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医养结合产业2021年破万亿

2017-05-01 刘露诗 动脉网

政策放宽,医养结合、智慧养老等尝试逐步演进,消费观念转变的几代人逐渐进入退休年龄,养老市场在各方的推动中正在打开,这个万亿级的“蓝海”将展现出更多的机会。

 

 

“养老的人没有钱,有钱的人还没老。”有人曾一语道破当前养老市场盈利难的窘境。但政策逐步放宽,医养结合、智慧养老等尝试逐步演进,消费观念转变的几代人逐渐进入退休年龄,养老市场在各方的推动中正在打开,这个万亿级的“蓝海”将展现出更多的机会。

据中投顾问对2017-2021年中国医养结合行业市场规模的预测,2017-2021年,此市场的年均复合增长率约为17.92%,2021年市场规模将达到11,603亿元,真正成为一个突破万亿的大市场。

2017-2021年医养结合规模预测

数据来源:中投顾问产业研究中心

中国从2000年开始成为老龄型国家。据中国网的资料,预计到2040年,65岁及以上老年人口占总人口的比例将超过20%。然而老有所养的诸多问题,尤其是其中最为棘手的医疗护理问题仍任重道远,甚至有的老年人为满足自身医疗需求而在医院“压床养老”,占用医疗资源而形成负担。医养结合的理念提出多年,但落实却难点重重,一直以来都是观望多于实践。

医疗、养老从业者既被“老吾老以及人之老”的情怀驱动,又被诱人的市场所吸引,医养产业的大观园看似里遍地有黄金,拾起来却是难上加难。在医养大潮下,哪些方面是此行业的潜力突破口?动脉网从三大养老模式——居家养老、社区养老、机构养老来分析医养结合产业的机会。

居家:医护上门和智能产品

受传统文化影响,居家养老仍是我国大多数老人的选择,也将是寿命相对更长的新一代养老群体较长期的选择。据全国老龄委办公室的数据,2033年左右60岁以上老年人口将达4亿,按照养老“9073”的格局,其中90%,也就是3.6亿的老年人将在家养老,这也就倒逼了家庭医疗护理体系以及设备设施的加速落成。

家庭医生、上门护士护工

一些患有慢性疾病或失能的老人需要长期的医疗照护,但受限于医疗资源紧缺而导致的看病难、看病贵,很多人选择了在家养老养病。若缺乏专业医护人员的照料,患病老人病情延误、患并发症和再次入院的几率将会升高。在此现状下,上门医护正成为趋势。

日本这个严重老龄化的国家,其居家养老医疗照护模式对中国有很好的借鉴意义。上世纪70年代起,日本就开始发展各种形式的居家照护服务,将医疗和长期照护整合起来,每个需要在家接受医护的人都有一个完整的医疗护理团队,包括医师、护理师、牙医、药剂师、物理师、语言治疗师,照顾服务员等等。

案例:上海“家庭医养”实验

上海市曾对家庭医生是否能减少居家失能老人并发症进行了研究,设家庭病床,配备以1名西医全科医师、1名社区护士和1名中医医生组成的家庭医生服务团队,实施的方法如下:

全科医生每周上门1次对患者进行生命体征监测、体检、换导管换药、康复训练,并开具医嘱、处方,对患者、家庭成员及护工人员进行宣教;

社区护士每周上门1次处理医嘱、做护理,并对老人做护理评估、传授护理技巧等;

中医医生提供推拿、针灸等中医适宜技术治疗。

上述实验案例进行了近一年的时间,得出的研究结论是:接受实验的老人并发症发生率下降,再次住院率减少,证明家庭医生团队服务与传统社区医疗服务相比,既改善了社区患者的健康状态,也减少了医疗资源的浪费。

在国内,上海对家庭医生的实践已经成为了全国推广模板。65岁以上老人免费享受健康筛查自选项目、基层就诊医保报销比例更高、“1+1+1”的医疗机构组合自由就诊等特色,都为居家养老的老人提供了医疗服务便利、降低了价格。四月中旬,国家卫计委在上海召开全国家庭医生签约服务现场推进会时,就称要广泛学习推广上海等地区的家庭医生经验。目前,我国已有26个省区市推进家庭医生服务,相信在全国的家庭医生网络逐渐建立起来之后,居家养老的医疗形式会更丰富多样,更多新形式的医疗创业投资机会也会出现。

对于上门的护士、养老护理人员,在动脉网(微信:vcbeat)之前发布的《护士上门产业报告:全球市场总值将达3498亿美元,中国市场尚在沉睡》一文中,我们提到“护士上门”的全球市场将在2020年达3498亿美元,而中国在此方面的监管在放开、标准将形成、探索将更多样化。这里所指的“护士”一是指有资质的执业护士,另一就是指受训的健康护工。

山东南丁格尔护理服务有限公司董事长、国内首家私立医科大学——山东力明科技职业学院(原山东中西医结合大学)校长王力一曾接受动脉网的专访,表示目前国内的长期照护人员已变成一些家庭的刚需,但护工短缺、养老护理专业程度不足、离职率高的痛点会越来越显着,政府和各养老企业也在以种种方式推动护理人才待遇的提升、能力的加强及受重视程度。这意味着专业养老护理培训机构、上门护理企业的市场机会。

居家智慧养老产品

除了医护人员的配备之外,以预防保健为主的“智慧养老”将形成居家养老保健的补充,即利用物联网、云计算、大数据、智能硬件等新一代信息技术产品为老年人服务,尤其是针对缺乏照料的空巢、独居老人。《智慧养老产业发展行动计划(2017-2020年)》中明确指出,在2020年前要培育100家以上具有示范引领作用的智慧养老行业领军企业。

政策:《智慧养老产业发展行动计划(2017-2020年)》指明居家养老医疗保健的智慧化发展

· 慢病管理:病情监测、档案管理、个性化评估、趋势分析、诊疗建议、异常预警、紧急救助、康复服务等。

· 居家健康工具:健康体检、居家环境监测、远程看护、健康干预、健康评估反馈等。

· 个性化健康管理:信息采集、健康计划、健康教育、健康跟踪、病情诊断、风险筛查、健康信息查询等。

· 互联网健康咨询:依托互联网平台,发展在线咨询、预约挂号、诊前指导、诊后跟踪等。

 

智慧养老的基本生态

其实在此项政策鼓励全面发展布局智慧养老之前,浙江乌镇已经率先开始了居家智慧养老体系的探索。其中的典型案例是这样:某位老人突然觉得身体不适,在家用智能体检仪器测了血压、血糖和体温,数据实时共享给养老服务中心,工作人员在发现异常后及时安排远程问诊,以很快的反应速度解决了问题。此外,青岛市南山区政府曾为老人发放智能手环,苏州市姑苏区也有“虚拟养老院”的智慧养老尝试等。

在前不久的“物联网+”高峰论坛暨赛伯乐投资集团年会上,清檬养老总经理张敬波告诉动脉网:“建立一套完整的个性化评估体系是智慧养老的基础。”据称,清檬养老正在用自创的1500条老年人画像标准,形成一款家庭护理咨询机器人,结合对老人健康的深入了解来给出评估和建议。

居家医养潜力机会

掌握家庭医生、上门护理人员资源来为居家老人提供医护服务;

专为居家老人医护场景设计的医疗设备和器械;

为家庭医生、上门护理人员定制的信息化工具;

居家养老护理人员专业培训机构;

具看护陪护、健康管理、远程监测等功能的可穿戴设备、便携式健康监测设备、自助式健康检测设备、智能养老监护设备、人工智能家庭服务机器人等;

具备远程问诊、健康咨询、挂号就医指导、养老便利等服务的各类平台。

社区:家门口的托养和康复理疗

鉴于老年人需要医疗支持、易缺乏关心、有老年社交娱乐需求等特点,传统居家养老若没有社区养老作为基础和补充服务,很难把一些养老需求落到实处。

目前,我国的社区养老主要分为普通住宅型社区和老年公寓型社区,前者更多是作为居家养老的补充功能;后者则是一种专业化的养老社区,主要针对自助、互助养老的健康老人。成熟的适老社区中,要求老年照料、医疗保健、娱乐、生活便利养老配套设施都一应俱全。

联合医护机构的社区托养

社区托养的模式,即日间照料中心、长者照护之家等“家门口”的养老,可以为老年人提供生活照料、康复理疗、精神慰藉和紧急救助等基础服务,以及娱乐、教育、交友等附加服务。随着老年托养逐渐向市场化发展,出现了多种形式的模式探索——通过PPP的形式进行公私合营、政府投资出租、私人建设社区运营等。其中政府的运营补贴支持,或低价甚至免费提供场地,让运营方资产更“轻”。在对老年人需求的持续探索下,结合上门服务、老年互助、多种服务平台化运营等资源盘活的方式,社区托养逐渐告别从前“不赚钱”的定式思维。

不仅是本身需要配备保健康复的设施,而且正在进一步紧密结合“医养”。街道社区卫生服务中心、乡镇卫生院、社区诊所等作为医疗体系的末梢神经,与就近的社区托养机构可形成天然的联合,开展如专家到社区、老年人绿色就诊通道等多种形式的合作。换个思路,基层医疗机构也开设社区托养点。如此合作,社区老年托养获得了专业医疗服务,同时也有利于整合、优化社区医疗机构资源,提升床位周转率。

中医药健康养老

此类服务能广泛适用于多种类型的社区,而老年群体对近在各社区的康复理疗、中医保健等有一定的需求。社区卫生服务中心开设中医康复理疗科,提供针灸、拔罐、药熏、艾灸、针刀、牵引、推拿、刮痧等治疗手段和中药、中成药等,切合分级诊疗理念来服务于老人,能够辅助促进以养为主的医养结合服务。

国家近期也出台政策,鼓励社会力量开办以老年人为主要服务对象的中医药养生保健机构和品牌。近年来,随着中医医养概念的提出,中医药健康养老服务市场的监管指标体系和监督评级制度正在建立,鼓励新的正规中医药理疗门店、服务点出现,并打击针对老年群体的非法营销者。

政策:国家中医药局《关于促进中医药健康养老服务发展的实施意见》,中医医疗保健在社区养老中起大作用

要让中医药服务进社区,85%以上的社区卫生服务中心、70%以上的乡镇卫生院要设置中医药综合服务区(中医馆、国医堂),提供中医药健康养老服务;

鼓励社会力量举办以老年人为主要服务对象的养生保健机构,为老年人提供中医健康状态辨识与评估、咨询指导、健康管理等服务,使用按摩、刮痧、拔罐、艾灸、熏洗等中医技术及以中医理论为指导的其他养生保健方法及产品进行健康干预;

促进经营规范、服务优质、特色鲜明的中医养生保健机构发展,培育一批技术成熟、信誉良好的知名中医养生保健集团或连锁机构。

社区医养潜力机会

多种方式经营的老年社区托养;

有专门针对老年医护、康复板块的社区诊所;

社区养老康复机构;

针对跌倒、卧床不起、衰弱综合征、重度骨质疏松、吞咽障碍等老年人问题的康复设备以及康复人才培训;

中医理疗养生馆等。

机构:医养多样合作、全产业链数据跟踪

独生子女一代赡养父母的压力越来越大,意味着仅居家和社区的养老照料将难以满足需求。养老服务机构市场正快速兴起,但据了解,目前这些机构的运营情况普遍不理想,还有待从服务和盈利模式上进一步探索。

近年来热谈的医养结合,很大程度上都是针对机构养老,提出养老机构可增设医疗服务资质、医院转型为医养结合服务机构、医疗机构可与养老机构协议合作等,在为老年人提供更方便的医疗服务的同时,实质上也增加了在信息数据互通、多方面医疗服务的机会。

政策:“十三五”规划对机构医养的支持

对民间资本和社会力量申请兴办养老机构进一步放宽准入条件,落实好对民办养老机构的投融资、税费、土地、人才等扶持政策,并支持养老机构按规定开办康复医院、护理院、临终关怀机构和医务室、护理站等。对养老机构设置的医疗机构,符合条件的按规定纳入基本医疗保险定点范围。

但话说回来,仅是养老院和医院签约、养老院办医院或医院改养老院是不够的,如果医疗服务没有真正深入老年人照护以及养老设施的管理,“医养”也就仅停留在概念上。

案例:医院转型医养结合

2014年底,北京市隆福医院开设北苑院区,同一栋楼内既有汇晨老年公寓又有医护人员。如果老人需要到医院治疗,只要在楼内换个房间,就能从公寓的床位转到医院的病床。

北京市炼焦化学厂医院是一家2010年建成的国有企业医院,共设有住院病床80张。随后几年,医院陷入了长期亏损。于是医院实施了向养老院转变的医养结合新模式改革,即保留医院的门诊,80张床位拿出一半用于养老院改建。

案例:医疗机构、医疗品牌与养老机构合作

北京隆福医院天通苑院区与东篱养老院紧紧相邻,于2014年底正式签约合作,隆福医院的医师每周都会到东篱养老院巡诊,为老年人进行康复治疗等。这也是北京市首家“医养融合”型机构。

乐普医疗旗下的陪诊服务品牌“随心诊”与普乐园养老院于2016年1月签约,宣告共同探索“专业医疗服务+社会养老机构”的医养结合新模式。

全国人大代表、燕达集团董事长李怀曾说,要真正解决医养结合问题,在养老机构当中就要设置医护团队,融入到养老工作中,解决养老者的基本需求;在出现重大疾病时,能够全面对接医院,全程负责。医养两者是互补的,医院发展得好可以带动养老发展,反之亦然。

而山东南丁格尔公司称,他们的核心业务之一就是为连锁加盟托管的养老机构配属附属医院,并辅以托管、云平台服务。通过这个医养大平台形成的数据,优化其托管的养老机构,管理护理人才,并对发展养老金融、医养用品都有助力。

 

 

机构医养信息化可产生的可能性

机构医养潜力机会

实现养老机构与医院健康档案、就诊记录、疾病管理、用药需求数据互通的信息化系统;

医养相关保险;

为制药企业以及医养相关保险提供研究信息的老年人身体状况大数据;

跟踪会员需求提供增值服务,如营养餐、保健品、药物、老年用品的定制等。

绕不开的难点:人员、费用、技术

养老市场从来就不是一块好切的蛋糕。首先,优质养老医护人员的短缺是家庭、社区、机构都必须面对的现实。据汇橙养老的数据,空巢老人有1亿+,独居和高龄老人都分别在2000万+,其中失能、半失能老人为4063万(18.3%),按老人护工比1:4计,对应的护工缺口高达千万,已与养老需求产生严重脱节。

很多自营护理人员培训的养老服务企业都会强调,要培养更多的养老护理人员,首先要做到的是提高该行业的收入。据报道,普通养老护理员的平均工资在3000-4000,而受过培训的月嫂约为8000-13000;再加之养老护理工作的苦、累、脏,缺乏保障、社会地位较低,极大地制约了养老人才发展。动脉网(微信:vcbeat)了解到,为了解决人员问题,有的养老企业采取的方式是与政府签养老护理员的扶贫战略合作协议,有的则是校企对接定向输送养老人才,给予补贴等。

未来,要补足缺乏的养老人员,一方面是靠护理人才补贴制度的完善,一方面是养老服务的市场化对服务价格形成自然调节,失能照料之类的刚需服务将逐渐涨价。

第二个直接影响医养结合发展机会的是医养服务报销问题。现在有一些医养结合机构已经接入了医保系统,但是只报“医”不报“养”,医疗费用比康复护理服务费用的价格更低,压床位养老节省费用的问题可能还是难以解决。对此,人社部为长期护理保险制度做顶层设计,山东青岛、吉林长春和上海也提早按地方特点开展了长期护理保险的探索,这些举措也将进一步推动社会养老照护体系的保障。

最后,养老服务网络基础设施的构建是一大难点。在医疗信息化程度更高的北美,SecurityScorecard调查了超过700家医疗健康机构并发布《2016年北美医疗行业网络安全报告》,发现医疗行业的信息安全现状非常糟糕,在2015年8月份至2016年8月,北美医疗行业发生22起重大数据泄露事故,数以百万计的病人信息遭到泄露。而在隐私保护还处于初级阶段的中国,随着医养逐渐信息化,类似问题出现会更加频繁,患病、保险等个人隐私信息需提早进行安全管控。

 

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  1. 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    2017-05-04 方舒

    学习

    0

  2. 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    2017-05-04 龙胆草

    学习了,谢谢分享

    0

  3. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue May 02 08:58:27 CST 2017, time=2017-05-02, status=1, ipAttribution=)]
    2017-05-03 1e0f8808m18(暂无匿称)

    医养结合,是可行的办法。

    0

  4. 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    2017-05-03 1e17414fm02(暂无匿称)

    学习

    0

  5. 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  6. 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    2017-05-02 林3301

    但是到老年,没人帮,即使再有钱也没用呀

    0

  7. 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createdTime=Thu May 04 06:44:45 CST 2017, time=2017-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=193373, encodeId=64131933e3b3, content=医养结合,是可行的办法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Wed May 03 19:29:37 CST 2017, time=2017-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=193072, encodeId=9fcd1930e2e6, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Wed May 03 05:45:28 CST 2017, time=2017-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1509047, encodeId=7928150904e42, content=<a href='/topic/show?id=ad25339450c' target=_blank style='color:#2F92EE;'>#医养结合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33945, encryptionId=ad25339450c, topicName=医养结合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=543b10034171, createdName=diushouji, createdTime=Wed May 03 03:28:00 CST 2017, time=2017-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=193006, encodeId=ebb9193006b8, content=但是到老年,没人帮,即使再有钱也没用呀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/04/24/1c2dbd6706e64df33befd6663f1d6b37.jpg, createdBy=94f61661779, createdName=lyh994, createdTime=Tue May 02 09:15:32 CST 2017, time=2017-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192791, encodeId=4056192e9127, content=so,目前医学生有发展前景喽, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuLuc8S5RMt9ZExKtFteCNL6gK27WrafW6OC8OZkF3dic4lHUf2OxZiaWFhEfNtNPFC8AWia2uJm8TLQ/0, createdBy=08cc2048658, createdName=tt199, createdTime=Tue May 02 09:01:41 CST 2017, time=2017-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192788, encodeId=7fb6192e88e6, content=了解,感谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue May 02 08:58:27 CST 2017, time=2017-05-02, status=1, ipAttribution=)]
    2017-05-02 cqykthl

    人口大国需要解决的问题好多

    0

  8. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue May 02 08:58:27 CST 2017, time=2017-05-02, status=1, ipAttribution=)]
    2017-05-02 lyh994

    建立一套完整的个性化评估体系

    0

  9. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue May 02 08:58:27 CST 2017, time=2017-05-02, status=1, ipAttribution=)]
    2017-05-02 tt199

    so,目前医学生有发展前景喽

    0

  10. 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    2017-05-02 执着追梦

    了解,感谢分享!

    0

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