| BackgroundThe aging of the population is a major achievement in the 21 st century in the world of human health and longevity,and is also a major challenge facing the community with a shared future for mankind.The aging of the population and how to achieve a healthy aging industry has become a global concern.In 1999,China entered the ranks of an aging society.With the acceleration of China's aging process,how to reduce the burden of chronic diseases,improve the quality of life and improve the health of the elderly has become an urgent solution in the process of achieving healthy aging.At the same time,home-based care and community care are also affected by many factors such as the weakening of traditional family functions and demographic changes in China.In addition,since most elderly people suffer from various chronic diseases,their demand for medical and health services is large,and traditional old-age care institutions do not have medical care qualifications.Therefore,once elderly people are sick,they need to travel back and forth in families,hospitals and old-age care institutions.This is extremely unfavorable for the treatment,care and rehabilitation of the elderly.The medical and nursing care institution combines professional prevention,medical care,and nursing services with old-age care and life care services.It aims to provide basic life care services for the elderly,and emphasizes the supply of medical care services.The quality of life of the elderly and improve their health to better achieve healthy aging.Although scholars at home and abroad have carried out relevant research on institutional pension services,in the context.of promoting the combination of medical and nursing care,research on medical and nursing institutions is still rare.The existing researches are mostly on the current mode of combined medical and nursing service from macro introduction in China.Few studies have compared the elderly's willingness to choose different types of medical and nursing institutions through quantitative analysis;and the supply and demand research on the combination of medical and nursing institutions is rarely compared with the established standards;the lack of the comparison of different types of medical and nursing care institutions among factors such as human,financial,and material resources and the study of the relationship between the factors of the combination of medical and nursing care institutions and occupancy rates.Based on this,the study takes Qingdao as the research site,and conducts a comprehensive and systematic study on the willingness to choose the service mode of the elderly and the status quo of service development,and provide reference and basis to explore the innovation and development of the integrating medical and nursing care services in China under the background of the new era.Research ObjectivesThe overall goal of this study is to analyze and explore three typical modes of medical and nursing care combined services in China(medical institution within the pension institution,pension institution within the medical institution,and medical pension institution),and to study the willingness of the elderly to choose different modes of medical and nursing care and the influencing factors,and analyze the service situation of different types of medical and nursing institutions based on the perspective of demand and supply,and combine the qualitative and quantitative research methods to analyze the demand of the medical and nursing care services,the current situation of the supplier and the external support environment,and related influencing factors.Exploring the status quo of the combination of medical and nursing institutions and the possible factors affecting the occupancy rate of the combination of medical and nursing institutions,and to provide data support and countermeasures so as to meet the government's response to the aging problem brought about by the old age problem,improve the quality of medical and institutional services,and achieve the goal of healthy aging.Specific objectives include:1.Taking Qingdao as an example,this paper systematically investigates the preferences of elderly people living in medical and nursing care institutions for the service mode of different types of medical and nursing institutions,and analyses the main factors affecting the choice of medical and nursing care institutions for the elderly;2.Based on SWOT-CLPV model,this paper analyses the construction and development of service modes of different types of medical and nursing institutions from a macro perspective,explores the existing problems and their influencing factors,and builds a model for the selection of service modes of elderly medical and nursing institutions based on decision tree model from a micro perspective;3.To comprehensively investigate the demands and utilization of the services for the elderly in the medical and nursing care institutions,analyze and explore the main factors affecting the demand for integrated medical and nursing services for the elderly-4.Conduct a comprehensive survey on the supply of medical and nursing care institutional services,compare and analyze the differences in the supply of human,financial,and material resources and services among different types of medical and nursing care institutions,analyze the possible factors affecting the occupancy rate of integrating medical and nursing care institutions,and make the qualitative analysis of service for quality in the integrating medical and nursing care institutions.5.Based on the systematic analysis of the willingness to choose of the elderly for the integrating medical and nursing care service model and the demand,supply and utilization of the services of the medical and nursing institutions,the countermeasures and suggestions for promoting the development of the combination of medical and nursing institutions are proposed.Data and MethodsThis study collects qualitative data on the demand and supply of integrating medical and nursing care institutions through literature analysis and focus group interviews,and collects quantitative data through field surveys and self-administered questionnaires.Focus group interview method is mainly used to obtain the knowledge of stakeholders on the supply and utilization of medical and nursing services,and to make qualitative analysis on the service content,quality and existing problems of medical and nursing care institutions.The in-depth interviews included managers and health care workers,elderly residents and government officials and a total of 50 people were interviewed.Questionnaires for medical and nursing institutions are mainly self-filled,which are used to obtain basic information,institution construction,personnel,service,operation and other related data of medical and nursing institutions.Using multi-stage stratified sampling method,according to the principle of optimum distribution of the number of medical and nursing care institutions in 7 municipal districts,2?11 medical and nursing institutions were selected from each district,and 43 medical and nursing care institutions were selected from 7 districts.On this basis,the proportion of the elderly in each medical and nursing care institution were completely layering with self-care,semi-self-care and completely unable to self-care,20?80 elderly people who meet the inclusion criteria were selected from each integrated medical and nursing institution.A total of 2,040 elderly people who were admitted to the medical and nursing institutions were surveyed by questionnaires.The basic characteristics,family conditions,health status and health services,self-care ability and daily living conditions,social and economic conditions and medical-maintenance services of the elderly were investigated and studied.Statistical analysis methods mainly include descriptive analysis,single factor analysis,multiple logistic regression,SWOT-CLPV model,decision tree model,multiple linear regression,structural equation model,etc.Excel 2016,SPSS25.0,Statal5.0,Amos 23.0 software were used for statistical analysis.Principal Findings1.The preferences and influencing factors of the medical and nursing care institutions for the elderly in Qingdao(1)A total of 2,040 elderly people from 43 medical and nursing institutions in 7 districts were surveyed with questionnaires.A total of 1950 questionnaires were collected,of which 1907 were valid,with an effective rate of 97.79%.(2)Among the elderly surveyed,42.32%of them chose the medical institution within the pension institution as the ideal combination of medical and nursing care,20.14%chose pension institution within the medical institution,and 37.55%chose medical pension institution.Among the non-agricultural household registered elderly,39.80%chose to have the medical institution within the pension institution,21.12%chose to have the pension institution within the medical institution,39.08%choose to have the medical pension institution,49.22%of the agricultural registered elderly choose to have the medical institution within the pension institution,17.45%chose to have the pension institution within the medical institution and 33.33%have the medical pension institution.(3)Among the elderly surveyed,multivariate regression analysis was carried out by using the model of" medical pension institution " as the control group,it showed that the elderly with low education,no illness,full self-care and semi-self-care preferred to choose the medical institution within the pension institution,while the middle-aged,low education,divorce,no illness and one disease,full self-care and semi-self-care preferred to choose pension institution within the medical institution.2.Selection model of medical and nursing institutions service for elderly based on SWOT-CLPV and decision tree(1)Through SWOT-CLPV model analysis of different types of integrating medical and nursing care institutions in Qingdao,it is found that the quantity and quality of medical and nursing care services provided by the current integrating medical and nursing care service model for the elderly should continue to be optimized;the polarization of integrating medical and nursing care institutions is serious,and the level and capacity of integrating medical and nursing care services in some institutions need to be improved.The integrated medical and nursing service mode can realize the organic integration of "medical+ pension",but there are some problems such as high operating cost and imperfect external supporting facilities of the integrated medical and nursing care institutions;the medical service and pension function of the integrated medical and nursing care institutions need to be improved,the top-level design needs to be strengthened,and the system of long-term nursing insurance needs to be further improved and innovated.(2)The decision tree model is used to analyze the willingness of the elderly to choose the service mode of the medical and nursing institutions.It can be concluded that older people whose marital status is widowed,unmarried and married,living with their children in different districts or other ways,having very good and good health,fully self-care and semi-self-care,and working as office general staff,agriculture,forestry,fishery and other personnel prefer the service mode of "medical institution within the pension institution" more;older people who are divorced,in poor health or in bad condition are more likely to have the service mode of" pension institution within the medical institution";the elderly who live in the same district with their children,general health status are in poor or very bad condition,can not take care of themselves completely,occupations are ordinary workers,professional technicians,leaders of state enterprises and institutions,as well as individual households and freelancers prefer the service mode of" medical pension institution ".3.Demand status and influencing factors of integrated medical and nursing services for the elderly(1)The contents of the integrated medical and nursing services most needed by the elderly in the integrated medical and nursing institutions were disease diagnosis and treatment(87.68%),life care(76.25%)and health management(73.83%).The elderly in the integrated medical and nursing institutions had the lowest demand for terminal care services(11.69%),followed by the elderly hotline services(33.77%)and sports and recreational activities(36.92%),the most needed support team is the government's support for poverty alleviation in rural areas(71.83%);the lowest demand for elderly sports associations(33.67%).Older people are more satisfied with the service modes of "the medical pension institution" and "pension institution within the medical institution",among which the content and quality of the service mode of "pension institution within the medical institution " are more favored by older people.(2)Influencing factors:age,the economic status of the elderly,average monthly income,education level,previous occupation,where to seek medical treatment in peacetime,satisfaction with current care situation,satisfaction with interpersonal relationship,most worrying and anxious problems and frequency of meeting with children are the influencing factors of the demand for integrated medical care for the elderly(t=-3.139,-6.477?3.770,-4.307,-2.980,-2.492,-5.856,-2.938,-2.706,-2.511,P<0.05).Through structural equation model analysis,it is found that where the elderly goes to see a doctor and their daily living conditions have a direct impact on the demand for integrated medical and nursing services.The social and economic status of the elderly has a direct impact on the demand for integrated medical and nursing services,and has an indirect impact on the demand for integrated medical and nursing services through where they go to see a doctor and their daily living conditions.The most important factor affecting demand is daily living conditions,followed by personal social and economic status and the third factor is where to seek medical treatment in peacetime.4.Influencing factors of service supply and occupancy rate in medical and nursing institutions(1)At present,the development of medical and nursing institutions is uneven,and the supply of services can basically meet the needs of the elderly,but the quality of medical and nursing services needs to be improved urgently.The nursing member have the situation of high mobility,low level,poor professional level and low social status,and nursing staffs' daily life care services and the professional skills of medical and nursing care need to be improved.In order to meet the needs of the elderly in different levels and health conditions,we need to establish a comprehensive,multi-level and three-dimensional integrated medical and nursing care service model.(2)Forty-three medical and nursing institutions are classified according to the model of "medical and nursing integration".There are 19 " the medical institution within the pension institution",11 " pension institution within the medical institution"and 13 " medical pension institution " and the overall operation of the institutions is good.Among them,the ratio of licensed physicians to beds,nurses to beds and nurses to nursing member is basically conforming to the basic standard of medical and nursing service in Qingdao City,the ratio of nurses to beds is slightly higher than that of the basic standard of Qingdao;69.77%of the medical and nursing institutions can provide integrated medical and nursing services including "medical,pension,nursing,education and recreation".The work of doctors in medical and nursing institutions mainly focuses on medical and pharmaceutical services,nurses mainly provide professional nursing services,pension nurses mainly focus on daily life care services;elderly people with different self-care abilities in pension institution within the medical institution pay the highest average monthly fees,followed by the medical institution within the pension institution and medical pension institution is the lowest.(3)The occupancy rates of 43 medical and nursing institutions are quite different,with an average occupancy rate of 68.05%.The occupancy rate of 79.07%of the institutions meets the standard of "Classification and Assessment of Grades of Pension Institutions" issued by the Ministry of Civil Affairs,which stipulates that the occupancy rate of institutions should not be less than 50%.Through the comparative analysis of the three service modes" the medical institution within the pension institution,pension institution within the medical institution and medical pension institution",we find that the average occupancy rate of the medical institution within the pension institutions is the highest,followed by the medical pension institutions,and pension institution within the medical institutions are slightly lower.Whether or not to organize regular managed care for the elderly,the length of service and the number of doctors are the influencing factors of the occupancy rate of the medical and nursing institutions(t=-2.337,2.205,1.996,P<0.05).Among them,the medical and nursing institutions with regular managed care for the elderly,long operating hours of the institutions and a large number of doctors are organized its occupancy rate is higher.Conclusions and RecommendationsConclusion1.Demographic characteristics,health status and socioeconomic status factors have significant influence on the preference of the service mode of the elderly health care institutions.2.At present,the advantages,disadvantages,opportunities and problems of the service mode of Qingdao integrated medical and nursing institutions coexist.3.Marriage status of the elderly,living arrangement with their children,health status,self-care ability and previous occupation are the main factors affecting the willingness of the elderly to choose different types of medical and nursing institutions.4.Daily living conditions,individual social and economic status and health service utilization of the elderly are the main factors affecting the demand for integrated medical and nursing care services.5.The service supply of most medical and nursing institutions can meet the needs of the elderly,we should innovate and develop a comprehensive,multi-level and three-dimensional integrated medical and nursing service model.6.The integrated medical and nursing care institution occupancy rate of health management regularly,long business hours and more doctors for the elderly is higher.Policy suggestion1.To innovate and develop the service mode of medical and nursing combination,and promote the service optimization and upgrading of different types of medical and nursing combination institutions;2.Improve the social and economic status of the elderly,and optimize their ability and willingness to choose for the aged.3.Based on different characteristics of the elderly medical care service needs,the formation of a multi-medical and nursing care service security system;4.Explore and innovate the existing management model,and establish and improve the long-term care service system;5.To fully mobilize social medical and nursing care resources and improve the service capacity of the combination of medical and nursing care from macro and micro aspect.Innovations and LimitationsInnovation pointsThe innovation of this study is that it is the first time to conduct a comprehensive and systematic study on the influencing factors and service supply and demand of different types of medical and nursing institutions in China.The research experience and results obtained can provide reference for the follow-up study,and provide theoretical and empirical basis for the government to formulate policies related to the service mode of medical and nursing institutions.Specific manifestations are as follows:1.From the research point of view,under the background of healthy aging,this study is the first time to analyze and discuss the three modes of medical and nursing institutions from macro and micro perspectives;based on the perspective of demand and supply,it studies the service demand and supply of integrated medical and nursing institutions,at the same time,it also summarized the service of the gap between demand and supply of medical and nursing institutions,which will help us to understand the current situation of the development of the medical and nursing institutions in an all-round way,and lay a foundation for further research on the service of the medical and nursing institutions and the development of the medical and nursing health industry.Qingdao,as the first batch of demonstration units of medical and nursing integration and new first tier cities in China,is an important model of urbanization research in China.The research based on Qingdao has an important enlightenment for the development of medical and nursing integration in various cities in China.2.From the aspect of the application of research method,SWOT-CLPV model,decision tree model and other methods are applied to the study of the choice of service modes of medical and nursing care institutions in the first time for this study.From a macro perspective,SWOT-CLPV model is used to analyze the S(Strength),W(Weakness)of different types of medical institutions and the external O(Opportunity)and T(Threat),respectively.Inhibitory C(Control),L(Leverage),P(Problem)and V(Vulnerability)generated by interaction are analyzed.From the micro perspective,the survey data of sample population are judged by decision tree theory to determine the choice of medical and nursing care institutions for the elderly,and the integration of qualitative and quantitative research is realized.3.In terms of research contents and conclusions,This study is the first time to study the influencing factors of the choice intention of different medical and nursing institutions,enriching the research content of the service mode of the medical and nursing institutions;in terms of service supply and demand,it analyses the influencing factors of the service demand of the elderly medical and nursing institutions and the main factors affecting the occupancy rate of the medical and nursing institutions,so as to improve the reliability of the results.This study reveals that the demographic characteristics,health status and socio-economic status of the elderly have a significant impact on their choice of integrated medical and nursing care service model;daily living conditions,personal socio-economic status and utilization of health services affect the service demand of the elderly in the medical and nursing institutions;whether to regularly carry out health management for the elderly,the length of business and the number of doctors are the influencing factors of the occupancy rate of the medical and nursing institutions.These conclusions increase the elderly's understanding of the influencing factors of the choice of different types of medical and nursing institutions and the supply and demand of the service mode of the medical and nursing institutions It provides a new empirical basis for enhance the management of integrated medical and nursing institutions,promoting the construction of integrated medical and nursing institutions,and improving the service of integrated medical and nursing institutionsLimitations and research prospect1.This study is a cross-sectional study;cross-sectional data research has one-sidedness at the time point.In exploring the interrelationship between the demand for integrated medical and nursing care service and the elderly with dinfferent characteristics,as well as the occupancy rate of integrated medical and nursing care institutions and the supply of integrated medical and nursing care services,its timing and causality can not be further studied.In the future research,time series design or cohort study will be more conducive to further explore the relationship between variables2.This study makes a qualitative analysis on the service quality of medical and nursing institutions based on various stakeholders.In the future,we will further establish the evaluation index system of service quality standards and quantitative evaluation of service quality,and explore the main factors affecting service quality.3.For the analysis on the choice of the mode of combination of medical and nursing care for the elderly and the supply and demand of services,this study only surveyed seven municipal districts of Qingdao City.There are some problems of insufficient sample representation,and the supply and demand will be affected to some extent by the local health care policy and the degree of population aging.In the future,a comparative study will be considered in several regions. |
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