顾雯烨+茅燕芬+赵琦+沈安

摘 要 老龄化问题日益加重，上海市提出的“9073”养老服务体系建设缓解了部分养老问题，但大部分选择居家养老的老人由于日托照料机构少、利用率低等问题，其护理需求无法得到满足；已入住机构养老老人的医疗护理需求因养老机构医疗护理能级不足也无法得到满足，供需失衡问题日益突出。针对目前养老中的医疗需求，政府明确提出结合社区卫生改革现况依托基层医疗服务机构探索适宜的医养结合模式。上海市长宁区程家桥街道社区卫生服务中心将家庭医生签约服务与“9073”养老服务体系相结合，探索形成以家庭医生为核心的医养结合服务新模式，逐步完善社区老年人的养老机制和服务模式。同时通过新模式的探索分析总结其优势和存在问题，并以此提出进一步政策建议。

关键词 老龄化；家庭医生；医养结合

中图分类号：R197.1 文献标志码：A 文章编号：1006-1533（2017）14-0020-04

Exploring the mode of elderly care combined with medical care based on family doctors as the core

GU Wenye1， MAO Yanfen1， ZHAO Qi2， SHEN An1（1.Chengjiaqiao Community Health Service Center of Changning District， Shanghai 201103， China； 2.School of Public Health of Fudan University， Shanghai 200032， China）

ABSTRACT With the increasingly serious aging problem， the government of Shanghai proposes 9073 system of elderly care service， which solves parts of the problems， however most of the aged choose to live at home due to the lack of day care institutions and the low utilization rate so that the nursing needs are not met. The medical and nursing needs of the elderly who have been admitted to the institution cannot be met because of inadequate medical and nursing care in the nursing institutions， and the imbalance between supply and demand has become increasingly prominent. Aiming at the medical demands of aging care， the government puts forward clearly to explore the suitable mode of combination of medical care and endowment with community health reform depending on basic medical institutions. Chengjiaqiao Community Health Service Center of Changning District combines the community family doctor signing service with 9073 system of elderly care service to explore the formation of a new service mode of family doctors as the core of the medical support combined with endowment and gradually improves the elderly community pension mechanism and service mode. Meanwhile， by exploring and analyzing the advantage and the disadvantage of the new mode， the advice and policy will be proposed further.

KEY WORDS aging； family doctor； old-age care combined with medical care

隨着老龄化问题的日益突出，我国面临着沉重的养老问题，尤其是老年人的医疗需求逐步加重[1]。如何探索满足老年人多样化、多层次的养老需求，提高老年人的健康水平是目前亟待解决的问题[2]。发达国家通过养老服务整合、养老机构向医、护型机构转型等方式探索新的养老模式，为我们提供了借鉴[3]。2013年《国务院关于促进健康服务业发展的若干意见》[4]中明确提出要推进医疗机构和养老机构之间的合作，探索适宜的医养结合模式。2014年，上海市提出进一步完善“9073养老服务体系”，但是新体系中机构集中养老供需失衡的问题依然没有得到有效缓解。……