| Objectives: In this study,the medical and health care integration models were sorted out in terms of service space and convenience,and divided into four main models: institutional medical and health care integration,community medical and health care integration,home medical and health care integration and "Internet+" medical and health care integration,and further categorized into 12 specific types according to the main service providers and forms of medical and health care integration.Using Anderson’s model as the main framework,we analyzed the main factors influencing the willingness of middle-aged and elderly people to participate in health care integration and their tendency to choose the major categories and specific types of health care integration models through quantitative research,so as to provide an important theoretical basis for better optimizing the allocation of resources for health care integration services in Zhejiang Province,formulating a perfect,reasonable and long-term policy for health care integration services,improving the health and well-being of middle-aged and elderly people,and promoting active aging.satisfaction,and promote active aging.Methods:(1)Literature analysis method: to sort out the concepts related to the integration of health care and elderly care needs,and to provide the theoretical foundation and basis for this study.(2)Panel discussion method: to conduct a panel discussion on the concepts,models and specific types related to medical and nursing integration and the demand for medical and nursing integration services for the elderly,and to conduct a panel discussion on the dimensions and specific entries of the possible influencing factors on the willingness to participate in medical and nursing integration and model selection for the middle-aged and elderly.(3)Questionnaire survey method: four of the 11 prefecture-level cities in Zhejiang Province were selected as the prefecture-level cities for the survey,and the results of the sampling were Hangzhou,Shaoxing,Ningbo and Huzhou,and the target county-level cities(districts)were selected through convenience sampling,and face-to-face questionnaires were conducted through incidental sampling and snowball sampling methods,with 1,100 questionnaires collected and 1,034 valid questionnaires.The questionnaire was designed based on the theoretical framework of Anderson model,including propensity factors: gender,age,household registration,marital status,education level,occupation;enabling factors: disposable monthly income,whether there is medical insurance,whether there is pension insurance,whether there is medical staff visiting the home in the community,whether there is a pension service station in the community,and the convenience of going to the doctor;demand factors:self-assessed health status,the number of The number of chronic diseases.On this basis,the three variables of social support,loneliness and hierarchy of needs were extracted from Anderson’s model,and the comprehension social support scale(including family support,friend support and other support),loneliness scale(including social loneliness and emotional loneliness),and self-designed demand scale for the content of combined medical and nursing care services(including demand for life care,demand for medical care,demand for spiritual comfort,demand for safety,demand for rights.(4)Mathematical and statistical methods: In this study,abinary logistic regression model was used to analyze the willingness of the middle-aged and elderly people to participate in health care integration,and an unordered multicategorical logistic regression method was used to analyze the factors influencing the choice of health care integration mode and type of the middle-aged and elderly people.Results:1.Medical and health care integration mode and classificationFrom the perspective of service space and convenience,the medical and health care combination mode is categorized into: institutional medical and health care combination mode,community medical and health care combination mode,home medical and health care combination mode,and "Internet+" medical and health care combination mode.Each model is subdivided into three specific types from the perspectives of service subjects and service modes.Among them,the institutional medical and health care combination model can be divided into: medical institutions set up within the elderly institutions,medical institutions setup within the elderly institutions,medical and health care institutions cooperation;community medical and health care combination model can be divided into: community nursing stations set up within the elderly stations,community health service institutions + day care centers for the elderly,professional elderly operation institutions + day care centers for the elderly;home medical and health care combination model can be divided into: home elderly + family doctor The "Internet+" medical and health care combination model can be divided into: Internet+wearable smart devices,Internet+physical service institutions model,and medical and health care combination service platform.2.Willingness of middle-aged and elderly people to participate in medical and health care integration and factors influencing themThe results of binary logistic regression showed that the factors influencing the willingness of middle-aged and elderly people to participate in combined medical and nursing care were mainly age,education level,income,whether or not they had medical insurance,pension insurance,whether or not there was an elderly service station/day care center in their community,the number of chronic diseases,loneliness,and the degree of demand for combined medical and nursing care services(P<0.05).In contrast,there was no significant correlation between gender,type of household registration,marital status,retired/current occupation,availability of home-based services in the community where they lived,convenience of access to medical care,self-rated health status,and level of perceived social support and their willingness to participate in health care integration(P>0.05).Middle-aged and older adults with higher education,higher income,pension insurance,social isolation,and the need for life care and advocacy of health care integration were more willing to participate in health care integration(O R=1.853,95% CI: 1.082-3.171;OR=1.644,95% CI: 1.012-2.669;OR=1.788,95% CI: 1.026-3.115;OR=1.035,95%CI:1.003-1.068;OR=1.040,95%CI:1.008-1.073;OR=1.084,95%CI:1.031-1.139).middle-aged people aged 60-69 years,middle-ag ed people aged 70 years and above,middle-aged people with health insurance,middle-aged people without elderly service stations in their communities,and The more types of chronic diseases the middle-aged and older people had,the less willing they were to participate in the integrated health care model(OR=0.446,95%CI:0.297-0.671;OR=0.410,95%CI:0.261-0.642;OR=0.293,95%CI:0.106-0.813;OR=0.677,95%CI=0.475-0.964;OR=0.574,95%CI:0.370-0.891).3.middle-aged and elderly people’s tendency to choose the four major typ es of models of health care integration and the factors influencing themAmong the middle-aged and elderly people who participated in this study,21.8%,23.8%,48%,and 6.4% chose institutional,community,home,and "Int ernet+" models of health care integration,respectively,with the largest number of people choosing home health care integration and "Internet+" health care int egration.Internet+" medical and health care combination is the least.According to the results of multiple logistic regression,the differences in age,household registration type,education level,self-rated health status,and the degree of de mand for different services of medical and health care integration were statistic ally significant(P<0.05);while gender,marital status,occupation,income level,whether or not they had pension insurance,whether or not they had a family doctor/visit service in their community,whether or not they had a community There was no statistically significant difference between the choice of different spatial models of medical and nursing care services by middle-aged and elderly people in terms of gender,marital status,occupation,income level,whether or not they have pension insurance,whether or not they have family doctor/vis it service in their community,whether or not they have elderly service station/day care center in their community,convenience of medical treatment,number of chronic diseases,level of social support and loneliness(P>0.05).Using the "Internet+" model as a reference,middle-aged and older adults aged 60-69,70 and older,and those with higher life care needs were more lik ely to choose the institutional model of integrated health care(OR=2.596,95% CI:1.126-5.987;OR=4.455,95% CI :1.526-13.009;OR=1.114,95%CI:1.042-1.190),and middle-aged and elderly people with high school,college and above ed ucation were more reluctant to choose institutional medical care integration(OR=0.326,95%CI:0.144-0.737;OR=0.339,95%CI:0.133-0.862).Using the "Internet+" model as a reference,middle-aged and older adults with average and better self-rated health status were more likely to choose co mmunity-based health care integration(OR=6.385,95% CI:1.663-24.518;OR=6.653,95% CI:1.742-25.413),and those with high school,college or higher educ ation were more likely to choose community-based health care integration,mid dle-aged and older adults with college and above education were more reluctan t to choose the community-based health care integration model(OR=0.376,95%CI:0.171-0.826;OR=0.342,95%CI:0.136-0.862).Using the "Internet+" model as a reference,the older the middle-aged,the rural household,and the better the self-assessed health status,the more likely they were to choose the combined home health care model(OR=3.307,95% CI:1.503-7.280;OR=5.385,95% CI:1.918-15.123;OR=2.977,95%CI:1.343-6.601;O R=7.697,95%CI:2.100-28.215;OR=10.098,95%CI:2.798-36.441),middle-aged people with high school,college or higher education,and those with higher spiritu al comfort needs were less likely to choose the home care model.(OR=0.305,95%CI:0.142-0.655;OR=0.245,95%CI:0.098-0.611;OR=0.915,95%CI:0.846-0.990).4.factors influencing middle-aged and elderly people’s propensity to choos e specific types of health care integration under four models of health care int egrationIn institutional health care integration,using the reference of "setting up a nursing home within a medical institution ",the gender,age,availability of me dical staff in the community,self-assessed health status and level of demand for health care integration services of middle-aged and elderly people influenced their choice of specific types of institutional health care integration(P<0.05).Middle-aged and older adults who were female,60-69 years old,did not have medical staff visiting them in their community,and had average and good selfrated health status were more likely to choose " medical institution in a nursing home"(OR=3.105,95% CI: 1.330-7.251;OR=5.478,95% CI:1.735-17.302;OR=2.791,95%CI: 1.077-7.231;OR=8.477,95%CI: 1.601-44.877;OR=9.900,95%CI:1.646-59.555),and middle-aged and older adults with strong health care needs were less likely to choose(OR=0.855,95%CI.0.745-0.980).Using the reference of "setting up a nursing home in a medical institution",women were more li kely to choose the cooperation between medical and nursing institutions(OR=4.922,95% CI: 1.637-14.800).In community health care integration,using "nursing stations in community nursing stations" as a reference,the type of current/pre-retirement occupation,monthly income,availability of pension insurance,availability of medical staff in the community,convenience of medical care,and level of demand for health care integration services of middle-aged and elderly people influenced their choice of specific types of community health care integration(P <0.05).Middle-aged and older adults who were currently/pre-retired corporate employees,had high monthly income,and had strong security needs were more likely to choose "community health services+ day care center for the elderly"(OR=6.525,95% CI: 1.703-25.003;OR=6.721,95%CI: 1.854-24.368;OR=1.162,95%CI:1.041-1.296),while middle-aged and elderly people with a higher demand for combined health care and advocacy services were more reluctant to choose(OR=0.869,95%CI:0.779-0.969).Taking "nursing stations in community nursing stations" as a reference,middle-aged and elderly people who did not have medical staff visiting their communities were more likely to choose "professional nursing care operators + day care centers for the elderly"(OR=4.006,95% CI.1.116-14.386),while those with pension insurance and average convenience of medical care were less likely to choose(OR=0.053,95% CI: 0.005-0.605;OR=0.180,95% CI: 0.034-0.947).In the home health care integration,using "home care + family doctor con tract" as a reference,the middle-aged and elderly people’s education,monthly i ncome,availability of elderly service stations/day care centers in their communi ties,level of social support,and level of demand for health care integration se rvices influenced their choice of specific types of home health care integration(P<0.05).Middle-aged and elderly people with higher education and higher nee ds for health care integration and rights protection were more likely to choose "home care + long-term care insurance"(OR=3.168,95% CI:1.143-8.780;OR=1.112,95% CI:1.032-1.198;OR= 1.287,95%CI:1.128-1.469),the higher the percei ved family support and the stronger the security needs of the middle-aged and elderly,the less likely they were to choose "home care + long-term care insu rance"(OR=0.902,95%CI:0.823-0.988;OR=0.786.95% CI:0.683-0.905).Using "home care + family doctor contract" as a reference,the more supportive friend s and the stronger the need for advocacy,the more the middle-aged people we re willing to choose "regular visits by elderly service providers/social workers" (OR=1.099,95% CI:1.004-OR=1.202;OR=1.152,95%CI:1.039-1.277),while th ose with higher income,no elderly service station in their community,higher l evel of perceived family support and stronger need for spiritual comfort service s were less likely to choose "regular visits by elderly service agencies/social workers"(OR=0.296,95%CI:0.296;OR=0.296,95%CI:0.100-0.877;OR=0.342,95%C I:0.174-0.671;OR=0.858,95%CI:0.783-0.941;OR=0.901,95%CI:0.827-0.982).Conclusions:(1)Middle-aged and elderly people are more willing to participate in the combined medical and nursing care model.Although some middle-aged and elderly people have negative attitudes toward combined medical and nursing care,the shift from the traditional family-based nursing care method to socialized nursing care is the main trend for the future development of the nursing care business.Age,education level,income,whether or not to purchase medical and pension insurance,availability of senior care service stations/day care centers in the community,types of chronic diseases,loneliness,and level of demand for combined medical and pension services are the main factors influencing middle-aged and elderly people’s willingness to participate in combined medical and pension care model.(2)Among the four combined medical and nursing care models,home medical and nursing care is the preferred combined medical and nursing care model for middle-aged and elderly people,and the government should strengthen its support for strengthening the function of combined medical and nursing care services at the grassroots level,improving the quality of combined medical and nursing care services,improving the family doctor system,promoting long-term care insurance,and optimizing the security system of nursing care services.(3)The middle-aged and elderly people with different characteristics have significant differences in the selection of 12 specific categories of medical and nursing care integration.It is necessary to innovate and develop medical and nursing care integration services,provide sufficient space for middle-aged and elderly people who have plans and needs for nursing care to choose,fully develop a variety of medical and nursing care integration models and types according to local conditions and situations,and realize medical and nursing care integration model innovation.(4)The older the elderly,the higher the demand for life care and the stronger the sense of loneliness,the more they are willing to choose the combined medical and nursing care model of institutions.It is necessary to improve the social security welfare system,optimize the "combined medical and nursing care" elderly care service programs,and do a good job in assessing the needs of the elderly,so that the providers of elderly care services not only pay attention to the differences in the health conditions of the elderly,but also pay attention to the psychological state of the elderly,and meet the different needs of the elderly groups.(5)The older the middle-aged and the higher the demand for life care,the more they are willing to choose the institutional medical and nursing care model,age and demand level are important factors for the middle-aged to choose the medical and nursing care model.(6)The better the health condition of the middle-aged and elderly people,the more they tend to choose the community combined medical and nursing care model,and the middle-aged and elderly people with higher demand for spiritual comfort are more reluctant to choose the home combined medical and nursing care model,so when strengthening the construction of combined medical and nursing care services,it is necessary to pay attention to both the physical and psychological needs of the middle-aged and elderly people. |
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