Study On The Dilemma Of The Implementation Of The Policy Of Combining Medical Care With Nursing Care In Tianjin Community

With the deepening of population aging,the "integration of medical care and elderly care" was officially written into the national policy document in 2013,and a community-based integrated medical care and elderly care model was gradually built.According to the central government’s deployment,Tianjin has carried out a series of measures to combine medical care and elderly care.Although Tianjin has formulated a number of policies and regulations for implementation,there has been no breakthrough in the implementation effect.The disconnect between medical care and nursing care is serious,and it is difficult to meet the diversified elderly care service needs of the elderly.As an analytical tool for the policy implementation process,Smith’s policy implementation process model can provide strong theoretical support for the implementation of the policy of combining medical care and elderly care in Tianjin.The analysis of the implementation of the policy of combining medical care and elderly care in the municipal community has a high degree of fit.This paper mainly adopts the methods of field interview and questionnaire survey,First of all,we clarify the current situation of the implementation of the combination of medical and nursing care in the community in Tianjin,including the announcement of the policy,the institution implementing the policy,the target group with the elderly as the main body,and the The existing policy environment,and on the basis of on-the-spot investigation of the policy implementation of the two grass-roots community medical and elderly care institutions,explore the policy implementation dilemma.It can be found that there are vague elaboration of the policy text of the policy itself,and imperfect policy-related standards and norms;the executive body faces obstacles such as a shortage of medical staff,an insufficient market participation mechanism,and insufficient multi-level management coordination;low participation of target groups,on the one hand,policy Low awareness,on the other hand,“no feedback” on the needs of the elderly;in terms of policy environment,insufficient capital investment in the economic environment,unbalanced resource supply,and low social recognition of the elderly care profession in the social psychological environment.Aiming at various implementation dilemmas,on the basis of drawing lessons from the domestic Shanghai and Chongqing ’s medical and nursing practice experience,using Smith’s policy implementation process model analysis method,it proposes solutions for different reasons,which are mainly reflected in four aspects: First,improve The clarity of policy implementation,the second is to optimize the participation mechanism of the executive body,the third is to strengthen the two-way interaction between the executive body and the target group,and finally to optimize the policy environment for the combination of community medical care and health care.It is expected to provide new ideas for the implementation of the policy of combining medical care and elderly care in Tianjin,and to promote the improvement of the level of policy implementation.