我国长期护理保险制度建设的必要性及试点实践与思考

随着人口老龄化及失能老年群体规模扩大,家庭照护功能弱化,护理费用高,我国急需建设长期护理保险制度。文章通过对青岛、南通试点城市分析发现,目前我国长期护理保险制度建设处于探索阶段,存在法律缺失、筹资渠道较窄、受益比例底、专业服务人员少等问题,需借鉴他国长期护理保险制度建设成熟经验,为我国长期护理保险制度建设提供可靠建议。     

国外长期护理保险制度对我国的启示

我国老年人口不断增加,已经成为全球老年人口最多的国家,但是相应的我国老年人护理方面发展缓慢,形势不容乐观。由于人口基数大,城乡资源分布不均,东西部资源分布不均等原因,导致我国老年人护理面临重重问题。因此,建立健全老年人护理制度迫在眉睫。而我国已经开始尝试建立健全长期护理保险制度,虽然取得了一定的成果,但面临的问题也尤为突出。本文综述了我国试点城市现状以及国外长期护理保险制度带来的启示,以期为我国建立完善的长期护理保险制度提供参考。     

中国长期护理保险:制度实践、经验启示与发展走向——基于青岛和南通模式的比较分析

长期护理保险制度作为应对日益增长的老年长期护理需求的制度支撑,将是我国"十三五"时期社会保障体系建设的重点内容。文章围绕青岛、南通两市长期护理保险制度地方实践的现实背景、模式特征、制度设计进行比较分析。在总结经验启示的基础上,结合发达国家经验提出相应的对策建议,以期为我国长期护理保险制度的顶层设计提供有益的借鉴。     

建立老年护理保险制度初探

人口老龄化使越来越多的老年人需要接受长期的护理服务,而传统家庭护理功能正逐渐削弱,老年人护理费用给家庭造成沉重负担,迫切需要建立老年护理保险制度。本文通过借鉴国外老年护理保险制度实施的经验,提出建立适合我国国情的老年护理保险制度的政策建议。     

韩国老年长期护理政策新动向

面临人口老龄化等一系列问题的影响,韩国老年护理政策出现新的动向,将于2008年实施长期护理保险制度。根据韩国长期护理保险的模式,通过分析,发现该制度存在着覆盖面、服务及费用、筹资及归属层次、护理管理体制等既有理念上的又有制度设计上的一些问题。这些对中国应对人口老龄化下的老年生活服务问题具有借鉴价值。     

不同模式长期护理保险制度比较分析

采取比较研究的方法,选取长期护理保险制度较为完善的美国和日本,对两国长期护理保险制度建立的背景和中国的国情进行了深入的比较分析,同时对两国的长期护理保险制度进行了深入的对比分析。在此基础上,提出了在中国建立长期护理保险制度的政策建议。     

四川老年人对建立长期护理保险制度态度及原因调查

目的了解四川地区老年人对建立长期护理保险制度的态度及原因,为该制度的建立与实施提供参考依据。方法于2016年6月—2017年7月利用便利抽样法在四川省南充、达州、遂宁、广元、广安、德阳、绵阳7个市抽取符合条件的老年人进行问卷调查。结果在被调查的1 187名老年人中,对建立长期护理保险制度持"有必要"和"无必要"态度者分别为559人(47.1%)和628人(52.9%)。老年人对建立长期护理保险制度持有必要态度的原因主要为减轻家庭负担[36.2%(106/293)]和保障老年生活[32.4%(95/293)],老年人对建立长期护理保险制度持无必要态度的原因主要为自己生活能够自理且有家人提供照料[35.6%(131/368)]、对长期护理保险制度不够了解[33.4%(123/368)]和经济困难无力支付保费[22.6%(83/368)]。结论四川地区近半数老年人支持建立长期护理保险制度,本地区建立与实施长期护理保险制度应提倡居家照护和保费在民众可承担范围,并注重该制度的宣传工作。     

青岛市长期医疗护理保险：制度效能、实施困境与政策优化

目的:分析青岛市长期医疗护理保险制度的实践现状,为我国长期医疗护理制度提供参考。方法:采用案例分析法对青岛市的长期医疗护理保险制度进行个案剖析,同时将青岛实践与部分发达国家经验进行对比分析。结果:青岛市首创性地实施了长期医疗护理保险制度,在制度效能与实施困境方面为我国养老风险的制度性化解提供了参考路径。结论:针对该制度的实施困境,应当从法制建设、筹资结构、储备社工资源、政策公平性等角度优化长期医疗护理保险制度。     

美日德韩四国长期护理保险制度对我国的启示

运用文献研究法、对比分析法、归纳总结法等方法分析与研究我国长期护理服务需求现状和问题、我国试点城市长期护理保险制度供给与实施现状以及美日德韩等国长期护理保险制度经验,认为我国长期护理保险制度存在着制度设计公平性不足、过度依赖医保基金、年龄限制不符合权利义务对等原则、精神慰藉服务尚未被纳入服务项目、服务提供机构与专业人才短缺以及缺乏法律支持等问题,并提出逐步扩大制度覆盖范围,实现城乡统一;坚持社会化筹资模式,实行多层次的筹资比例;重视评估标准的制定,坚持权利义务对等原则;坚持老年人利益最大化,逐步扩大服务项目;鼓励社会力量全面参与,培养专业人才;建立长期护理保险法,强化政府责任等建议。     

美国长期护理保险制度的经验及借鉴

美国是实施长期护理保险最早的国家,其经验对我国建立长期护理保险制度具有一定借鉴意义。本文在简要介绍美国长期护理保险制度产生背景的基础上,重点阐释了美国长期护理保险制度的主要框架,分别从公共保障计划和商业保险两个方面进行详细介绍。美国长期护理保险制度的多层次性、照护资源体系的完善性及给付方式的灵活性为我国建立长期护理保险制度提供了经验借鉴。在此基础上,本文在构建多层次长期护理保险体系、优化护理服务资源、提高市场化运作水平等方面提出建议。     

医疗和养老保险与高龄失能老人长期照料支出——基于CLHLS数据的实证分析

我国尚未建立全国性的长期护理保险制度,老年人的长期照料费用主要由家庭承担,老年人拥有的医疗和养老保障是否影响其长期照料服务利用尚不清楚。利用2011年中国老年健康长寿调查(CLHLS)数据,构建两部模型,分析医疗与养老保险对我国城乡高龄失能老人长期照料支出的影响。研究结果表明,我国城镇高龄老人的长期照料支出显著高于农村高龄老人。公费医疗保险、新农合和养老保险对高龄老人长期照料支出有显著影响,且存在城乡差异。城镇高龄老人享有的医疗和养老保险既影响长期照料支出发生与否,又影响长期照料支出的多寡;农村高龄老人享有的医疗和养老保险仅对其是否发生长期照料支出有影响,对支出数量的影响不显著。建议通过加大医疗和养老保障强度,建立长期护理保险制度,减轻高龄老人家庭长期照料经济负担。     

Long-term care insurance demand limited by beliefs about needs, concerns about insurers, and care available from family

In spite of the high costs and major financial risks involved in long-term care, the majority of older Americans do not own long-term care insurance. We conducted a survey designed to learn more about the role of the following four broad factors in affecting the demand for long-term care insurance: preferences and beliefs, such as notions about the likelihood that one will become disabled; substitutes for insurance, such as savings that could be spent on long-term care; substitutes for formal care, such as care provided by family members; and features of the private market, such as concerns about the high costs of coverage. We found evidence that each of these factors was important in explaining low demand for long-term care insurance. For example, people who believed they might need long-term care were more likely to purchase long-term care coverage. People who had alternative ways to pay for care, such as through savings, or those who could use unpaid care from family members, were less likely to purchase insurance. Features of the private market, such as people's lack of trust in insurers and the high cost of coverage, made people less likely to buy long-term care insurance. We conclude that policy interventions designed to address only one factor limiting the purchase of long-term care insurance are unlikely to dramatically increase demand for long-term care insurance.     

我国长期照护保险需求影响因素分析——基于江苏省的实证研究

目的:对我国长期照护保险需求的影响因素进行探究,为我国建立完善长期照护保险制度提供参考。方法:以江苏省调研数据为例,采用因子分析、多元回归和Logistic回归等计量方法进行分析。结果:(1)从主观态度角度来看,护理费用、家属支付能力、保险观念、护理需求和慢性病认知均与长期照护保险需求存在正相关关系,并且影响显著;(2)从人口统计学角度来看,文化程度高的居民购买长期照护保险的意愿更高。结论:我国应充分考虑长期照护保险需求的影响因素,提高城乡居民收入,加大宣传力度,鼓励护理机构多层次发展,构建以政府为主导的长期照护服务体系。     

中国长期照护保险制度的地区比较与思考

本文通过对青岛等13个国家级试点城市和北京市海淀区已出台的长期照护保险相关政策进行梳理,总结各地长期照护保险面临的问题与挑战,并提出对长期照护保险制度建设过程中的福利化与市场化、长期照护保险与医疗保险的关系、具体实施方案等问题的初步思考。根据各试点地区和海淀区已出台文件中有关长期照护保险的基本内容,发现它们在保障对象、筹资来源、评定和保障方式、保障金额、保障内容等方面既有共性,也存在差异。本文认为,虽然各试点地区的长期照护保险制度已初步建立,但在监督管理、护理服务提供等方面的具体实施方案还有待论证;此外,各地还需要不断扩大长期照护保险的受益范围,做好长期照护保险与养老保险、医疗保险的协调与衔接,合理配置医疗、养老和照护资源。     

美德日韩4国长期护理保险制度对我国的启示

目前我国尚未建立具体的长期护理保险制度,理论研究取得一定成果,实践上仍处在试点阶段。运用文献研究法,对比分析对法美国、德国、日本、韩国4国长期护理保险制度的建立背景、模式特点与运营机制、资金筹集方式给付方式和服务提供内容展开论述,基于国外的先行经验结合我国社会经济现状提出:实行多渠道的筹资扩大覆盖范围,设立全国统一的长期护理保险需求分级和等级评估标准,鼓励发展商业长期护理保险、补充完善长期护理保险体系等建议,以期为我国建立长期护理保险制度提供参考。     

The determinants of long-term care utilization and equity of access to care among older adults in Dong-Ku of Incheon Metropolitan city, South Korea

Under the current health care system, around three percent of the elderly remain uninsured. Based on the 2003 Dong-Ku Health Status Survey and the Aday and Andersen Access Framework, the present study examined the social and behavioral determinants of long-term care utilization and the extent to which equity in the use of long-term care services for the elderly has been achieved. The results indicate that universal health insurance system has not yielded a fully equitable distribution of services. Type of coverage and resource availability do not remain predictors of long-term care utilization. The data suggest that a universal health insurance system exists in South Korea with significant access problems for the population without insurance. Access differences also arise from obstacles in expanding the scope and level of plan benefits due to financial disparity among insurers. Health policy reforms must continue to concentrate on extending insurance coverage to the uninsured and establishing long-term insurance system for the elderly.     

荆门市长期护理保险制度构建及试点运行状况分析

目的：分析湖北省荆门市长期护理保险（以下简称长护险）试点制度构建及近年运行状况,以期为长护险制度优化提供建议。方法：使用回顾性研究,基于荆门市长护险基本运行情况的半结构式访谈和2017年7月-2019年6月8 712名长护险受益人赔付数据,整理政策内容和运行状况,运用描述性统计方法进行分析。结果：荆门市长护险采用制度全民覆盖,等级评定重度失能（<40分）为准入标准,差异化待遇支付和以全日居家护理为主的照护模式;受益人群中,73.2%选择全日居家护理服务,17.0%选择非全日居家护理服务,2017年7月-2019年5月人均护理费用支出为13 756.0元,其中人均保险统筹支出为11 086.0元（80.6%）,人均自付费用为2670.0元（19.4%）。结论：荆门市长护险试点工作运行平稳,建议该试点在细化资金筹集标准,建立多样化服务给付体系和分级护理体系规范化等方面持续探索,以实现长护险制度的可持续发展。     

德国长期照护保险制度:缘起、规划、成效与反思

在人口老龄化加剧、长期照护需求增加、原有社会保障制度存在缺陷的背景下,德国在原有健康保险制度的基础上,于1994年推出了具有全民性与强制性、公私混合给付的长期照护保险运行模式。对长期照护保险关系、申请资格、给付条件、筹资机制等进行了详细规定。经过多年的运行和完善,长期照护保险在社会保险中的份额和贡献逐渐提升、投保人与受益群体不断扩大。但另一方面,在服务质量、申请条件和内容、筹资机制等方面仍面临许多争议。德国在完善社会保障体系、重视长期照护质量、完善筹资机制等方面积累的经验可以为我国长期照护保险制度的发展提供有益借鉴。     

Impact of long-term care insurance on institutional dementia care in Japan

Japan started long-term care insurance for nursing and home help services in April 2000 to cope with growing medical expenditures for the population aged over 65. To study the impact of the new insurance on utilization of dementia care, we compared demographic and clinical characteristics including diagnosis, degree of disability and behavioral disturbance before and after the launch among people with dementia covered by either long-term care or medical insurance. The subjects of the study were randomly selected patients/residents of specialized dementia care units in both psychiatric hospitals and geriatric care facilities before (1145 patients/residents in early 2000) and after (262 for medical insurance and 205 for long-term care insurance in 2001) the new system was launched. Although patients/residents in 2000 and 2001 were similar as a whole, the 2001 sample showed differences between patients in each of the types of insurance systems. Logistic regression analysis revealed that patients/residents covered by long-term care insurance were significantly more likely to be females and require higher levels of care. Patients covered by long-term care insurance were significantly less likely to be transferred from a psychiatric department nor did they display behavioral disturbance or an inability to put out or deal with fire. These results suggest that health care facilities have shifted to the new insurance system for patients requiring higher levels of care but without behavioral disturbances as it was intended. On the other hand, there were policy concerns of that demented persons with moderate activities of daily living impairments and behavioral disturbances would be at risk being excluded from the long-term care scheme.