整合型老年人健康服务体系研究——英国的案例与思考
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摘要
整合型老年人健康服务体系是英国应对老龄化压力的主要手段之一,简明地说,是将医疗、照料资源进行整合,从而全面覆盖老年人健康需求。本文以英国为研究对象,梳理实践模式,归纳整合动因,评价实践结果,在此基础上发现,英国在进行整合时已具备三个关键要素:医疗服务和照料服务发展较为完善、均衡;合作模式已在公共服务领域形成常态化机制;IT技术在公共事务中广泛应用。对中国而言,若要完善健康服务体系,应当侧重于社会照料体系硬件和软件方面的全面完善,以与医疗服务相协调。随着客观条件逐步完备,整合健康服务资源,提升健康服务效果也将成为中国的选择。
The integrated care for elderly people has been one of the main ways to cope with the pressure of aging problem in UK. In brief, the integrated care can connect health care resources and social care resources into a framework to cover the complex needs of elderly people by service portfolios. Taking integrated care in UK as a study object, this research explores the motivations, summarizes main practice models, evaluates the service outcomes. Based on meticulous analysis, this article finds that UK has three key elements for the integration of health care and social care, which concludes the balanced development of health service and social care service, the normal mechanism of cooperation in the field of public services, and the widespread application of IT technology. For China, with aim to improve the health service system, it should focus on the overall improvement of the hardware and software of the social care system to coordinate with the medical services. The author believes that with the gradual completion of objective conditions, integration of health service resources and improvement of health service effect would become the choice of China.
The integrated care for elderly people has been one of the main ways to cope with the pressure of aging problem in UK. In brief, the integrated care can connect health care resources and social care resources into a framework to cover the complex needs of elderly people by service portfolios. Taking integrated care in UK as a study object, this research explores the motivations, summarizes main practice models, evaluates the service outcomes. Based on meticulous analysis, this article finds that UK has three key elements for the integration of health care and social care, which concludes the balanced development of health service and social care service, the normal mechanism of cooperation in the field of public services, and the widespread application of IT technology. For China, with aim to improve the health service system, it should focus on the overall improvement of the hardware and software of the social care system to coordinate with the medical services. The author believes that with the gradual completion of objective conditions, integration of health service resources and improvement of health service effect would become the choice of China.
引文
[1] CURRY N, HAM C. Clinical and service integration: the route to improve outcomes [R]. London: The King’s Fund, 2010.
[2] GOODWIN N, SMITH J, DAVIES A, et al. Integrated care for patients and population: improving outcomes by working together [R]. London: The King’s Fund, 2011.
[3] ALASZEWSKI A, BALDOCK J, BILLINGS J, et al. Providing integrated health and social care for older persons in the United Kingdom [R]. Canterbury: Centre for Health Service Studies, 2003.
[4] GOODWIN N, DIXON A, ANDERSON G, et al. Providing integrated care for older people with complex needs: lessons from seven international studies [R]. London: The King’s Fund, 2014.
[5] MACADAM M. Frameworks of integrated care for the elderly: a systematic review[R]. Ottawa: Canadian Policy Research Networks, 2008.
[6] DEPARTMENT OF HEALTH. The NHS plan: a plan for reform [R]. London: Department of Health, 2000.
[7] HUDSON B. Interprofessionality in health and social care: the achilles’ heel of partnership [J]. Journal of Interprofessional Care, 2002, 16 (1): 7-17.
[8] LEICHSENRING K, BILLING J, NIES H. Improving policy and practice in long-term care [M]// LEICHSENRING K, BILLING J, NIES H. Long-Term Care in Europe: Improving Policy and Practice. London: Palgrave Macmillan UK, 2013: 325-336.
[9] DICKINSON A. Implementing the single assessment process: opportunities and challenges [J]. Journal of Interprofessional Care, 2006, 20 (4): 365-379.
[10] WILD D. The single assessment process [J]. Primary Health Care, 2002, 12 (1): 20-21.
[11] DEPARTMENT OF HEALTH. Out in the open: breaking down the barriers for older people [R]. London: Department of Health, 2000.
[12] GOODWIN N, LAWTON-SMITH S. Integrating care for people with mental illness: the care programme approach in England and its implications for long-term conditions management [J]. International Journal of Integrated Care, 2010, 10 (1): 1-10.
[13] LEWIS J. Older people and the health-social care boundary in the UK: half a century of hidden policy conflict [J]. Social Policy and Administration, 2001, 35 (4): 343-359.
[14] DICKINSON H, GLASBY J. International perspective on health and social care: partnership working in action[M]. Oxford: Blackwell Publishing Ltd, 2009: 1-9.
[15] ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT. Health at a glance 2015: OECD Indicators [R]. Paris: OECD Publishing, 2015.
[16] WODCHIS W, DIXON A, ANDERSON G, et al. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis [J]. International Journal of Integrated Care, 2015, 15 (6): 1-13.
[17] CAMERON A,LART R,BOSTOCK L, et al. Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature [J]. Health and Social Care in the Community, 2014, 22 (3): 225-233.
[18] DICKINSON H. The outcomes of health and social care partnerships [M]// DICKINSON H, GLASBY J. International Perspective on Health and Social Care: Partnership Working in Action. Oxford: Blackwell Publishing Ltd, 2009: 153-165.
[19] BROWN L, TUCKER C, DOMOKOS T. Evaluating the impact of integrated health and social care teams on older people living in the community [J]. Health and Social Care in the Community, 2003, 11 (2): 85-94.
[20] HU M. The impact of an integrated care service on service users: the users’ perspective [J]. Journal of Health Organization and Management, 2014, 28 (4): 495-510.
[21] 罗布·巴戈特. 解析医疗卫生政策[M]. 上海:上海人民出版社, 2012: 92-113.
[22] PECK E, DICKINSON H. Partnership working and organizational culture [M]// DICKINSON H, GLASBY J. International Perspective on Health and Social Care: Partnership Working in Action. Oxford: Blackwell Publishing Ltd, 2009. 10-26.
[23] KEEN J, DENBY T. Partnerships in the digital age [M]// DICKINSON H, GLASBY J. International Perspective on Health and Social Care: Partnership Working in Action. Oxford: Blackwell Publishing Ltd, 2009: 95-106.
[24] 中华人民共和国民政部. 2017年社会服务发展统计公报[Z], 2018.
[25] 青连斌. 中国养老服务业发展报告[M]// 郑功成. 中国社会保障发展报告2016. 北京:人民出版社,2016: 166-187.
[26] 中华人民共和国国家卫生健康委员会.2018中国卫生健康统计年鉴[M]. 北京:协和出版社,2018.
[27] REED J, COOK G, CHILDS S, et al. A literature review to explore integrated care for older people [J]. International Journal of Integrated Care, 2005(5): 1-8.
(1)新公共管理(New Public Management)始于20世纪80年代左右,是在信息化和全球化时代背景下,以英国、美国为代表的西方国家对本国公共管理部门展开的改革运动,通过强调和提升公共服务效率,以解决传统行政模式无法适应经济、社会发展的问题。新公共管理影响范围较大,同时波及部分发展中国家及转型国家。
[2] GOODWIN N, SMITH J, DAVIES A, et al. Integrated care for patients and population: improving outcomes by working together [R]. London: The King’s Fund, 2011.
[3] ALASZEWSKI A, BALDOCK J, BILLINGS J, et al. Providing integrated health and social care for older persons in the United Kingdom [R]. Canterbury: Centre for Health Service Studies, 2003.
[4] GOODWIN N, DIXON A, ANDERSON G, et al. Providing integrated care for older people with complex needs: lessons from seven international studies [R]. London: The King’s Fund, 2014.
[5] MACADAM M. Frameworks of integrated care for the elderly: a systematic review[R]. Ottawa: Canadian Policy Research Networks, 2008.
[6] DEPARTMENT OF HEALTH. The NHS plan: a plan for reform [R]. London: Department of Health, 2000.
[7] HUDSON B. Interprofessionality in health and social care: the achilles’ heel of partnership [J]. Journal of Interprofessional Care, 2002, 16 (1): 7-17.
[8] LEICHSENRING K, BILLING J, NIES H. Improving policy and practice in long-term care [M]// LEICHSENRING K, BILLING J, NIES H. Long-Term Care in Europe: Improving Policy and Practice. London: Palgrave Macmillan UK, 2013: 325-336.
[9] DICKINSON A. Implementing the single assessment process: opportunities and challenges [J]. Journal of Interprofessional Care, 2006, 20 (4): 365-379.
[10] WILD D. The single assessment process [J]. Primary Health Care, 2002, 12 (1): 20-21.
[11] DEPARTMENT OF HEALTH. Out in the open: breaking down the barriers for older people [R]. London: Department of Health, 2000.
[12] GOODWIN N, LAWTON-SMITH S. Integrating care for people with mental illness: the care programme approach in England and its implications for long-term conditions management [J]. International Journal of Integrated Care, 2010, 10 (1): 1-10.
[13] LEWIS J. Older people and the health-social care boundary in the UK: half a century of hidden policy conflict [J]. Social Policy and Administration, 2001, 35 (4): 343-359.
[14] DICKINSON H, GLASBY J. International perspective on health and social care: partnership working in action[M]. Oxford: Blackwell Publishing Ltd, 2009: 1-9.
[15] ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT. Health at a glance 2015: OECD Indicators [R]. Paris: OECD Publishing, 2015.
[16] WODCHIS W, DIXON A, ANDERSON G, et al. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis [J]. International Journal of Integrated Care, 2015, 15 (6): 1-13.
[17] CAMERON A,LART R,BOSTOCK L, et al. Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature [J]. Health and Social Care in the Community, 2014, 22 (3): 225-233.
[18] DICKINSON H. The outcomes of health and social care partnerships [M]// DICKINSON H, GLASBY J. International Perspective on Health and Social Care: Partnership Working in Action. Oxford: Blackwell Publishing Ltd, 2009: 153-165.
[19] BROWN L, TUCKER C, DOMOKOS T. Evaluating the impact of integrated health and social care teams on older people living in the community [J]. Health and Social Care in the Community, 2003, 11 (2): 85-94.
[20] HU M. The impact of an integrated care service on service users: the users’ perspective [J]. Journal of Health Organization and Management, 2014, 28 (4): 495-510.
[21] 罗布·巴戈特. 解析医疗卫生政策[M]. 上海:上海人民出版社, 2012: 92-113.
[22] PECK E, DICKINSON H. Partnership working and organizational culture [M]// DICKINSON H, GLASBY J. International Perspective on Health and Social Care: Partnership Working in Action. Oxford: Blackwell Publishing Ltd, 2009. 10-26.
[23] KEEN J, DENBY T. Partnerships in the digital age [M]// DICKINSON H, GLASBY J. International Perspective on Health and Social Care: Partnership Working in Action. Oxford: Blackwell Publishing Ltd, 2009: 95-106.
[24] 中华人民共和国民政部. 2017年社会服务发展统计公报[Z], 2018.
[25] 青连斌. 中国养老服务业发展报告[M]// 郑功成. 中国社会保障发展报告2016. 北京:人民出版社,2016: 166-187.
[26] 中华人民共和国国家卫生健康委员会.2018中国卫生健康统计年鉴[M]. 北京:协和出版社,2018.
[27] REED J, COOK G, CHILDS S, et al. A literature review to explore integrated care for older people [J]. International Journal of Integrated Care, 2005(5): 1-8.
(1)新公共管理(New Public Management)始于20世纪80年代左右,是在信息化和全球化时代背景下,以英国、美国为代表的西方国家对本国公共管理部门展开的改革运动,通过强调和提升公共服务效率,以解决传统行政模式无法适应经济、社会发展的问题。新公共管理影响范围较大,同时波及部分发展中国家及转型国家。