Research On The Dilemma And Relief Of Combined Medical And Nursing Services In Elderly Care Institutions

Promoting the combination of high-quality medical and nursing institutions is an important measure to deal with aging population.For a long time,medical and old-age care institutions have been trapped in the bottleneck of uneven resource allocation,poor connection between medical and old-age care,and unbalanced service supply and demand.In order to explore the failure process of cooperative service supply between pension institutions and medical institutions,this paper builds a comprehensive analysis framework of medical and nursing care cooperative symbiosis based on the symbiosis theory and cross-sector cooperative governance theory.Taking three pension institutions in Shanghai as representatives,this paper makes a case comparison analysis of the combined service mode of three kinds of pension institutions.This paper analyzes the effect difference and influence mechanism of the combination of medical and nursing services in different pension institutions.The research found that the current cooperative symbiosis mode between medical institutions and pension institutions is not sound,and the three types of service modes of"medical care in care","medical care in care" and "medical care adjacent" have their own weaknesses.The formalization of the medical institutions in the nursing institutions is serious and the level of medical services is low.There are problems in the connection between medical and nursing care,such as insufficient participation of primary medical institutions and substitution of medicine for medicine.Overall supply exceeds demand.There is a tendency of excessive medical care and medical care for the elderly in the "medical care" type of pension institutions.The quality of life of the elderly is poor,but the demand gap is too large."Medical care adjacent" type of elderly care institutions have high access threshold for medical care coordination and strong dependence on medical resources,so it is difficult to scale promotion.The practical dilemma of the combination of medical care and nursing care in different pension institutions is the result of their common influence as independent interest individuals under the ideological deviation and resource dependence.The preference of pension institutions for the concept of combining medical and nursing services and the dependence on different resources are the direct causes of the practice deviation of pension institutions,which are caused by multiple factors such as the deviation of the service orientation,the mismatch of service objects,the lack of service human resources and the lack of service economic impetus.The root cause behind the dilemma in the practice of the combination of medical care and old-age care institutions is the result of the fragmented and discoordinated management of the combination of medical care and old-age care.From the perspective of cross-departmental collaborative governance,the excessive division between departments has become the primary obstacle to the promotion of the policy of the combination of medical and nursing care,which is mainly manifested in the following aspects:the authoritarianism of the cross-departmental leading institutions of the combination of medical and nursing care is insufficient,and the effective collaboration mechanism between departments has not been established.The goal of each department is not coordinated;Interdepartmental policy cohesion is not smooth.The urgent task to improve the effect of the policy is to work together from the micro and macro levels.At the micro level,it is necessary to optimize the selection mode of medical and nursing care services in old-age care institutions,develop regional inclusive medical and nursing care services,and establish a long-term development mechanism for talents cultivation of medical and nursing care services.At the macro level,we should strengthen the authoritarianism of cross-departmental leading institutions to combine medical and nursing care,and build an effective collaboration mechanism between departments.To construct the target integration mechanism of multi-department medical care combination and improve the driving force of departmental collaboration;We will strengthen the effective coordination of various policies between departments and break down hidden barriers to departmental cooperation.