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“医养结合”可能对长期照护产生误导

2017-10-12 唐钧 中国医疗保险

在目前的大环境中,“医养结合”已经成为一个对老年服务有着重要影响的新概念。但是,“医养结合”又是一个极具中国特色的概念,在国际上闻所未闻

2015年,国办转发卫计委等部门《关于推进医疗卫生与养老服务相结合指导意见的通知》(国办发〔2015〕84号)。时隔两年,关于“医养结合”的认识仍没有达成一致,现实操作也出现诸多问题。那么,“医”与“养”的关系以及结合界限如何厘清?“医养结合”难推进的根本原因是什么?实际操作中存在哪些误区?也许,真正的“医养结合”前提是要做好“医养分开”,而不是“医养不分”“医养一体”。

在目前的大环境中,“医养结合”已经成为一个对老年服务有着重要影响的新概念。但是,“医养结合”又是一个极具中国特色的概念,在国际上闻所未闻。放眼世界,医疗服务和老年服务本就是两个相对独立的服务领域。在重要的国际文献里,历来都把医疗服务和社会服务划分清楚,而不会将这两者混为一谈。

“医养结合”会引发的服务误区

目前,为医养结合,有些地方大量兴办“护理院”,甚至统统办成护理院。按既定标准,从硬件设施到软件配备,从环境氛围到细节安排,护理院就是一个医院的住院部。这种“医院模式”的护理院并不适合老年人长期居住,即便是完全失能的老年人也一样。

对失能老人进行长期照护的老年服务机构,应该办成一个有温馨的家庭氛围的“社区”,而入住老人的角色应该是“社区居民”,绝非病人或患者。圈内评判好的老年服务机构有三个标准,即“无异味、无压疮、老人脸上有笑容”,但“无异味和有笑容”在大多数护理院里却是难得一见。

同时,按规定,护理院的门槛非常高。

仅人员配备,每50张床位至少要有1名具有副主任医师以上职称的医师和3名执业医师,还要配备5名具有主管护师以上职称的护士和13名执业护士,还要有护理人员20多名。想一想,这50位入住的老人要负担多大的人工成本?另外,我国目前总共有将近700万完全失能老人,按上述配备,至少需要56万名医师,182万名注册护士。但是,我国执业医师和助理医师只有304万人,注册护士324万人。在医疗服务领域人力资源稀缺性短时期内难以改变的情况下,护理院再来分一杯羹只能会使得医疗资源更加紧张。

从经营者来说,这么高的标准,如果指望“民建民营”,如此之高的基建、设施设备投入和日常运营成本,什么时候才能收回成本?当然,目前也有一些民营护理院依然存活,但此中又生出了多少靠吃医保而赖以生存的“潜规则”?

“医养结合”会引发的筹资误区

从国际经验看,长期照护的经费最初也的确来自于医疗保险基金。中国长护制度初建,作此选择也可以理解。现在一些地方试点,初衷就是减少“社会性压床”。但是,虽然失能老人离开了医院,他们的费用却仍由医保基金支付。医院的床位是不会空着的,如果没有一笔独立的基金支付长期照护的费用,那么,结果事与愿违,医保支出仍在增加。当然,相关的医院的收益也在增加。

我国医疗保险制度是脆弱的。职工医疗保险是“由用人单位和职工按照国家规定共同缴纳基本医疗保险费”。相比养老保险而言,少了政府托底的承诺。实际上,近年来学界一直认为医疗保险的未来趋势不容乐观。有研究表明:据预测,职工医疗保险基金2029年将当期收不抵支,到2034年基金结余将为负数。长期照护支出不能也不该成为压垮骆驼的最后一根稻草。

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    2017-10-13 Y—xianghai

    学习了新知识

    0

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    2017-10-13 榄枷檬

    谢谢分享

    0

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    2017-10-13 雅文博武

    学习了很多先进的医疗技术

    0

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    2017-10-13 183****7028

    学习

    0

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    2017-10-12 changjiu

    学习了.谢谢

    0

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    2017-10-12 1dea4a7em68(暂无匿称)

    其实就是政府甩手养老的新花样

    0

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    2017-10-12 1e0f8808m18(暂无匿称)

    医养结合不能误导服务.

    0

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