广西医养结合养老机构发展现状及对策

目的　总结广西医养结合养老机构的典型发展模式，分析其现阶段发展所面临的主要问题，并提出针对性的政策建议。方法　2015年7—9月，采用典型调查的方法，选取广西南宁、桂林、北海、柳州作为项目调研地区，每市选取1家具有代表性的养老机构作为调研对象。综合运用问卷调查、知情人深度访谈等方法进行调查，在4家养老机构中通过随机抽样的方式分别抽取20%~40%的工作人员进行问卷调查，并对被调查养老机构的1~2名负责人进行深度访谈。调查内容包括医养结合养老服务模式，养老机构的性质、规模、资金来源和收费标准，养老机构工作人员学历结构等。结果　广西医养结合养老服务的模式主要有3种，分别是在养老机构中创办医疗机构、在医疗机构设立“养老院”和养老机构与医疗机构协作服务。机构性质主要有公建民营和民办民营两类，床位数逐年增多但总量不足，公建民营型养老机构房屋等基础设施建设资金来源主要以政府投入为主。养老机构床位费为400~1 200元/月，一、二、三级护理收费标准为400~1 400元/月，生活费为400~600元/月，加上在医养结合养老机构产生的康复理疗等服务费用，医养结合养老机构综合服务收费总体偏高，老年人收入不足以支付。养老机构工作人员中，80%的管理人员为本科和大专学历；医生以大专和本科学历为主；近90.0%的护士为大专及以下学历；94.4%的护工为高中及以下学历；83.7%的后勤人员为高中及以下学历，学历层次整体偏低。结论　广西医养结合养老机构存在床位数量不足且供给侧结构失衡、老年人支付能力不足影响了医养结合养老服务产业的发展、养老护理从业人员素质不高等问题。建议从落实相关配套政策，增加医养结合养老机构服务供给、建立长期护理保险制度、建立健全养老行业人才培训与激励机制等方面促进广西医养结合养老机构的发展。

Status Quo and Countermeasures for Developing Institutions Combining Old-age Care and Medical Care in Guangxi

Objective　To summarize the typical development model of institutions combining old-age care and medical care in Guangxi；to analyze the main problems currently affecting this development；and to propose targeted policy recommendations.Methods　Using a typical survey method，Guangxi Nanning，Guilin，Beihai，and Liuzhou were selected as the project research areas.In each area，a representative old-age care institution between July and September 2015 was selected.Comprehensive surveys and in-depth interviews with staff were used.In the four old-age care institutions，20%–40% of the staff were randomly sampled to conduct a questionnaire survey，and 1 or 2 of the persons in charge in the investigated old-age care institutions were interviewed in depth.The investigation assessed a combination of medical care and old-age care services；the nature，scale，sources of funds，and fees in old-age care institutions，as well as the educational levels of the staff in those institutions.Results　There were three main modes of combination of medical-care and old-age care services in Guangxi：establishment of medical institutions in old-age care institutions；establishment of nursing homes in medical institutions；and establishment of institutions providing collaborative old-age care and medical care services.There were two types of institutions：public and private.The number of beds has increased each year，but the total number has been insufficient.The main source of funding for infrastructure construction of elderly nursing homes was established by states，but the institutions are run privately，independently of government investment.Each bed in an old-age care institution costs RMB 400–1 200 per month；the nursing fees for first-，second- and third-tier care providers are RMB 400–1 400 per month；and the living expenses are RMB 400–600 per month.In addition，the rehabilitation physiotherapy services in the institutions combining old-age care and medical care，as well as other service costs，make the overall service charges of old-age care combined medical care institutions very high，such that the income of the elderly is insufficient to cover costs.A total of 80% of the staff in old-age care institutions have college education and bachelor's degrees；the doctors are mainly college educated and bachelor's degree holders；nearly 90.0% of nurses are college graduates and below；94.4% of nursing workers have high school degrees and below；and the persons handling logistics are mostly most high school graduates and below，accounting for 83.7%，and the educational level is generally low.Conclusion　The shortage of hospital beds in facilities providing old-age care combined with medical care in Guangxi，the imbalanced structure of the supply side，and the inadequate payment ability of the elderly have affected the development of the medical care and old-age care industry and the quality of nursing care workers.It is recommended that the development of medical and nursing care in Guangxi be promoted through implementing relevant supporting policies，increasing the services provided by institutions combining old-age and medical care，establishing a long-term care insurance system，and establishing a sound training and incentive structure for the elderly.