医学

公共管理/公共政策与社会保障

李晓斌

河南医药大学

医养结合；养老服务；委托运营；中医医院；多中心-协同治理

本案例基于对河南省濮阳市中医医院实地调研，通过对政府部门、医院、养老机构的相关人员访谈基础上完成。案例描述了在濮阳市中医医院托管养老服务中心的事件过程中，医养结合推进的“难”与“解”。濮阳市政府为了高标准建设养老服务中心，决定在养老服务中心推进医养结合工作，濮阳市民政局经过调查分析和方案优选，确定与濮阳市中医医院合作。但是医养结合推进面临诸多难题，主要有医院对于参与医养结合意愿不高、医养结合牵涉面广且利益关系复杂、跨部门协同陷于困境等。濮阳市民政局和中医医院在具体的医养结合模式选择上存在较大分歧，双方最终达成一致，医中设养型模式更符合养老服务中心的实际。濮阳市政府出台委托运营决议，由濮阳市中医医院托管养老服务中心，濮阳市民政局和中医医院达成委托运营协议，中医医院医养结合得到深入推进。 濮阳市中医医院在深入推进医养结合的过程中，仍然面临诸多发展难题与困惑，制约了医养结合工作的顺利开展，医养结合推进依然“前路漫漫”。 本案例研究基于多中心-协同治理理论视角，考察濮阳市中医医院托管养老服务中心的医养结合实践，从政府、医疗和养老机构、基层社区、老年人及其家庭等多元参与主体层面，分析多中心-协同治理存在问题，运用SFIC模型探讨问题原因，提出协同治理路径。

This case is based on on-site research at Puyang Traditional Chinese Medicine Hospital in Henan Province, and was completed through interviews with relevant personnel from government departments, hospitals, and elderly care institutions. The case describes the "difficulties" and "solutions" in promoting the integration of medical care and elderly care during the process of the entrusted elderly care service center in Puyang Traditional Chinese Medicine Hospital. In order to build a high standard elderly care service center, the Puyang Municipal Government has decided to promote the integration of medical and elderly care in the elderly care service center. After investigation, analysis, and scheme selection, the Puyang Civil Affairs Bureau has decided to cooperate with the Puyang Traditional Chinese Medicine Hospital. However, the promotion of medical and elderly care integration faces many difficulties, mainly including low willingness of hospitals to participate in medical and elderly care integration, broad and complex interests involved in medical and elderly care integration, and difficulties in cross departmental collaboration. There are significant differences between the Civil Affairs Bureau of Puyang City and the Traditional Chinese Medicine Hospital in the specific selection of medical and elderly care integration models. The two sides ultimately reached an agreement that the medical and elderly care model is more in line with the actual situation of elderly care service centers. The Puyang Municipal Government has issued a commission operation resolution, with the Puyang Traditional Chinese Medicine Hospital hosting the elderly care service center. The Puyang Civil Affairs Bureau and the Traditional Chinese Medicine Hospital have reached a commission operation agreement, and the integration of medical care and elderly care in traditional Chinese medicine hospitals has been deeply promoted. In the process of promoting the integration of medical care and elderly care, Puyang Traditional Chinese Medicine Hospital still faces many development difficulties and confusions, which restrict the smooth progress of the work. The promotion of the integration of medical care and elderly care still has a long way to go. This case study is based on the perspective of polycentric collaborative governance theory, investigating the practice of integrating medical care and elderly care in the entrusted elderly care service center of Puyang Traditional Chinese Medicine Hospital. From the perspective of multiple participating entities such as government, medical and elderly care institutions, grassroots community, elderly people and their families, the problems in multi center collaborative governance are analyzed, the reasons for the problems are explored by using SFIC model, and a collaborative governance path is proposed.

公共政策分析、公共管理、社会保障改革与管理

本案例描述了在濮阳市中医医院托管养老服务中心的事件过程中，医养结合推进的“难”与“解”。本案例基于这样一个完整的事件基础上，以“起、承、转、合”的叙事方法呈现该事件。在调研中我们发现濮阳市中医医院推进医养结合的“难点”，表现为医养结合推进面临诸多难题，主要有医院对于参与医养结合意愿不高、医养结合牵涉面广且利益关系复杂、跨部门协同陷于困境等。为了深入探讨和解决案例正文中呈现的问题，案例分析基于多中心-协同治理理论视角，考察濮阳市中医医院托管养老服务中心的医养结合实践，从政府、医疗和养老机构、基层社区、老年人及其家庭等多元参与主体层面，分析多中心-协同治理存在问题，运用SFIC模型探讨问题原因，提出协同治理路径。 1.本案例以问题为导向，引导学生带着问题来了解案例的发展和推进，构建公共政策分析框架，探讨问题及其原因，启发学生的探索性思维， 2.本案例研究将公共治理理论引入医养结合领域，从而促进公立医院参与医养结合实践的深入发展，帮助学生理解和掌握现代公共管理理论，并运用这些理论解决实践中公共管理问题。 3.本案例研究分析医养结合实践模式的特点、运行机制与优化策略，让学生在现实情境中探讨当前老龄化背景下如何解决健康养老问题，增强学生在实际工作中的创新和实践能力。

为了使案例教学发挥更好的效果，需要完成以下工作： 1.要求学生提前阅读、熟悉案例正文部分内容，并对关键信息进行标记和记录。 2.要求课前将学生进行分组，一般4—6人为一组，并选出各小组组长，组长主要负责组织小组讨论和汇报讨论结果。 3.要求提前布置教室，可以采用“U”形排列的方法，这种方法既可以突出教师的主导地位，也适合小组讨论和结果交流。 4.要求教师设计教学方案，根据教学人数、时间、地点、目标等提前做出计划和备选方案。

1.以濮阳市中医医院托管养老服务中心的案例为例，构建多中心-协同治理框架，分析医养结合推进过程中多元参与主体的各自不同诉求。 2.本案例中濮阳市中医医院托管养老服务中心的医养结合实践，对于公立医院推进医养结合有很强的借鉴和参考价值。请运用多中心-协同治理理论和SFIC模型，分析公立医院推进医养结合的多中心-协同治理存在问题，探讨问题原因，提出协同治理路径。

本案例的教学内容以濮阳市中医医院医养结合发展历程为主线，以案例后思考题为辅线，引导学生带着问题来了解案例的发展和推进。在学生通过阅读、学习和了解本案例基础上，案例分析基于多中心-协同治理理论视角，逐层递进分析濮阳市中医医院医养结合发展过程中存在的困境及其原因，提出有建设性的建议和观点。1.案例的理论基础与适用性分析；2.公立医院推进医养结合的多中心-协同治理框架构建；3.公立医院推进医养结合的多中心—协同治理存在问题及其原因分析；4.公立医院推进医养结合的多中心-协同治理路径。