社区“医养结合”模式下卫生服务机构与养老机构合作行为的动态博弈分析

社区"医养结合"养老模式为社区老年人提供医疗、照料、护理于一体的养老服务,在我国严重老龄化及家庭社区化的背景下具有重要的现实意义.该新型养老模式推行的最大问题在于卫生服务机构与养老机构开展"医养结合"的利益协调.利用两阶段不完全信息动态博弈对社区"医养结合"下卫生服务机构与养老机构的合作行为展开研究,分析两者在博弈中的最佳成本和收益策略,结合模拟仿真实验探讨两者在进行"医养结合"中的行为机理以及阻碍"医养结合"的关键因素.应该完善医保与养老费用的衔接体系,助力"医养结合"模式建设;形成"居委会-医疗-养老"三方的协商机制,促进"医养结合"有效开展;加强"医"和"养"双方的服务渗透,建立"医养"双向服务通道,提高"医养结合"服务水平.加大政策、资金、人才等扶持力度,保证"医养结合"可持续发展.

A study of the dynamic game between the health-service institution and the old-age service institution in the community-based model of integrating medical care and old-age care

The community-based model of integrating medical care and old-age care provides an integrated model of medical care and daily care and nursing care for the elderly in their community. This model is of great significance against the background of the quickly aging population and the community-relied family in China. The key to promoting this model is the integration of the interest groups of the health service institution and old-age institution. This paper uses the two-stage incomplete information dynamic game for the analysis of the cooperative behaviors of the health-service institution and the old-age institution to reveal their optimal cost-effectiveness and profit-gaining strategies. Simulation experiments are conducted to analyze the optimal solution of the two-stage game and the principle of behaviors of the two kinds of institutions and factors which hinder their cooperation. Efforts should be made to improve the integration between medical insurance and old-age expenses, to form a consultation mechanism of "neighborhood committee, medical treatment and old-age care", to build a bi-channel of medical care and old-age care and to provide more supports in terms of policies, funds and talents.