老龄化背景下的医疗服务体系(硕士)(论文38000字)
中文摘要
早在15年前我国就己经步入老龄化社会，目前80岁以上老龄人口高速递增；法国用一百多年才达到的老龄化状态，我国仅仅用了不到30年的时间就已达到。截止2017年年末，我国60周岁及以上人口24090万人，占总人口的17.3%，其中65周岁及以上人口15831万人，占总人口的11.4%。全国老龄化已进入高速发展阶段。因为老年人的生理机能衰退,健康水平降低,使得患病率及人均医疗费用均高于年轻人。随着人口老龄化、高龄化、失能化的加剧，老龄人口的患病率和伤残率逐步增加，老年人医疗服务需求和医疗费用支出不断提高，医疗资源的消耗也在逐年增长。而相对于我国处于发展阶段，多数老年人出现“未富先老”的特点；再加上我国卫生水平、医疗卫生保障体系较为落后，存在较多问题。因此,在老龄化背景下，如何保障老龄人口的医疗服务需要,为其提供有效、快捷的医疗保健服务,改善其健康水平,提高生活质量,实现"老有所医"的目标,成为我国医疗工作所面临的巨大难题。
党中央、国务院高度重视老龄事业，结合中国国情，借鉴老龄化先行发达国家的经验教训，从基本方略层面提出实施积极应对人口老龄化和老龄社会的重大战略安排。2016年7月人社部出台了《关于开展长期护理保险制度试点的指导意见》，各地方开展长期护理保险试点。10月，国务院在印发的《“健康中国2030”规划纲要》中明确提出推进老龄医疗卫生服务体系建设，推动医疗卫生服务延伸至社区、家庭。健全医疗卫生机构与养老机构合作机制，支持养老机构开展医疗服务。推进中医药与养老融合发展，推动医养结合，为老年人提供治疗期住院、康复期护理、稳定期生活照料、安宁疗护一体化的健康和养老服务，促进慢性病全程防治管理服务同居家、社区、机构养老紧密结合。鼓励社会力量兴办医养结合机构。加强老年常见病、慢性病的健康指导和综合干预，强化老年人健康管理。推动开展老年心理健康与关怀服务，加强老年痴呆症等的有效干预。但是，老龄医疗服务涉及甚广，是一项系统工程，错综复杂的现实导致其不可能一蹴而就。
做好老龄人口医疗服务工作，是应对人口老龄化的重要内容。本文将老龄人口医疗服务体系作为研究对象，通过多种途径搜集国内外医疗服务体系相关资料，详尽阐述我国人口老龄化的趋势与特征、老龄人口对医疗服务的需求特征，从完善和发展的角度入手，总结了当前医疗服务体系的现状、阐述了当前老龄人口医疗服务体系的运行现状，找出存在的问题，概括和提炼实践成果上升到理论高度，进而最后提出了确实有效且有针对性完善老龄人口医疗服务体系的对策。
全文通过五个部分阐述了老龄化背景下的医疗服务体系建设问题。第一章引言部分指出了文章的研究背景、研究目的和意义、研究方法；第二部分指出了文章的理论综述；第三部分从人口老龄化的现状、发展趋势、老龄人口的健康状况及其医疗服务需求的角度介绍了全国人口老龄化的趋势与特征的基本理论；第四部分介绍了全国医疗服务体系的现状，分别从全国医疗服务体系概况、全国医疗服务体系的空间分布状态、全国医疗服务体系医疗技术结构特征、全国医疗服务体系老龄人口医疗服务需求的响应能力加以论述。第五部分是对当前老龄人口医疗服务体系的现状及存在的问题进行分析，详细介绍老龄人口医疗服务体系的现状的基础上，重点阐述了政府对老龄医疗卫生的宏观管理能力不强，缺乏制度设计导致老龄综合连续服务缺失；基层服务能力不够，服务可获得性不足；康复护理服务不完善，不能满足老龄人口的医疗服务需求；医疗服务和养老服务分割；老年人医疗保障制度不完善；学科建设不足，专业人才匮乏六大问题；最后一部分提出了完善老龄人口医疗服务体系的对策措施，从政府作为、医养结合、医疗保险、学科建设、人才培养等方面整体上把握老龄人口医疗服务体系的发展脉络。
关键字：老龄化、医疗服务体系、老年医学、临终关怀
Medical Service system in the context of Aging
Abstract
As early as 15 years ago, China has entered the aging society, the aging population over the age of 80 speed increasing; the aging state of France for more than 100 years to reach, in China for less than 30 years of time has been reached. By the end of 2017, China's 60 years old and above population of 240 million 900 thousand people. The total population of 17.3%, of which 65 years old and above population of 158 million 310 thousand people, accounting for 11.4%. of the total population aging has entered a stage of rapid development. Because of the physiological function of the elderly depression, health level decreased, making the prevalence rate and per capita medical expenses were higher than those of young people with old population.With the aggravation of aging, aging and disability, the prevalence rate and disability rate of the elderly population are gradually increasing, and the demand for medical services and medical expenses for the elderly are constantly increasing. The consumption of medical resources is also increasing year by year. Compared with the development stage of our country, most elderly people have the characteristic of "getting old before they get rich". In addition to the health level of our country, the medical and health security system is relatively backward and there are many problems. Under the background of aging, how to ensure the medical service needs of the aged population, to provide them with effective and fast medical and health care services, to improve their health level, to improve their quality of life, and to achieve the goal of "old people with medical care" has become my goal.China's medical work is facing a huge problem.
The Party Central Committee and the State Council attach great importance to the cause of ageing, and in light of China's national conditions, learn from the experience and lessons of the developed countries leading the aging process. In July 2016, the Ministry of Human and Social Affairs issued the "guidance on the pilot of the long term Care Insurance system", and all localities began to carry out the long-term care insurance system. Nursing Insurance pilot. October, In the "healthy China 2030" Program issued by the State Council, the State Council clearly proposed to promote the construction of the medical and health service system for the elderly, and to promote the extension of medical and health services to the community, the family, and to improve the cooperation between medical and health institutions and pension institutions.To support the development of medical services in old-age institutions, to promote the integration of traditional Chinese medicine and old-age care, to promote the integration of medical care and support, to provide the elderly with hospitalization during treatment, nursing care during rehabilitation, and care for life during stable periods. Health and old-age care services integrated with tranquillity, treatment and protection, promoting the close integration of family, community and institutional old-age care services throughout the prevention and management of chronic diseases, encouraging social forces to set up medical and nursing institutions, and strengthening common diseases in the elderly, Health guidance and comprehensive intervention for chronic diseases, strengthening the health management of the elderly, promoting the development of mental health and care services for the elderly, strengthening effective interventions such as Alzheimer's disease, etc.A systematic engineering, an intricate reality, has caused it to be impossible to achieve in one stroke.
It is an important content to deal with the aging population by doing well the medical service work of the aged population. This paper takes the medical service system of the aged population as the research object and collects the relevant data of the medical service system at home and abroad through various channels. This paper expounds the trend and characteristics of aging population in China, the demand characteristics of aged population for medical service, and summarizes the current situation of medical service system from the angle of perfection and development. This paper expounds the current operating situation of medical service system for the aged population, finds out the existing problems, generalizes and refines the practical results to the theoretical level, and finally puts forward the effective and targeted medical service for the aged population.The countermeasures of the service system.
The first chapter points out the research background, the purpose and significance of the research, the research method, the second part points out the theoretical summary of the article. The third part introduces the basic theory of the trend and characteristics of the aging population in China from the point of view of the current situation of the aging population, the development trend, the health status of the aged population and the demand for medical services. Part 4th introduces the current situation of the national medical service system, including the general situation of the national medical service system, the spatial distribution of the national medical service system, and the medical technical structure of the national medical service system.The response ability of the elderly population to the demand for medical services in the national medical service system is discussed. Part 5th is an analysis of the current situation and existing problems of the medical service system for the elderly population. On the basis of introducing the current situation of the medical service system of the aged population in detail, the paper emphasizes that the macro management ability of the government on the health care for the aged is not strong, the lack of institutional design leads to the lack of comprehensive continuous service for the aged, the insufficient service capacity at the grass-roots level, Inadequate availability of services; inadequate rehabilitation care services, unable to meet the medical needs of the elderly population; separation of medical services and old-age services; inadequate medical security system for the elderly; discipline construction The last part puts forward countermeasures and measures to improve the medical service system of the aged population, from the government as the government, the combination of medical care and support, medical insurance, discipline construction, Personnel training and other aspects of the overall grasp of the elderly population medical service system development.
Keywords: aging， medical service system， geriatric medicine， hospice care
目录
中文摘要 5
Abstract 6
第一章 引言 7
1.1研究背景 7
1.1.1全国人口老龄化、高龄化、失能化趋势加剧 7
1.1.2 现有老年人群医疗服务体系 7
1.1.3 国家高度重视老龄事业 8
1.2研究目的和意义： 9
1.2.1有利于医疗卫生体制改革 9
1.2.2 有利于保障老年群体安享老年生活 9
1.2.3 有利于社会经济和谐稳定发展 10
1.3 研究方法 10
1.3.1文献法 10
1.3.2 访谈法 10
第二章 理论综述 11
2.1 人口年龄结构状况 11
2.2医疗服务体系 12
2.2.1医疗服务体系 12
2.2.2老龄人口医疗服务体系 12
2.3老龄人口的医疗服务 12
2.3.1老年医学 13
2.3.2 临终关怀 14
第三章 全国人口老龄化的趋势与特征 14
3.1人口老龄化的现状 14
3.1.1基本现状：老龄化程度高，分布不均衡 14
3.1.2经济状况：收入来源少，收入基本稳定 16
3.1.3生活状况：老年人口空巢化，无偶化 16
3.2人口老龄化的发展趋势 17
3.2.1老龄化进程快，高龄化趋势明显 17
3.2.2老年人口空巢化、失能化态势居高不下 17
3.2.3老年人口由家庭养老转向居家养老 18
3.3 全国老龄人口的健康状况及其医疗服务需求 18
3.3.1 老龄人口的健康状况 18
3.3.2老龄人口的医疗服务需求 20
第四章 全国医疗服务体系的现状 22
4.1 全国医疗服务体系概况 22
4.1.1服务体系逐步完善 22
4.1.2资源总量持续增长 22
4.1.3信息化水平显著提高 23
4.2 全国医疗服务体系的空间分布状态 23
4.2.1西部地区医疗卫生资源质量较低 23
4.2.2基层医疗卫生机构服务能力不足，利用效率不高 24
4.2.3医院所占医疗资源比重大 25
4.2.4中医医院、专科医院发展相对较慢，康复、老年护理等领域服务能力较为薄弱 26
4.3 全国医疗服务体系医疗技术结构特征 27
4.3.1专科化 27
4.3.2碎片化 27
4.3.3以治愈为目的 27
4.4 全国医疗服务体系老龄人口医疗服务需求的响应能力评估 27
第五章当前老龄人口医疗服务体系的现状及存在的问题 28
5.1老龄人口医疗服务体系的现状 28
5.1.1老年专科医院以及综合性医院设立的老年医学科 29
5.1.2社区卫生服务中心 29
5.1.3老年康复护理、临终关怀机构 29
5.1.4疗养院、福利院 30
5.2老龄人口医疗服务体系存在的问题 30
5.2.1政府对老龄医疗卫生的宏观管理能力不强，缺乏制度设计导致老龄综合连续服务缺失 30
5.2.2基层服务能力不够，服务可获得性不足 31
5.2.3康复护理服务不完善，不能满足老龄人口的医疗服务需求 32
5.2.4医疗服务和养老服务分割 32
5.2.5老年人医疗保障制度不完善 33
5.2.6学科建设不足，专业人才匮乏 34
第六章 完善老龄人口医疗服务体系的建议 35
6.1加大政府投入，完善老龄人口医疗服务的法律保障体系 35
6.1.1加大财政投入 36
6.1.2完善法律保障体系 37
6.2强化政府职能，构建衔接流畅的连续性老龄医疗服务框架 37
6.3完善医保制度，推进医养融合 38
6.3.1完善医保制度，健全“医养结合”医疗保险体系 39
6.3.2强化资源整合，推进医疗卫生与养老服务相融合 40
6.4强化治疗规范，推动学科发展 41
3.加强老年医疗护理学科建设。 41
6.5以需求为导向，加强人才培养 42
6.5.1加大人才培养力度 42
6.5.2创新人才使用、管理和评价机制 43
参考文献 43
综述 45 |
