Study On The Combination Of Medical Care And Pension In The Community Based On The Needs Of The Elderly

BackgroundSince the 21st century,China's population aging has been aggravated.By the end of 2016,the number of people over the age of 60 in Guangzhou has reached 1.546 million,accounting for 17.76%of the total population;and elderly people become disabled,aging,empty nest phenomenon is more and more obvious,Statistics show that over half of the elderly over 60 are suffering from chronic diseases and their medical expenses are three times that of young people.With the development of society and economy and the improvement of people's living standards,the elderly have begun to pursue healthy retirement,and the demand for medical care and health care services is also increasing.Whether it can meet the medical needs of the elderly is related to the quality of life of the elderly and happiness in old age.However,the system of separation of medical care and pensions in our country makes the medical resources Serious mismatch of pension services,China's current pension service system is facing serious challenges,but also makes the elderly medical and pension problems even more serious.In 2013,the State Council promulgated relevant opinions,promoted the development of the combination of medical service and health care,explored new ways for cooperation between medical institutions and pension institutions,In 2015,it also proposed the combination of medical services and old-age services Pension,reintegration of pension services and medical resources to meet the needs of the elderly as the goal,the policy to promote the extension of medical services from the hospital to the community and family.In 2017,Xi Jinping proposed to work hard to solve the social problems of population aging,advance the combination of medical treatment and support.The combination of community medical care and support refers to the use of the community as the basis of government-led,community-based platform advantages to promote cooperation between pension institutions and medical institutions in the community,and to promote the integration and utilization of resources such as medical resources and endowment,and to use older people.Based on its physical health and specific service needs,it provides multi-level and diversified old-age care services for the elderly in the community,including daily care,recreational activities,disease treatment,preventive care,psychological comfort,and hospice care.Community medical care combined with the mode of endowment is the new hope of China to solve the problem of endowment,but also to ease the medical resources,pension resources allocation unreasonable new method.In this context,this article from the community care theory,the need hierarchy theory,welfare diversification theory,community care with the pension services to organize,through non-structural interview and field visits to understand the development of community health care community in Guangzhou to understand the problems and causes in the process of development of community-based care and old-age model.At the same time,taking the actual needs of the elderly as a starting point,the questionnaire was used to understand the factors that affect the needs of the elderly in the community and to put forward science to promote community-based care and pension development Suggestions.ObjectiveIn this study,through the methods of literature review,questionnaire and interviews,the author studied the development status of community medical and nursing combination and guided by demand,and discussed the existing problems and influencing factors in the development of community medical and health care in Guangzhou.Analysis of the reasons for the proposed policy recommendations for the medical-care-based pension services in the community to promote the optimal allocation of resources,policy formulation,to provide a scientific theoretical basis.Methods1.Document analysisThrough the search for books,magazines,and online search of related electronic resources,search for relevant documents at home and abroad,search for relevant theoretical research and practical research materials,summarize the development status and development trend of community medical care combined with aged care services,and analyze and summarize the different countries and regions The combination of development experience and features will pave the way for the smooth development of the project.2.Semi-structured interviewsSelect a representative of the twelve community care service agencies for field surveys,design a scientific and reasonable interview outline,and interview the persons in charge of community-based care institutions and service personnel through the semi-structured interview method.The contents mainly include the current status of community service centers,The actual operation of the service center and the development of the current medical care combined with pension services,the descriptive statistical analysis of the information obtained from interviews,accumulating a large amount of practical information to deepen the understanding of the theory and practice of community medical and nursing integration3.Random samplingAccording to the number of elderly population in each district of Guangzhou,stratified into three levels,randomly selected one representative city at each floor,namely Yuexiu District,Baiyun District and Tianhe District,each district randomly selected 120 A survey of elderly people,questionnaires on-site recovery site collection.The contents of the survey mainly include:The basic conditions of the elderly,The status of community aged care services utilization,The utilization of community health service,The survey on the demand status of community health services in combination with old-age care services.Questionnaire data using Epidata3.1 dual-track data entry,while the use of Spss22.0 descriptive statistical analysis of the data and differences in comparison,count data to take chi-square test,P<0.05 for the difference was statistically significant.Results1.Interview resultsThe basic situation of community care facilities:According to the interview,community care service institutions received less daily visits,weekends and community visits were slightly higher,the community aged care facilities had sound infrastructure including sports facilities,Activity room,library,etc.Some of the community also carry out the elderly college,psychological counseling room,day care facilities,etc.but the problem of ubiquitous utilization rate,some community-based care facilities,said day care facilities utilization Almost zero,and the lack of professional health service staff,can not guarantee the quality of medical services.Community pension services institutions operating conditions:The pension has always been a social welfare undertaking in our country.In recent years,it gradually introduced the market-oriented mechanism and shifted from the government-led to the introduction of social capital.However,the concept of paying for the pension service is affected by many factors of the elderly,I become the main concept of society,and operating community nursing home nursing staff shortages,the degree of specialization is low,the majority of community pension funding sources are mainly government grants.The current community-provided pension services can be roughly divided into four categories:life care,culture and entertainment,health care and spiritual comfort.However,the interview found that the content of community-based care services is more concentrated on cultural and entertainment aspects.Community pension service institutions with the combination of health care:According to interviews and field visits,only a few demonstration-level service agencies are equipped with medical clinics and medical staff to provide some basic medical services to the elderly.Further interviews revealed that due to the restriction of manpower and resources in the community,The community has very limited medical resources devoted to providing endowment services,and most of the medical services are mainly provided by community health centers or hospitals.2.Questionnaire results:? Basic situation investigation:Among 326 seniors,Yuexiu District accounted for 33.1%,Tianhe District 32.8%,Baiyun District 34.1%,men 40.2%and females 59.8%,mostly aged 60-79 Accounting for 48.8%;before retirement,the majority of workers were civil servants and workers,accounting for 58.9%;most of the elderly were married and spouses were healthy,accounting for 60.7%of the total;children The number of one or two,accounting for 70.8%;monthly income is mainly concentrated in 2000 to 3999 yuan,of which 76.5%of the elderly source of their pension mainly;? Community care service status survey:According to the survey,89.3%of the 326 elderly people indicated their willingness to participate in community activities,80.7%of the elderly attended cultural and recreational services provided by the community,The elderly have reached 72.1%satisfaction with the community-based care services.? Community health service status survey:According to the survey,55.2%of the elderly live independently,and the elderly have two or more diseases 54.3%,high incidence of chronic diseases are mainly high blood pressure and joint disease,and 57.7%of the elderly said they need medication every day;in the choice of medical institutions,most choose provincial or municipal tertiary hospitals,Home is the primary reason for the elderly to choose treatment;Further investigation showed that 72.7%of the 326 community aged people received community health services,of which 56.7%of the elderly were satisfied with community health services,In the survey on medical expenses for the elderly,a small part of the elderly people have their own medical expenses completely at their own expense.In the recent year,59.0%of the total part of their medical expenses are mainly from 1000 to 6999 yuan.? Community health care services in conjunction with the demand situation survey:The survey showed that 43.9%of the community's elders heard of medical combination or community medical combination.After further explanation,the survey found that 75.8%of the elders said that the combination of community medical treatment meets individual needs.According to the survey on the specific needs of the elderly community-based medical care and pension care service,health education seminars and consultations,physical examinations,medical care,home visits and medical consultations,rehabilitation care,and psychological counseling services are popular among many elderly people and they hope that the community can provide them.? Analysis of the Factors Influencing the Elderly Community Medical Service Combined with the Elderly Care Service Demand:Multivariate logistic regression analysis excluded other interference factors and found that there are six factors affecting the needs of the elderly community medical care combined with elderly care services,namely age,education level,pre-retirement occupation,self-care status,daily exercise situation,Satisfaction of comunity health services:Older seniors have higher demand for community-based medical care and pension care than those with younger ages.Conclusion1.At present,the combination of community medical care in China is still in the experimental stage,and it has not been fully promoted.Compared with the combined needs of the elderly medical care,the development is slow.It also needs the attention of the government and the society,and it also intensifies publicity to increase the number of elderly people.Really understand the combination of community medical care and support,so that more communities can participate together to increase awareness and participation rate of community-based medical care and support;2.The development of community health care and pension services can promote the integration and effective utilization of resources,promote the rational distribution of resources,and ease the phenomenon of the elderly having difficulty in seeing and seeing a doctor;3.Community medical care combined with elderly care services can meet the diversified service needs of the elderly,but also can strengthen the management of chronic elderly patients to make up for the deficiencies of the current pension system so that the elderly can enjoy convenient,accessible and efficient medical services;4.Community medical care combined with old-age care services can promote the construction of community-based old-age care services and health services,which can not only enrich the content of community-based care services.improve the elderly's satisfaction with community-based care services,but also promote rational distribution of health resources and improve community Health service quality,ease the pressure of large hospitals;5.Community medical care combined with pension services to promote the information services and network development of pension services,integration of social resources,building community resources for medical care and pension services,more convenient and efficient service for the elderly;6.There are many factors influencing the service needs of the elderly,Multivariate logistic regression analysis excluded other interference factors and found that there are six factors affecting the needs of the elderly community medical care combined with elderly care services,namely age,education level,pre-retirement occupation,self-care status,daily exercise situation,Satisfaction of community health services.