我国长期护理保险典型发展模式研究

随着我国人口老龄化速度不断加快,老年护理的需求越来越大,我国自2016年开始长期护理保险的试点工作。通过对长期护理保险各试点地区的发展模式进行研究,认为目前我国长期护理保险主要有3种发展模式:政府管理、民营机构参与经办模式,政府主导的社会保障模式,商业保险模式。本文选取了3种模式的代表性地区青岛市、上海市和北京市海淀区进行比较研究,并结合国外长期护理保险的发展经验,旨在探索出适合我国长期护理保险发展的模式。     

倡导健康管理理念,建立长期护理保险

文章对在我国建立长期护理保险的必要性和紧迫性进行了分析，并结合我国医疗保险发展的现状，提出建立长期护理保险应明确和解决的问题。     

多层次长期护理保险体系构建的思考和建议

以长期护理保险的发展现状为出发点,分析长期护理社会和商业保险的实践经验及挑战,提出通过建立健全相关政策法规,加大财税支持、完善统一评估体系、建立长期护理数据共享平台、提高公众的护理风险防范意识、加强长期护理人才队伍建设等途径,构建符合我国以长期护理社会保险为主、商业保险为辅的多层次长期护理保险体系,以满足老年人多元化长...     

长期护理保险的有关问题概述

在我国老龄化进程加快,养老问题日益严峻的背景下,如何选择适合中国老年人的养老模式和长期护理保险,目前尚待研究.通过回顾国内、外关于长期护理保险制度及内容的相关文献,对长期护理保险的相关概念、研究背景、发展进程、实施措施等方面进行梳理及总结,以期为我国养老模式的选择及政策的制定提供参考.     

构建长期护理保险缓解人口老龄化压力

长期护理是指那些为慢性生理疾病、失能和感知紊乱（老年痴呆症）的人提供长期和广泛的康复和支持性服务。长期护理保险是对被保障人住进护理中心等护理机构而发生的费用的津贴型保险。它在20世纪70年代首先在美国出现，随后迅速在德、法、英等国相继出现。目前全世界有越来越多的保险公司开始办理长期护理保险，在德国和日本甚至已将其纳入政府强制性保险。长期护理保险既为个人提供了年老时的保障，     

老龄化背景下我国长期护理保险发展模式及优化路径研究

基于委托-代理理论对我国长期护理保险发展的现有模式、存在问题进行分析后发现,我国存在筹资模式和待遇给付困难、护理资源供需不平衡、现有长期护理保险产品形式内容单一等问题。结合国外长期护理保险发展模式的实践经验,提出我国应逐步建立起多元化的长期护理保险筹资模式和给付形式、建立多元支付激励机制和科学的护理评估标准、加强相关法律法规体系建设,设立有效的政府干预机制等建议,为我国长期护理保险实现可持续发展提供参考。     

卢森堡长期护理保险制度的发展与启示

卢森堡是较早发展长期护理保险的国家,历经两次改革,在资金筹集机制、保障群体范围、职能机构设立、护理需求评估以及待遇给付形式等方面,改革成效显著。对此,中国可尝试借鉴卢森堡的经验,从扩大保障对象、建立储备金制度、完善监督管理职能、优化评估服务、完善服务内容等方面,进一步健全长期护理保险制度。     

我国老年长期护理需求测算及保障模式选择

随着我国老龄化形势的加剧,老年长期护理需求呈现加速增长趋势,而传统以家庭为单位的免费护理供给渐见困乏,亟需国家调配资源,建立永续经营的长期护理融资体制,以减轻护理需求者及其家庭的经济负担。从宏观角度分析了我国老年长期护理服务的需求趋势,并根据我国老年人口特征及参照美国、德国、日本的护理服务使用标准,测算出未来我国老年长期护理需求数量、总费用开支等指标,并提出我国发展长期护理保险的战略规划。     

北京市社区居民长期护理保险购买和参与意愿及其影响因素研究

目的：分析北京市社区居民对长期护理保险及其护理服务提供的意愿,探讨北京市社区居民对长期护理保险购买/参与意愿的影响因素及其制度设计、服务提供模式、保险给付方式等的选择,为促进北京市长期护理保险制度的建设提供建议。方法：采用分层多阶段的抽样方法,从北京市16个区抽取10个社区卫生服务中心,自行设计调查问卷,以406名社区居民作为研究对象开展问卷调查,单因素分析采用χ²检验,多因素分析采用多元Logistic回归开展统计学分析。结果：31.8%的社区居民愿意购买/参与长期护理保险,41.1%的被访者保持中立态度,27.1%的被访者表示不愿意购买/参与长期护理保险。分析发现,年龄、职业、婚姻状况、失能人员数量、长期护理保险了解程度对居民购买/参与长期护理保险的意愿影响,且影响具有统计学意义。结论：北京市社区居民对长期护理保险了解程度不高,且多数居民购买/参与长期护理保险的意愿不明确,还处于中立态度,在长期护理服务模式上多数居民倾向于居家护理和社区居家护理,北京市建立长期护理保险制度应加大政策宣传、实现覆盖范围的普及性、服务提供的多样性。     

日本的长期护理保险

从１９９９年４月开始,日本实施长期护理保险。长期护理保险的对象主要是生活不能自理的卧床老年人。这一保险的实施旨在缓解人口迅速老龄化对医疗保健机构和医疗保险的压力,缓解由家庭护理卧床病人沉重的精神和经济负担。本文就长期护理保险的发起和具体操作做一简单介绍。     

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.     

Explaining lapse in long-term care insurance markets

Expansion of private long-term care insurance (LTCI) is often posited as a potential mechanism to finance long-term care (LTC) for a growing elderly population in the US. One largely ignored issue is lapse or cancellation of policies. Individuals who let a LTCI policy lapse face resumed risk of LTC expenditures while suffering the financial loss of premiums paid. The motivation for lapse has been poorly understood, though some have hypothesized that improvements in health risk may be responsible. We use 1996-2006 Health and Retirement Study data from 3974 respondents who report having private LTCI to estimate baseline and dynamic predictors of lapse and test for ex post adverse selection. Individuals who lapse are generally poorer, less educated, less healthy, and more likely to be racial and ethnic minorities than those who retain their policies. Changes in health status play a relatively small role in lapse, and we find little evidence for adverse selection associated with lapse. We conclude that lapse of LTCI is more an issue of finances and alternatives than a reassessment of health risk. Because lapse rates are highest among the least healthy individuals, lapse should be considered explicitly in efforts to expand the LTCI market.     

Family spillovers and long-term care insurance

We examine how long-term care insurance (LTCI) affects informal care use and expectations among the insured individuals and co-residence and labor market outcomes of their adult children. We address the endogeneity of LTCI coverage by instrumenting for LTCI with changes in state tax treatment of LTCI insurance policies. We do not find evidence of reductions in informal care use over a horizon of approximately eight years. However, we find that LTCI coverage reduces parents’ perceptions of the willingness of their children to care for them in the future and that the behavior of adult children changes, with LTCI resulting in lower likelihoods of adult children co-residing and stronger labor market attachment. These findings provide empirical support for the presence of spillovers of LTCI on the economic behaviors of family members.     

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。     

Public health nurses' activities after the initiation of long-term care insurance (Part 1). Focus on operations for long-term care insurance

OBJECTIVE: We conducted a nationwide questionnaire survey to elucidate the present status of public health nurses (PHNs) after initiation of the Long-Term Care Insurance (LTCI) system, in order to study the influence of the allocation of PHNs upon the performance of the system. METHODS: In March 2001, a questionnaire was mailed to 1,344 municipalities throughout Japan (all cities and 23 wards in Tokyo; one quarter of towns/villages). RESULTS: Responses to the questionnaire were received from 569 (42.3%). The largest percentage (36.4%) of PHNs was assigned to Elderly Health, 29.8% was assigned to Maternal and Child Health, and 10.2% assigned to the LTCI. Among LTCI operations, follow-up of individuals not certified as requiring care, guidance for the family caregiver, and counseling/grievance procedures were performed with participation of PHNs in more than 80% of municipalities. In urban areas, PHNs participated in training/guidance/advice for care certification investigators/care managers, guidance for service providers, and preparation/coordination for the Certification Committee for Long-Term Care Need in 60-80% municipalities, while those who participated in these activities were only 30-60% in towns/villages. The participation ratios were highest in municipalities where PHNs were allocated to the LTCI department for almost all of the activities except individual counseling. More PHNs from LTCI departments participated in certificating of care need and improving quality of care plans/services than from other departments in offices of municipalities. On the other hand, more PHNs in Welfare or Public Health-Welfare sections than in the LTCI were involved in individual counseling, guidance for both clients and caregivers, or in case management. Training or guidance for service providers was conducted in nearly 50% of municipalities and the performance rates were lower in towns/villages. In open-ended items of the questionnaire, the following problems were mentioned: difficulties in collaboration between sections; large workloads for certification of care need/care management, and difficulties in capturing information about clients. CONCLUSION: The allocation of PHN influences the activities of the LTCI system, especially in relation to quality assurance. Recently, the sections to which PHNs are posted have expanded to include LTCI and Welfare. While improvement in the quality of LTCI services is anticipated, efforts are needed to strengthen collaboration among different departments. In towns/villages, performance rates of activities such as guidance for service providers of LTCI are low, suggesting the support from prefectural health centers in necessary.