作　者：杨晶 阳建
关键词：医养结合；整体性治理；协同式共建
摘　要：

人口快速老龄化对现有养老保障体系提出了严峻考验，面对老年群体医疗与养老的刚性需求，医养结合已成为我国积极应对人口老龄化的必然选择。但是，传统农村养老服务面临着服务品质不甚理想与供给效率低下等挑战，其根源在于要素的碎片化及治理主体间缺乏协调和整合，导致医养服务难以发挥合力。通过立足于中部G 镇医养结合案例，构建基于“技术—主体—制度”的整体性治理分析框架，剖析医养结合从碎片化供给向深度融合转变的历时性特征，进而揭示基层医养深度融合的实现机理，研究发现：技术、主体和制度是基层医养深度融合的关键要素；基层医养深度融合的内在机理和路径在于通过“协同式共建”，以跨部门协作消解多主体利益冲突与促进资源整合，以智慧医养技术驱动多层级联动与流程优化，以明晰权责突破政策执行壁垒与梗阻困境，从而提升医养服务质量。“协同式共建”揭示了社会结构与技术进步间的深刻联系，为基层医养结合的整体治理提供了独特的视角。

 

Collaborative Co-construction: A Holistic Governance Of

In-depth Integrated Medical and Elderly Care at Grassroots Level

A Mechanism-tracing Study of the "Medicare-embedded Elderly Care" in G Town In Central China

Yang Jing，Yang Jian（Hunan University）

Abstract The rapid aging population poses a severe challenge to the existing elderly care security system. Faced with the rigid demand for medicare and elderly care services, the integrated medical and elderly care has become an inevitable choice for China's active response. However, traditional rural elderly care services face challenges such as unsatisfactory service quality and low supply efficiency, with its root causes lying in the resource fragmentation and insufficient coordination among governance entities, which hinder the synergistic effects of healthcare and elderly care services. Based on the case of integrated medical and elderly care in G town in central China, this study analyzes the diachronic transformational characteristics of integrated medical and elderly care from fragmented supply to in-depth integration under a holistic governance analysis framework of "technology-subject-institution", and further reveals its realization mechanism at the grassroots level. The study finds that technology, subject and institution are the key elements enabling deep integration of medical and elderly care at the grassroots level. Moreover, the internal mechanism and path of in- depth integration of medical and elderly care at the grassroots level lie in "collaborative co-construction": resolving interest conflicts among multiple subjects and promoting resource integration through cross-departmental collaboration, driving multi-tiered connectivity and integration, and process optimization with relevant smart technologies, and breaking down policy implementation barriers and bottlenecks with clearly defined rights and responsibilities, thereby improving the quality of medical and elderly care services. In short, "collaborative co-construction" reveals the profound connection between social structure and technological advancement, providing a unique perspective for the holistic governance in integrated medical and elderly care at grassroots level.

Key words  integrated medical and elderly care; holistic governance; collaborative co-construction

 

■作者简介 杨 晶，湖南大学公共管理学院副教授，湖南 长沙410082；阳建，湖南大学公共管理学院博士研究生。

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