农村老年人“医养结合”服务利用的困境与对策

Dilemmas and Countermeasures in the Utilization of “Integrated Medical and Nursing” Services among the Rural Elderly

摘要: 伴随我国老龄化进程的不断加深，农村老年群体对医疗与养老复合型服务的需求日益凸显。尽管医养结合模式整体已迈入高质量发展阶段，但受制于基层资源匮乏与居民有效支付能力不足等客观约束，农村地区医养结合服务的供给与实际需求仍难以有效匹配。本文从农村老年人医养需求的分层结构切入，系统梳理当前主要的医养结合服务供给模式，深度剖析农村老年人在服务利用中面临的部门分治导致的资源割裂、支付能力有限、跨部门协同不畅以及专业照护人才匮乏等现实困境。结合多地典型实践经验，本文从强化顶层制度设计与政策协同、盘活基层存量医疗资源、深化支付体系改革及加强专业队伍建设等维度提出针对性的优化路径，以期为推进农村医养结合服务的普及与高质量发展提供理论参考。

Abstract: With the continuous deepening of population aging in China, the demand of the rural elderly population for integrated medical and elderly care services has become increasingly prominent. Although the integrated medical and nursing care model as a whole has entered a stage of high-quality development, restricted by objective constraints such as inadequate grassroots resources and the insufficient effective paying capacity of residents, the supply and actual demand for integrated medical and nursing services in rural areas remain difficult to match effectively. Starting from the hierarchical structure of the medical and nursing demands of the rural elderly, this paper systematically reviews the current primary supply models of integrated medical and nursing services. It deeply analyzes the realistic dilemmas faced by the rural elderly in service utilization, including resource fragmentation caused by departmental segmentation, limited paying capacity, poor cross-departmental synergy, and the shortage of professional caregiving talents. Drawing on typical practical experiences from various regions, this paper proposes targeted optimization paths from the dimensions of strengthening top-level institutional design and policy synergy, revitalizing existing grassroots medical resources, deepening the reform of the payment system, and enhancing the construction of professional teams. The aim is to provide a theoretical reference for promoting the popularization and high-quality development of integrated medical and nursing services in rural areas.