Study On The Aged Care And Medical Care Integrated Mode And Health Security Of The Elderly Under The Background Of Healthy Aging

[Purpose]This study aimed to analysis of the characteristics of service provision and service compensation in aged care and medical care integrated mode,clear the effect of aged care and medical care integrated mode on elderly health security,propose a corresponding health security optimization strategy,help to promote health equity and achieve healthy aging,which based on the perspective of the demand side.[Methods]1.Literature analysis methodThrough the search of CNKI,Wan Fang,Web of Science,PubMed and other online databases,as well as the review of related books and the review of classic theories,combing the research topics of medical integration and health security at home and abroad.Relevant theoretical foundations and developmental dynamics,and determine research tools such as health security analysis dimensions,research index selection,questionnaires and interview outlines.Collect gray documents such as existing policy documents,work summaries,and data reports from government departments and related institutions,and obtain relevant information on economic,social,policy,population,and medical insurance required for research.2.Empirical analysis method(1)Typical case site survey.According to the literature study and expert recommendation,there were 23 typical aged care and medical care integrated institutions and communitieme in Xianning City,Yichang City and Xiangyang City of Hubei Province were investigated on the spot.31 managers from aged care and medical care integrated institutions and communitieme and from government management were interviewed.System documents such as cooperation agreement,service management method,medical insurance management method,and regional medical insurance management data were collected.(2)Face-to-face Questionnaire survey method.Face-to-face interview questionnaires were conducted among 23 typical health care institutions/communities in the community that met the inclusion exclusion criteria using survey tools such as the International General Scale and self-designed questionnaires.The study collected a total of 872 individual questionnaire data of the elderly under the aged care and medical care integrated mode,and obtained the medical expenses and medical insurance compensation data of the elderly from the medical and nursing institutions,and supplemented the verification of the cost data.Understand the needs of the combination of medical care and support for the elderly,the choice of aged care and medical care integrated mode and their willingness to accept,the utilization of health services,and insurance compensation.(3)Personal in-depth interviews.Understand the reasons for the elderly to choose the aged care and medical care integrated mode,and their willingness to accept,the medical experience and the experience of insurance benefits in the combination of medical care and rehabilitation,and through the literature study,topic group discussion,expert consultation to determine the semi-structured interview outline for the elderly,interview 22 The person who has the willingness to communicate and the ability to communicate,the doctors and nurses in the institution to receive medical treatment and receive medical insurance compensation,and elderly who have a strong attitude towards the aged care and medical care integrated mode.3.Data collation and analysis method(1)Content analysis method.The qualitative data obtained from on-site collection and interviews were collated,the connotation of the mode of medical integration was summarized,and the differences and characteristics of service items,service prices,and service compensation between different aged care and medical care integrated modes were are compared.(2)The 22 interviews of the elderly were transcribed into texts,and the qualitative research and analysis software Nvivo11.0 was introduced for data management and analysis.The nodes were created and meticulously coded under the “native concept” of the service utilization and service compensation experience.The nodes are then merged and grouped to form related categories,and the related topics are compared,summarized,and refined through iteration.(3)Statistics and regression analysis.The chi-square test was used to analyze the individual characteristics of the elderly with different modes of medical integration.The disordered multi-class logistic regression model and the binary regression model were used to analyze the combination of aged care and medical care integrated mode,and the factors affecting the willingness of acceptance.The rank sum test and multiple linearity were used.The regression model analyzes the hospitalization compensation for the elderly.(4)Propensity score matching method.Using propensity score matching method,matching the confounding factors affecting the outcome variables between different modes of health care,based on the balance between the modes,the health equity,the fairness of health service utilization,the fairness of health service financing,and the analysis of medical care Combine the impact of the mode itself on the elderly health security.[Results]1.Constructing the conceptual model of elderly health security affected by aged care and medical care integrated mode.Macroeconomic factors such as politics,economy,culture and system exert indirect and long-term effects on the health protection of the elderly.The core subject--the combination of medical and nursing institutions,medical insurance institutions and the elderly will provide direct and short-term impact on the health protection of the elderly through the provision of medical care services,service compensation and service utilization.2.Based on the perspective of the demand side,the combination of medical research and typical case studies found(1)According to the service provider,the aged care and medical care integrated mode were summarized into the mode of medicine in institution(Mode 1),the mode of pension services in hospital(Mode 2),the mode of integration of institution and hospital(Mode 3),and the mode of community home care(Mode 4).Considering the aged care and medical care integrated service as a packaged comprehensive service,the aged care and medical care integrated mode has different characteristics.(2)In terms of service provision,mode 1 can better balance the provision of aged care services and basic medical services,limited provision of special medical care,and moderate price of aged care services.Mode 2 has obvious advantages in providing convenient and effective medical care services,lack of spiritual and cultural services,and high prices for aged care services.Mode 3 health management services cover all elderly residents,but the frequency of health management services is less than mode 2 and Mode 1,and the price of aged care services is low.Mode 4 is more in line with china's traditional concept of old-age care,but it is greatly influenced by the family support system.Health management services are mainly targeted at key populations,and the threshold for home medical services is high and coverage is limited.(3)In terms of service compensation,the medical insurance coverage items of Mode 1 and Mode 3 are less than Mode 2 and mode 4.The rehabilitation medical items of Mode 2 are included in the scope of medical insurance reimbursement.In Mode 4,the family bed belongs to the medical insurance fixed-point bed and is included in the scope of medical insurance reimbursement.The inpatient medical reimbursement rate in Mode 3(50~70%)is lower than the other three modes(60%~90%).3.The findings of the aged care and medical care integrated service utilization behavior(1)Individual characteristics that affect the use of the aged care and medical care integrated service in the elderly include: senior citizens,occupation,marital status,number of children,frequency of visits to children,monthly income per capita,type of medical insurance,self-evaluated health status,chronic diseases,ADL,society support(P<0.05).(2)With reference to Mode 4,the elderly who participate in employee medical insurance are more inclined to choose Mode 2 and Mode 1,which are 92.1 times(95%CI,4.8~175.3)and 39.9 times(95%CI,2.7~58.1)higher than those who do not participate in medical insurance,respectively.Unmarried,divorced or widowed elderly the preference is to choose Mode 1,Mode 2 and Mode 3.The probability is 3.5 times(95%CI,1.4~9.2),4.5 times(95%CI,1.5~13.9)and 2.6 times(95%CI,1.2~5.7)that of married elderly people respectively.The economic income level is medium level and the low level is higher than the economic income.For the elderly,the possibility of choosing Mode 1 and Mode 3 is less than that of Mode 4.The self-assessment of the general health status of the elderly is as follows: 1.the possibility of Mode 2 is 3.3 times(95%CI,1.2~8.9),3.5 times(95%CI,1.1~11.2)better than self-assessment of health status.Older people with reduced function are more likely to choose Mode 1,Mode 2 and Mode 3,which are 27.7~212 times and 12.6~55.2 times of the normal functioning elderly,respectively.(3)Older people with obvious barriers to function have higher acceptance of combined services.For example,the elderly who have obvious obstacles in functioning are more than five times more likely to receive Mode 2(95%CI,1.5~ 23.4).The lower the social support score,the lower the willingness of the elderly to accept.Such as the lowest group of social support scores,the probability of accepting Mode 2,Mode 3,and Mode 4 were 1.2%~30.3% of the highest score group.4.The findings of health security based on the propensity score matchingAfter constructing propensity score matching,the various aspects of the elderly between the different modes of medical integration are balanced,and the different modes are comparable.The differences among the observed variables should be caused by the difference in mode.(1)The results of the matched sample test showed that the elderly quality of life of Mode 2 was lower than that of Mode 3(t =-3.05,P<0.05),and the elderly subjective happiness of the Mode 2 was higher than that of Mode 4(t = 3.18,P<0.05).Insufficient provision of spiritual and cultural services,and the environment in Mode 2 limits the function of the elderly,which affects the elderly to obtain the best health status.(2)The frequency of health management services of the elderly between different modes.The utilization frequency of blood pressure measurement service,blood glucose measurement service,and physical examination service in the Mode 2 were higher than the other three modes(P<0.05).The standardized and streamlined health management service provided by Mode 2 enable older people to obtain health management services that are superior to other models.Utilization frequency of outpatient service in Mode 1 and Mode 2 were higher than Mode 3 and Mode 4(P<0.05).The high geographical availability of services in Mode 1 and Mode 2 makes the elderly have a better opportunity to obtain outpatient services.(3)For the middle-income level elderly who were covered by Urban Employee Medical Insurance,the amount of hospitalization medical compensation obtained in Mode 3 was higher than that in Mode 2 and Mode 4(H=12.9~19.8,P<0.05).For the same income level elderly who were covered Urban and Rural Residents Medical Insurance,the amount of hospitalization compensation received in Mode 3 were higher than Mode 4(H=19.7~37.5,P<0.05),Mode 1(H=23.6~35.2,P<0.05),and Mode 2(H=23.0,P<0.05),respectively.Mode 3 is more prone to high-cost hospitalization,resulting in medical insurance fund expenditures and personal economic burdens,and there may be a phenomenon of occupation of health resources.5.Elderly health security in aged care and medical care integrated mode faces problems such as unsatisfied needs of the elderly,unfair use of health services,heavy economic and care burdens,occupation of health resources,insufficient support and promotion of environmental construction.[Conclusions]1.The utilization of medical care combined services for the elderly is not only affected by health factors,but also by economic factors.The elderly with low economic incomes have difficulty in meeting the needs of medical care and services.Therefore,by improving the service provision and security system and leaning toward low-income seniors,it might help improve the accessibility of medical care and improve the overall level of health security.2.In the context of socio-economic and policy environment,the mode affected elderly health security through service provision and service medical insurance compensation.Service provision and service compensation strategies should be targeted to optimize the combination of medical and nursing modes to improve the health of the elderly and promote health equity.On the one hand,health management services,outpatient services,professional medical and ambulance services,home medical services,spiritual culture and hospice care services should be strengthened,and pension institutions should be promoted to cooperate with medical institutions below the secondary level.On the other hand,it is necessary to expand the financing channels for medical insurance,optimize the design of compensation mechanisms,improve the level of outpatient treatment,explore the role of health risk sharing,and accelerate the development of long-term care insurance independent of basic medical insurance.[Innovation and Deficiency]InnovationFrom the perspective of research,this study focuses on the service needs of the elderly from the perspective of the demand side,explores the service utilization behavior of the elderly,analyzes the health security level of the elderly in the model,analyzes the problems of health security in the model,and proposes propose a corresponding health security optimization strategy under the background of healthy aging.Therefore,there is a certain new meaning in the research perspective.In terms of research ideas,this study is based on the classical theory of health equity theory and welfare economics theory.Based on the comprehensive consideration of the influence of healthy social determinants on the health of the elderly,this paper constructs a model health security model.Whith provides a theoretical basis and provides support for the determination of research content and methods.Strict connection between the various chapters of the paper.Therefore,this research has certain innovation in the way of thinking.In the application of the method,this study used preference score matching mothed to matching the confounding factors affecting the outcome variables between different models,and verify the influence of the model itself on the elderly health security.Therefore,this study has some innovations in the application of methods.DeficiencyIn the process of constructing preference score matching,all the influencing variables can not collected due to the limited measurement method.Therefore,the confusion factors that affect the effectiveness of individual matches may be ignored in the matching process.At the same time,the sample loss caused by the initial gap between the medical and nursing modes may affect the representativeness of the sample.In the future,the sample size can be increased to increase the representativeness of the sample.This study based on the preference score matching and analysed on the difference and influence of elderly health security between aged care and medical care integrated mode.This is the idea of taking parallel control studies.In the future,we can study the differences in the level of health security before and after the elderly receive services,to verify a direct impact of aged care and medical care integrated mode on elderly health security.