively significant,while nursing homes with integrated medical services show improvements in both physical health and cognitive function.Health status stability has enhanced remarkably,particularly in health maintenance rate under medical institutions with integrated nursing care,complemented by substantial health depth and scale variation improvement in nursing homes with integrated medical services.Mental health contributes most significantly to MHPI,whereas physical health shows minimal contribution,with relatively stable dimensional contributions under the model of nursing homes with integrated medical services.Different service models indicated significant group differences and heterogeneity in the MHPI.Finally,this paper proposes policy implications to enhance the precision of supply-demand alignment in integrated medical and elderly-care services,establish a multi-dimensional psychological support and social function restoration system,build multi-stakeholder benefit-sharing and incentive mechanisms,and provide targeted integrated medical and elderly-care services for different groups.
作者
张园
胡亚琼
刘义奇
ZHANG Yuan;HU Yaqiong;LIU Yiqi(School of Law and Public Administration,China Three Gorges University;School of Mathematics and Physics,China Three Gorges University)
出处
《河海大学学报(哲学社会科学版)》
北大核心
2025年第4期132-147,共16页
Journal of Hohai University(Philosophy and Social Sciences)
基金
国家自然科学基金面上项目(72374125)。
关键词
医养结合服务
医内设养模式
养内置医模式
多维健康绩效
integrated medical and elderly-care services
medical institutions with integrated nursing care
nursing homes with integrated medical services
multidimensional health performance
