Research On The Effective Articulation Of Health Policies For The Rural Elderly From The Perspective Of Accessibility ——Taking Village X In City D,Shanxi Province As An Example

Since the begining of the 21 st century,China’s health care system reform has entered the fast lane,and the reform of "three medical care linkage" has made great achievements.A medical security system consisting of basic medical insurance,major medical insurance and medical assistance has been established,achieving simultaneous increases in coverage,scope and level of protection.At the same time,it has promoted the reform of equalization of basic medical and health services,increased the investment in primary medical and health institutions,and improved the accessibility of medical and health services.However,changes in the age structure of the population and the spectrum of diseases have brought great challenges to the reform of the health care system,and the health needs of the rural elderly population in particular need attention.To this end,this paper selects X village in D city,which has a more serious aging problem,as the subject of investigation,and uses literature and interview methods to gain an in-depth understanding of the health needs of the elderly in X village from the perspective of accessibility,and finds that the accessibility dilemma of the elderly in terms of health needs is largely caused by poor policy convergence.With the improvement of living standards,the health needs of the rural elderly are characterized by diversification,including the demand for medication caused by the prevalence of chronic diseases,the demand for care and rehabilitation caused by disability,the demand for preventive care to maintain health,and the demand for financial compensation arising from the treatment of diseases.However,the elderly face four dilemmas in meeting their health needs: in terms of geographic accessibility,village health offices have reduced the spatial distance for the elderly to seek medical treatment,but the service content and service capacity are insufficient;in terms of service accessibility,the service level is limited,the service content is single,and the function of primary care cannot be brought into play;in terms of economic accessibility,there is a lack of institutional arrangements tailored to the needs of the elderly,and the medical insurance system has a limited role in relieving the pressure of medical expenses on the rural elderly;in terms of acceptability,the match between service supply and demand is insufficient.This paper analyzes the dilemma of accessibility to the health needs of rural elderly from the perspective of policy interface.The barriers to policy convergence are mainly reflected in four aspects: the primary medical institutions cannot play a unified function and cannot realize the effective convergence of different types of service demands of the elderly;the lack of convergence between different medical compensation systems and between different components within the same system cannot meet the financial compensation needs of the elderly;the lack of effective information channels cannot establish a benign mechanism between policy makers,implementers and policy targets.The lack of effective information channels does not establish a positive interaction mechanism between policy makers,implementers and policy recipients.The reasons for the obstacles to policy convergence are the fragmentation of policy supply,the low quality of service supply and the fragmentation of management bodies.To address the policy interface problem that causes the health accessibility dilemma of the elderly,this paper proposes to realize the transformation from "treatment"-centered to "health"-centered by promoting conceptual changes;to increase the medical care ceiling for the elderly through the effective interface between medical compensation mechanisms;and to meet the multiple health service demands of the elderly through the effective interface between different service providers.The paper also proposes to improve the upper limit of medical compensation for the elderly through the effective connection between medical compensation mechanisms,and to meet the multiple health service needs of the elderly through the effective connection between different service providers.