A Research On "Community-based Medical-care Coordination" Model Of Urban Elderly Service

In the background of aging,empty nest and destabilization,in order to optimize the supply of old-age services and achieve healthy aging and active aging,meanwhile,correct the shortage of decentralized supply of medical services and old-age services,China proposed the "medical-care combination" strategy.The institutional " medicalcare" service supply has defects such as "unnormalization","suburbanization" and "aristocratization".Through the system design,the elderly should be kept in the familiar community environment,and the various resources are coordinated and integrated to meet the multiple needs of the elderly such as care,medical and nursing.It is an important issue to establish the "community-based medical-care coordination" model of urban elderly service.At present,the practice of "medical-care combination" based community can be divided into four types: community on-site service,community day care,communitybased small institutions,and pension-oriented communities.Each of these types has its own advantages and limitations.Overall,China’s existing medical-care service practice based community shows the disadvantages of the unclear role of the service providers,the uncoordinated relationships between the service providers,and the fragmentation of the supply rules,presenting a supply dilemma of "decentralized governance".It directly constitutes the actual pressure of service transformation supply.The differentiated needs of the elderly are a direct impact on their acceptance of the "community-based medical-care coordination" service.Through empirical investigations,we found that community-based home services are generally accepted by urban seniors.For community-based "medical-care combination" services,community on-site service is the most popular service model for the elderly,and community-embedded institutions are also accepted by some older people.The variables of “educational level”,“living form” and “income level” and “health status”are the most important factors influencing the needs of the elderly.Most of the elderly have a low level of cognition and understanding of “medical-care combination”.The elderly’s demand for “medical-care combination” generally emphasizes the need for survivability,neglects developmental needs,and attaches more importance to health care services,while ignoring nursing and rehabilitation services.Combining the status of supply and demand,the "absence","dislocation" and "deviation" of the services of medical-care combination directly constitute the endogenous driving force,external driving force and practical driving force of the "community-based medical-care coordination" model,realizing the supply of "complement".Under the concept of “integrated care” and “all-inclusive care”,in foreign countries,the PACE program of United States,the nursing service of Japan,and the elderly home care service of Sweden can be regarded as typical practices of "community-based medical-care coordination".From the view of the Titmuss’ trichotomy,the three projects can be assigned to different welfare models,while government responsibilities,social participation,professional service provision,shared responsibility mechanism,community-based support are the common points of the projects,which provided valuable experiences for the construction of "communitybased medical-care coordination" model of urban elderly service in China.The “community-based medical-care coordination” model is based on the theory of collaborative governance.Various types of resources should be integrated into urban community,the roles and functions of service providers such as government,community,social organizations and market departments should be defined.The relationships should be coordinated and the norms should be unified,in order to overcome the " decentralized " supply dilemma of the service supply for the elderly.With "home care","day care","embedded institutions" and "elderly community" as practice forms,"upgrade","collaboration",“inter-embedded” and “new building” as promoting path,to realize the "cooperative" medical-care service supply based on the community.The pluralism of providers,the cooperation of the relationship,and the identity of the rule are the core connotations of "community-based medical-care coordination" model.Pluralism of providers is the premise of "community-based medical-care coordination" model.This model includes four main service providers such as government,grass-roots community,social organization and market organization.Government is primary responsibility provider which plays the role of “metagovernance”.Community is the main supporting,which serves as the function of“service field” and “service organization”.Social organization is the executor which acts as specialized service producers and transmitters.Business enterprise is the marketoriented provider,which serves as the function of personalized service provision.Collaborative relationship is the manifestation of "community-based medical-care coordination" model.This model should coordinate the relationships between government and social organization,government and community,government and market,social organization and market organization,social organization and community,market organization and community.The multiple entities should form a collaborative relationship of effective communication,resource coordination,information sharing and organic interconnection,which build an organic community of "community-based medical-care coordination" with advantages integration,resource sharing and complete functions,in order to achieve community coordination,government-community collaboration,government-enterprise collaboration,government-organization collaboration,organization-enterprise collaboration and institutional collaboration.The unified coordination rules are the basis for the "community-based medicalcare coordination" model.First of all,a macro top-level program for this model should be designed,which includes value concepts,basic principles,goal orientations and implementation paths.Second,the practical rules of the model should be clarified,which includes the specific formulation of classification service standards for elderly,the establishment and star rating system about community care institutions,and the government’s financial subsidies.In addition,it is necessary to implement long-term care insurance system as a fundraising support for the "community-based medical-care coordination" model.Strengthening the training of service personnel as the human resource support for the model.Meanwhile,promoting the reform of the primary health care system,which is institutional basis of this model.