I, "institutionalized old age" medical care combination mode
1,"big old age + small medical" type
The model is based on the nursing home to build a new small medical institutions, new medical services, in order to pension as the main, medical as a supplement. At present, most of the nursing homes have adopted this model to carry out medical services. The model has obvious shortcomings: the built-in medical institutions can only carry out outpatient business, can not solve the problem of direct hospitalization in the nursing home; at the same time, the operating costs of medical institutions are high, only the salaries of medical staff to the nursing home has brought a great burden, the nursing home is difficult to support long-term.The research found that: many have applied for the establishment of a medical institution within the nursing home, medical institutions for a period of time in the trial run can not continue to adhere to the "people away from the building empty".
2."Medical and nursing care" type
This model is mostly for the newly built medical and nursing care institutions or hospitals transformed into nursing care institutions or nursing homes, emphasizing the development of both medical and nursing care. The new large-scale nursing institutions, synchronized with the construction of comprehensive hospitals or nursing homes, to achieve the development of medical and nursing care; some idle resources of the medical institutions will be surplus resources for the transformation of the elderly service, to open the elderly special care wards or directly transformed into nursing homes, rehabilitation centers, and other ways to provide health care integrated health care services.The research found that this model integrates medical and nursing resources into one, forming an operational situation of medical care and nursing care, which can basically realize the enjoyment of medical care and nursing care for the elderly who are not critically ill in the institutions.
3,"Large medical + small pension" type
This model is mostly a large-scale medical institutions to build a new small pension institutions, through the provision of relevant facilities, increase nursing staff and other initiatives, in the medical institutions. The new hospital is also a new professional nursing home organization.The research found that this model is to use high-end medical resources to set up nursing institutions, with the advantage of good conditions in the nursing environment, good medical care, and higher-end, but there are obvious shortcomings: on the one hand, the use of existing hospital resources is not economical or even wasteful, and on the other hand, the cost of nursing care is higher, which is difficult to be borne by ordinary families with middle to lower economic conditions.
4,"Large medical + small rehabilitation" type
This model is mostly a large-scale medical institutions to build a new small rehabilitation institutions, such as geriatrics or rehabilitation, rehabilitation centers, with medical care as the main, rehabilitation as a supplement.Most of these models involve the creation of new rehabilitation and care functions in the existing medical institutions to build a service system that integrates medical care, nursing care and rehabilitation.
The research found that most of the development of this model is good, but the proportion of "nursing" in the system of "integration of medical care, rehabilitation and health care" is relatively small.5."Two hospitals in one" type
The model is mostly the local government to build the old age home by the local township health center hosting operation, township health centers and old age home to realize the "integration" of the township health center and the old age home. Township health centers make use of the resources of homes for the aged to take care of the "five guarantees for the elderly" as well as to accommodate some of the social pensioners. This model is an effective integration of existing pension and medical resources, can activate the supply of medical and nursing resources gravity, close to the service of the rural elderly population, to help them realize the local pension.The research found that compared with the "public-private" elderly services, this model is easy to maintain the value of the original state-owned assets of the elderly homes, is a more ideal model of health care integration.
6,"medical health care" type
On the basis of the hospital, the new nursing home and nursing home, the implementation of the integration of medical care, health care, nursing operation. This model has the advantage of rehabilitation patients hospitalized for a period of time, the physical condition is greatly improved, many patients from bed-ridden to walk independently, the social benefits are excellent; rehabilitation patients in the hospital during both the rehabilitation treatment services, but also to get pension services, rehabilitation may also be a group of people in the nursing home long-term stay, the agency's economic efficiency will be greatly improved, is the most efficient allocation of resources combined with the model of health care.7,"Individual clinic + small pension" type
This model is generally organized by individual clinics, the front foyer for the clinic, behind the family-type small pension, clinic doctors, nurses to provide medical care for the elderly, and employ 1-1/2 years of service. Doctors and nurses from the clinic provide medical services to the elderly, and 1-2 nursing staff are hired to take care of the elderly. The research found that the advantages of this model are low fees, close to home, more convenient, full utilization of resources, and good results; but the disadvantages are that the medical and nursing facilities are relatively simple, care is not standardized, and there is also the problem of diseconomies of scale.8,"Elderly institutions + medical services outsourcing" type
This model refers to the establishment of medical institutions do not have the conditions of the elderly institutions, and the nearest hospitalization function of the medical institutions (most of them). Medical institutions (mostly first-class general hospitals) signed a cooperation agreement, the medical services required by the elderly institutions outsourced to the medical institutions, the elderly institutions for the medical institutions to provide space and the necessary conditions, the medical institutions in the elderly institutions to set up branches such as hospitals, medical institutions to send medical personnel to the elderly institutions to provide medical services outsourcing services, or "the whole of the elderly hosting This model has the advantage that both the medical and nursing parties can provide medical services to the elderly. The advantage of this model is that the responsibilities, rights and benefits of both sides of the medical care are clear, and both sides use the market mechanism to carry out cooperation. The research found that: this is a specialized division of labor and cooperation between medical and nursing, improve the efficiency of resource utilization in an effective form, especially for 100-300 people in the elderly institutions to carry out medical and nursing services (smaller elderly institutions to use this model, the medical institutions may "lose money" caused by the unsustainable service, the need for elderly institutions to give some subsidies to the medical institutions). The medical institutions will be subsidized to a certain extent).9,"Elderly institutions + medical services green channel" type
This model refers to the elderly institutions and neighboring medical institutions signed a cooperation agreement, medical institutions for the elderly institutions to provide patients with a "green channel" to seek medical care. The shortcomings of the model is: medical institutions and nursing institutions to cooperate with the basis of trust and interest from both sides of the drive, the cooperation between the two sides of the lack of effective constraints and interests of the coordination mechanism, once the agreement affects the interests of a party, it is easy to terminate the agreement of the situation, it is difficult to ensure that the effectiveness of the cooperation, continuity. The research found that: this model is difficult to realize the integration of medical care, basically belongs to the "form", it is difficult to carry out substantive cooperation between the medical care, basically each do their own (such as the elderly institutions need to hospitalize patients, although the agreement requires priority to the cooperation of the medical institutions hospitalized, but the patient's family does not necessarily agree, may go to larger, more secure hospitals). larger, more assured hospital), over time, it is difficult to long-term cooperation.10,"Large elderly + small medical + medical service green channel" type
This model is the elderly organization itself first build a small medical institutions, such as health room or clinic, and at the same time another with other larger medical institutions signed a cooperation agreement. The first is to build a small medical institution, such as a health room or clinic, and at the same time, sign a cooperation agreement with other large-scale medical institutions, and provide a "green channel" for the patients of the institution to seek medical treatment. For general medical problems, the nursing home institutions to solve their own problems, when there are more serious patients immediately transferred to the cooperative medical institutions for treatment. The above ten "institutionalized elderly" medical care combined service model, the first seven for the "integrated" model, the eighth and ninth for the "embedded", the tenth for the "hybrid". The first seven are "integrated" models, the eighth and ninth are "embedded", and the tenth is "mixed". The first eight kinds of medical and nursing combination is relatively close, the ninth for the loose combination of medical and nursing, the tenth for the half-loose half-tight. At present, the relevant departments to introduce the results of the health care integration coverage rate of how many when, often to sign an agreement type of loose model. The research found that: we believe that the loose model is basically a "form", it is difficult for medical institutions and nursing institutions to cooperate substantively, and it is even more difficult to operate in a market-oriented manner; the combination of health care must be used in an "integrated" development model.Two, "community elderly" health care model
11,"community health service institutions + day care center for the elderly "
Day care center facilities can be in the elderly, medical care, basic public **** health services and other aspects of **** enjoy the use of resource allocation efficiency; generally sent to the "day care center for the elderly", most of the people are Most of the people who are sent to "day care centers for the elderly" are "sick in one body", and these people need the services of medical personnel more, so this model can meet the medical needs of the elderly more; at the same time, only when the medical personnel undertake the corresponding services, the children of the elderly can be more assured and send more elderly people to the day care centers for the elderly.
The research found that: community health service organizations are entities, which operate day care centers for the elderly, in line with the requirements of "can be responsible and accountable", and the separation of ownership and operation, which not only solves the systemic problems brought about by the management and operation of day care centers for the elderly by the community committee, but also solves the problem of assets of the day care centers for the elderly. Solve the problem of idle assets of the day care centers for the elderly, but also resolve the tension of the community health service institutions, to achieve resource *** enjoyment; not only can reap the social benefits of "better protection of health care for the elderly, the elderly children more at ease", but also through more services for the community health service institutions to bring due economic benefits, and also promote the industrialization of the elderly. At the same time, it can also promote the industrialization of the elderly, and truly realize the win-win situation, which is the ideal way to realize the integration of health care at the community level.12,"Community health care facilities ****build **** enjoy" type
The elderly service facilities with primary health care services unified planning, unified construction, such as rural hospitals and health center synchronization construction, urban community day care centers The construction of urban community day-care centers and community health service institutions synchronized construction. Through the synchronization of construction, the community level of medical integration in one step.13,"Professional pension operating institutions + day care centers for the elderly" type
The large-scale professional pension institutions hosting day care centers for the elderly, the elderly day care centers idle resources to make full use of. The first is to make full use of the resources of the day-care centers for the elderly. The research found that this model due to the elderly day care centers of small scale (generally only 10 beds), it is difficult to play the economies of scale; at the same time, some professional elderly care institutions can not keep up with the medical services, it is difficult to do a good combination of medical care, once the government subsidies are reduced or canceled, it is difficult to maintain.14,"Community integrated nursing service institutions and community health service institutions signed an agreement" type
This model is often the community to build a comprehensive service center for the elderly, in order to carry out the combination of medical care and community health service institutions signed a cooperation agreement This model is often the community to build a comprehensive service center for the elderly, in order to carry out the combination of medical care and community health service institutions signed a cooperation agreement. Community health service organizations signed a cooperation agreement, but the services provided are mainly basic public **** health services, basic medical services are relatively small.15,"Village Health Office + Rural Well-being Home" type
The village health office hosting the operation of the rural wellbeing home, to realize the combination of medical care at the rural community level, but at present there are not many typical cases.Three, "home care" health care combination model
16,"Internet + wearable devices + physical service organizations" type
This model needs to provide a better service to the elderly.
This model requires the home elderly equipped with wearable devices, the elderly life and physical condition of remote monitoring, through the information management platform and the use of the Internet, the Internet of Things, the elderly in daily life, health and travel situation of the relevant data in a timely manner to the entity of the combination of medical care of elderly institutions or entities of the community institutions (such as nursing stations, community health services) and the children of the elderly. Based on the monitoring data of the elderly's body, the physical service organizations will make a service plan, and at the same time, according to the needs of the elderly and their children, they will provide the elderly with relevant services such as diet, medical care, fire safety, leisure and entertainment, and call for the police in a timely manner. The research found that: at present, many enterprises are keen to develop this model, some of which are designed on a large scale, but there are not many successful cases.17,"Home care + family doctor contracting service"
This model is to promote family doctor services by carrying out family doctor contracting service activities, signing service agreements with elderly residents in need and providing contractual services.18,"Home care + long term care insurance 'home care' services"
This model is to provide home care services for eligible elderly people with disabilities.This model is to provide eligible disabled elderly people with home care services, whereby the disabled elderly people will be cared for at home by their own family members, and the designated medical institutions of the long-term care insurance will provide "home care" services focusing on rehabilitation, and the relevant costs will mainly be provided by the medical insurance funds. This home care model is mainly for urban workers who enjoy long term care insurance, which is welcomed by residents, but the social cost is very high, and the time cost for medical staff to travel between the medical institution and the residents' homes is also very high, and the resource allocation is not effective compared to the "home care" of the elderly who are unable to stay in the nursing home institutions.
Research findings: In addition, the research also found that some of the large-scale organizations combining medical care and nursing care provide extended services to "community nursing care" and "home nursing care" at the same time as they do a good job of "institutional nursing care". Some large-scale organizations have extended their services to "institutional care" while providing services to "community care" and "home care", synchronizing their services at the three levels of "institutional care", "community care" and "home care", thus forming the "three levels of institutional care, community care and home care". Institutions, community, home integration of the three levels of development of intelligent "medical integration model, economic and social benefits are relatively good.