Population aging is an important trend in social development, and it is also the basic national condition of the mainland for a long time to come. According to the National Bureau of Statistics, the total number of elderly people aged 60 and above in mainland China was 296 million at the end of 2023, and the number of elderly people in China is expected to reach a peak of 487 million by around 2050.
With the advent of aging, in the face of the inconvenience of nursing homes and the fact that hospitals do not support patients, the combination of medical care and elderly care has come into being. In 2016, the National Health and Family Planning Commission and the Ministry of Civil Affairs successively issued the "Notice on Determining the First Batch of National Pilot Units for the Integration of Medical Care and Elderly Care" and "Notice on Determining the Second Batch of National Pilot Units for the Integration of Medical Care and Elderly Care", and the national pilot project for the integration of medical care and elderly care was officially launched.
After 8 years, at present, the exploration of the integration of medical care and elderly care has been expanding across the country. At present, what are the models of the integration of medical care and elderly care? What are the difficulties in the process of exploration? In the past few days, this reporter has conducted a visit and investigation.
Professional care is integrated into clinical care
Medical care is the mainstay, and nursing is supplemented by dual services
Chengdu Eighth Hospital, as a municipal tertiary geriatric hospital, is a typical example of the combination of medical care and elderly care. At the first stop of the investigation, the reporter came here.
Because of a fracture caused by a fall, Granny Zhang needed to stay in bed. On the one hand, it is necessary to provide treatment such as pain relief and fracture healing, and on the other hand, it is necessary to carry out risk prevention measures such as pulmonary embolism, pneumonia, and skin pressure injury, and at the same time, it is necessary to control the underlying diseases to avoid aggravation, and carry out rehabilitation treatment and nutritional support in a timely manner. For the elderly, this is destined to be a long-term medical process.
General hospitals often only deal with acute diseases, and the subsequent rehabilitation, risk prevention, safety management and other processes rely on outside the hospital, and the family is not competent for the task of professional care. By chance, she learned that the city's No. 8 Hospital provides integrated medical and elderly care services, and after coming here, Granny Zhang's medical needs have been better solved.
"Many 'disabling comorbidity' elderly people have recurrent diseases, and their conditions need to be monitored frequently, and their lives need continuous care. We integrate professional care into clinical diagnosis and treatment, with medical care as the main focus and nursing as the supplement. Zhang Shumin, director of the medical department of the city's eight hospitals, told reporters that the government has given the hospital a lot of policy support in promoting the integration of medical care and elderly care. At present, many medical institutions are also going to hospitals to learn relevant experience, and some medical and health institutions are also beginning to try similar models of medical and elderly care. But in fact, pension belongs to the category of civil affairs, medical care is under the jurisdiction of the Health Commission, the differences between the systems still exist, in addition to the eight hospitals such as the city's eight hospitals, many private institutions are also exploring their own medical and elderly care model.
"Medicine" and "nourishment" are adjacent to each other
The typical approach is still inconvenient
At half past six in the morning, Granny Zhong, who lives on the 11th floor of Heyang Gulian Geriatric Hospital in Tianfu New District, Chengdu, has already gotten up and washed up with the help of nurses. The day before the reporter met Granny Zhong, she had just finished her hospitalization and returned from the ward on the 6th floor to the rehabilitation area on the 11th floor. Through regional division, the hospital has completed the construction of the integration of medical care and elderly care.
According to Gong Zhiguo, president of Chengdu Tianfu New Area Heyang Gulian Geriatric Hospital, the function of the 6th floor of the hospital is equivalent to the geriatric comprehensive department of the general hospital, and the elderly care area on the 11th floor is similar to the elderly apartment equipped with professional medical personnel. ”
In addition, during the visit, the reporter found that the setting up of medical resources in the "neighbors" of the pension community is also the "path" that many medical and elderly care institutions are trying.
"We have built our own first-class hospital in the elderly care community, plus shared a tertiary general hospital in the same city, and realized the integration of medical care and elderly care through built-in and linkage." The relevant staff of a pension community in Wenjiang District, Chengdu told reporters that contrary to the city's eight hospitals, the pension community is mainly based on nursing, supplemented by medicine, although it is impossible to realize the seamless connection between medical care and nursing, but the audience of the elderly in the environment and services is wider.
The person in charge of the relevant department of the Chengdu Municipal Health Commission said that the model of Heyang Gulian Geriatric Hospital in Chengdu Tianfu New District and the model of setting up medical resources in the community pension "close neighborhood" are currently the most typical combination of medical care and elderly care, but there are also some drawbacks to the demand for the elderly, "no matter how close the distance is, the pension area and the medical area are always physically separated, especially for the disabled or semi-disabled elderly, inconvenience still exists." ”
Policy barriers and funding issues
There are still difficulties in the development of the integration of medical care and elderly care
The reporter learned from the Chengdu Municipal Health Commission that at present, there are 120 relevant institutions in Chengdu that have obtained the qualification of combining medical care and elderly care, and most of them adopt the model of embedded elderly care services in medical institutions. "On the whole, at present, Chengdu is very rich in medical resources and pension resources, but there is also an uneven distribution of resources." The person in charge of the relevant department told reporters that at present, although the state has introduced supportive policies, there are still many difficulties in the development of medical and elderly care institutions.
In fact, the services provided by the combination of medical care and elderly care in the city's eight hospitals are the most needed by many elderly people who choose institutional pensions. Patients' expectation for the integration of medical care and elderly care is to enjoy the dual services of medical care and elderly care in one step. However, at present, the development of medical and elderly care institutions needs to take into account the policies of civil affairs, health care, medical insurance and other parties, and there are no communication between departments, and there are barriers between policies, which makes many medical and elderly care institutions unable to truly provide "integrated" services.
In addition, during the visit, many relevant persons in charge of medical and elderly care institutions mentioned the problem of funding. The reporter learned that although the relevant policies have clearly stated that "encourage and support social forces to participate in the development of medical and elderly care", as far as the current situation is concerned, it is difficult for private institutions to survive when they enter the medical and elderly care industry, and most institutions will be in a state of loss.
"The reason why many large enterprises choose to enter the industry now is that they see the trend of the 'silver economy' in the future and look forward to more policy dividends in the future. However, for many companies that are not strong enough, it is not a wise choice to take the risk of 'entering the game' without exact guarantees. Gong Zhiguo said.
Policy support for a change in attitude
Encourage social forces to also "loosen" public medical institutions
At present, the problem of population aging is becoming more and more prominent, although in the mainland, only 3% of the elderly choose institutional pension, but in the face of a huge base, this 3% problem still urgently needs a solution.
In May this year, Wang Haidong, director of the Department of Aging and Health of the National Health Commission, mentioned at a press conference that many provinces across the country have formulated preferential policies such as taxes and fees, investment and financing, and land use to support social forces to set up medical and elderly care institutions. In Jiashan, Zhejiang, family hospital beds and family pension beds are gradually integrated, and bed construction fees are included in the scope of medical insurance reimbursement. Shandong provides financial support for social forces to carry out integrated medical and elderly care services, and encourages insurance companies, trust and investment companies and other financial institutions to set up integrated medical and elderly care institutions as investment entities. Through the government's procurement of services, support medical and elderly care institutions to provide services for the elderly.
The top-down policy is one aspect of the development of the integration of medical care and elderly care, and another difficulty in the promotion of the model is that many citizens do not have a thorough understanding of the concept and service content of the integration of medical and elderly care, and there are also doubts about its effectiveness and safety. "Won't it be cold to go to the hospital for the elderly, so that the elderly can't feel cared for?" "Will the price of an institution with a good environment be expensive? And will the relatively cheap care for the elderly not be in place? ”
Liang Wannian, executive vice president of the Vanke School of Public Health and Health of Tsinghua University, said in an interview with relevant media that the combination of medical care and elderly care has crossed the traditional concept of elderly care and only emphasizes the service connotation of a single "care", and pays more attention to the integration of elderly care services and medical services. "To achieve high-quality development of the combination of medical care and elderly care, it is necessary not only to expand social forces to run medical services, but also to 'loosen' public medical and health institutions." Huang Shisong, a researcher at the National Institute of Development and Strategy at the Chinese University and a professor at the Institute of Gerontology, said.
Chengdu Daily Jinguan News reporter Hu Guiwei Photo courtesy of the interviewee Responsible editor Luo Hao Editor Zhang Chaojie