| The aging situation in rural areas is severe,with more disabled elderly,elderly and poor elderly.The demand for medical services for the elderly in rural areas is rising,but the supply of supporting pension and medical services is insufficient,making rural pension a difficult and painful point.The combination of medical and old-age care services effectively integrates medical,old-age care,rehabilitation,nursing and other resources,which is conducive to meet the diversified needs of the elderly in rural areas,and provides a new solution for rural oldage care.Under the promotion of relevant national policies and the influence of pilot areas,some rural areas have also begun to explore a suitable mode of combining medical care and elderly care services,and a number of typical cases have emerged,with a lot of experience worth learning from.What is the operating mechanism of the combination of medical care and elderly care service in rural areas? Can we construct a theoretical framework that reflects the overall picture of its practice? In the process of actual operation,what factors will be affected?What is the relationship between the influencing factors?Therefore,based on the 18 rural medical with typical cases,combining the theory of hierarchy of needs,welfare pluralism and collaborative governance theory is analyzed,with“the operation mechanism of combining medical care and old-age care services” as the research subject,from “construct a theoretical model of the operation mechanism” and“analyze the influencing factors of operation mechanism” two aspects.First of all,the grounded theory is used to construct a theoretical model of the operation mechanism of the combination of medical and elderly care services in rural areas,and the internal mechanism and practical logic of the model are illustrated with specific cases.Secondly,based on the 6main categories in the theoretical model,22 influencing factors were identified through the second root,and the influencing factor system of the operation mechanism of the rural medical and elderly care combined service was constructed,which was composed of six dimensions including design,demand,service,management,participation and supply.Finally,in order to further explore the relationship between the 22 influencing factors,fuzzy-DEMATEL-ISM was used to quantitatively analyze the influencing factors,draw the cause and result diagram of the influencing factors,build the three-order and four-layer interpretation structure model,and determine the attribute and importance of each factor through comprehensive analysis.The paper draws the following conclusions: demand-oriented,multi-participation,toplevel design,resource supply,multiple services and comprehensive management constitute the theoretical model of the operation mechanism of rural medical and old-age care service.In the whole operation mechanism,the direct influencing factors are the willingness of the elderly to participate and the number of medical and nursing personnel,which belong to two dimensions of demand and supply.The indirect factors are institution and information technology,which are embodied in the design dimension.The key factors are precise nursing and fine management,which belong to two dimensions of service and management.The fundamental factor is financial security,which belongs to the supply dimension.Combined with the actual situation,the paper puts forward corresponding countermeasures and suggestions for the operation of the combination of medical and nursing services in rural areas from the early stage,middle stage and long-term stage.In the early stage,we should focus on rural medical and nursing needs and effectively supply medical and nursing resources.In the medium term,we should focus on the level of medical and nursing services,improve the quality and efficiency of careful management;Long-term planning,can rely on technological innovation mode,give full play to the advantages of the system. |
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