| BackgroundChina is a big country with an aging population.In the face of the ever-increasing burden of pension,the government put forward the concept of the combination of medical care in 2013.The state development planning commission and other ministries jointly issued "about promoting health and pension service of combining the guidance" in 2015,local governments also combined with local actual formulated the relevant documents,in order to promote the medical combined with ground implementation of the policy.Since the government encouraged the development of medicine and nursing,investors have started to explore different pension modes.However,in the present practice,the combination of "care" and"care" in the practice of "care" has been developed,and the combination of pension and medical resources is not close enough,and the concept cognition of the combination of medical care is not complete[1].In addition,there is a lack of resources for pension institutions and the inability to flexibly control the medical resources of their cooperative medical institutions.By the end of 2012,the national pension service agencies,44304,has 4.165 million beds[2],pension coverage less than 2%of total beds,namely every 1000 older people have less than 20 of the beds,it is not only lower than the average of 5%in the developed countries,even lower than the average level of 3%in developing countries,endowment resources structural vacancy[3]is explained.At the same time,according to the civila affairs department statistics show that more than 40 thousand pension institutions in our country,the true health service capacity accounted for only 20%[4],medical function obviously,lead to can't meet the demand of endowment.ObjectivesAccelerating the development of the old-age industry shows the government's determination to safeguard the quality of life of the elderly.The development of old-age service is an important breakthrough to solve the empty nest,the incapacitating and the left-behind elderly.Elderly population size and rapid growth,pension services of pension services and medical care,pension agency services is relatively single,more only provide life care,nursing serious deficiencies in diagnosis and treatment.Pension institutions in the health and pension service separation of light or heavy medical,causing many of the sick old man to the hospital as a nursing home,sick old man "and bed" became the norm of the hospital,causing severe excessive medical care.This is not conducive to the healthy development of China's old-age service and the health of the elderly population.In view of the above situation,this study will explore the resource allocation of different pension service modes in the context of the combination of medical care,and provide scientific reference for further rational allocation of old-age resources.Secondly,it aims to improve the quality and level of the service by evaluating the content of the service.Methods(1)Literature analysis method:by using China academic journal network,a database of ten thousand,science and technology periodical database,such as data-searching database and read show,such as network search engine to retrieve and,foreign periodicals in the library such as citation tracking,with "d keep combination","resources","endowment service ability","service evaluation","pension institution"and "aging" as keywords,collect the relevant domestic and foreign medical combination,maintenance,allocation of health resources,pension service evaluation related policy,works and papers;(2)Expert consultation method:interview medical and pension management department related policy makers,medical and pension institution management experts and staff,understand the factors that affect the combination of medical care;(3)Field investigation method:to know more about the specific situation of the pension fund;(4)The combination of descriptive research and analytical research:comprehensive analysis of resource allocation,service quality,supply and utilization of old-age services;Calculate the Gini coefficient:understand the fairness of the allocation of old-age resources;Use of entropy rights-TOPSIS method:service to pension services.ResultsTo a more comprehensive understanding of the Wuhan medical combined with the whole situation of the allocation of resources endowment service,according.to the research purpose,to the community endowment,institution endowment as the research object,the results are as follows:The first part-Institutional Pension Resource Equity Analysis.(1)In Wuhan over 60 number of elderly population is HP District,is one of the biggest area of geographical area,the elderly population is 10.3 times that of the southern China geographic area of nearly 80 times that of JH District.In the east lake high-tech zone,JX District,CD District,XZ District and HP District as the suburban areas,the elderly population accounts for nearly 40 percent of the total population,but the combined medical and nursing care institutions are less than 20 percent of the total.The elderly population in the central urban area is relatively reasonable in its allocation of resources.(2)From the perspective of the fairness of the population allocation of the integrated nursing care resources in Wuhan,the resources of the pension institution are superior to the human resources.The number of traditional Chinese medicine nursing institutions has been improved with the population accumulation,and the health care allocation is the worst.From the perspective of the geographical distribution of old-age resources in Wuhan,the allocation of business area is improved with the accumulation of geographical area,and the fairness of medical care allocation is the worst.(3)In Wuhan old-age population resource allocation fairness is superior to the geographic configuration,which based on the population configuration,agencies,beds,fixed subsidies Gini coefficient between 0.20 0.30,shows that the three resource allocation is relatively fair;The Gini coefficient of medical care is over 0.40,which is relatively unfair.Based on geographical configuration,institutions,business area,beds,fixed subsidies,medical,the Gini coefficient of more than 0.60,the health care of Gini coefficient was 0.845,in the perilous state of the highly unfair,suggests that this five resources allocation gap is larger.(4)The Wuhan area divided into two big groups,city center and suburban county,medical subsidy and fixed regional contribution rate is greater than the area of contribution,the contribution rate of endowment resources within the region is greater than the other regional contribution rate;The most significant factor of the regional medical care is 0.0571,indicating that the most important reason for the fairness of regional resources is the allocation of medical resources.The second part-the Fairness of Community Endowment Resources.(1)The survey shows that there are up to 14 communities in Wuhan WC district providing medical care and pension services.,HS District has the largest business area,bed number,fixed subsidy and the largest number of doctors and nurses.(2)Based on the fairness of the population allocation of the integrated nursing care resources in Wuhan,the resources of the community endowment are superior to the human resources,and the property resources are inferior to the human resources.Among them,the number of community pension service institutions is better with the population,and the fixed subsidy is the least fair.The geographical distribution of endowment resources in Wuhan area is fair.(3)In Wuhan old-age population resource allocation fairness is superior to the geographic configuration,which based on the population configuration,institutions,business area,beds,fixed subsidies,medical,the Gini coefficient of more than 0.40,the relative unfair.Based on geographical configuration,institutions,business area,beds,fixed subsidies,medical,the Gini coefficient of more than 0.60,the health care of Gini coefficient was 0.800,in the perilous state of the highly unfair,suggests that this five resource allocation gap is larger.(4)The Wuhan area divided into two big groups,city center and suburban county,institutions and health care area,the contribution rate of the contribution rate is greater than the area between the,the contribution rate of endowment resources within the region is greater than other regional contribution rate;The most significant factor of the interregional medical care is 0.0669,indicating that the largest reason for the equity of regional resources is the allocation of the number of institutions.The third part-the evaluation of medical care and pension service.Regional average every ten thousand people the number 0.39,on average every ten thousand people building covers an area of 1448.35 m2,average 20.7 beds&personnel per ten thousand people,on average every ten thousand people care for an average of 18.86 people,every region were staying in the old man number 209,each district average managed old number 389,each district average cooperation agreement was signed at a rate of 62%,each area of health management in an average of 1702 times,the average medical staff workload is 17.73 m.To calculate the relative closeness of each region to the optimal solution,Ci,the higher the Ci,the better the service quality.Of the 13 districts extracted in Wuhan,HS District has the best quality of old-age care service and the worst in HY District.Conclusions and recommendations1.The overall structural shortage of the pension resources,the difference in the endowment resources of different economic development levels,and the difference in the pension resources of different pension modes are obvious.2.There are differences in the quality of medical care in different areas,and the contents of medical and nursing integration services are single.3.There is a large gap in the health workforce of primary care,and the overall quality is low,and the lack of service capacity is the biggest reason to influence the fairness of regional resources.4.The quality of medical care and pension service is related to the guarantee of resources.5.Give full play to the guiding role of government departments,strengthen guidance,and bring the medical care and nursing care into practice,so that the elderly can realize the benefits of pension service.6.Explore the standardization and standardization of medical care and nursing service institutions,and integrate humanistic care into the nursing work,so as to change the understanding of the combination of medical care.7.While actively encouraging and attracting social capital to establish pension institutions,we should strengthen the construction of community-based medical services and avoid the phenomenon of "keeping" and "caring".8.Improve the treatment of old-age medical-workers,strengthen pre-job training and improve the quality of elderly care services.9.Provide diversified auxiliary services to meet the needs of diversified pension needs,and seek long-term development of medical care and pension services. |
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