农村医养结合养老服务的“供需错配”及政策可及性问题

为提升农村养老服务质量和水平，对医养结合概念和政府有关部门陆续出台的系列支持医养结合发展政策进行分析，论证医养结合供需非均衡性发生的逻辑及影响，研究完善新型健康养老服务模式的新路径。研究认为，在政策演进和落地过程中，农村医养结合出现了“供需错配”问题，体现为医养结合政策制度与现实需求、医养结合养老供给主体与实施细则、地方政府行为与居民需求间的差距问题，农村医养结合呈现多元供给多元失灵的非均衡性悖论；通过多元供给模式对“供需错配”矛盾进行调处，搭建农村医养结合的“均衡性治理”体系，利用元治理理论加强政府的制度设计和政策执行，利用内部的制度化均衡逐步转变农村养老观念，有助于医养结合养老模式的可及性和可持续性发展。

"Mismatch of supply and demand" and policy accessibility of the rural old age care through combination of medical treatment and endowment

In order to improve the quality and level of old age care service in the rural areas, this paper analyzes the concept of combining medical treatment and endowment as well as the series of policies supporting the development of the combination of medical treatment and endowment issued successively by relevant authorities, demonstrates the logic and influence of the imbalance between supply and demand in the combination of medical treatment and endowment, and studies the new path to improve the new type of old age healthcare service model. The research shows that in the process of policy evolution and implementation, a mismatch between supply and demand developed in the combination of medical treatment and endowment in rural areas. It is mainly reflected by the lagging gap between the policy system and actual demand of the combination of medical treatment and endowment, the main body of the supply for old age care and specific implementation rules, local government behaviors and residents’ needs, exhibiting a paradox of imbalance with multiple supply subjects and failures. The paper proposes to mediate the mismatch between supply and demand through multi supply mode, build a "balanced governance" system for the combination of medical treatment and endowment in rural areas, use the meta governance theory to strengthen the government’s institutional design and policy implementation, and gradually transform the concept of old age care in rural areas through internal institutionalization balance, which is conducive to the accessibility and sustainable development of the old age care mode of combining medical treatment and endowment in rural areas.