长期护理保险制度下定点专护机构运行模式探讨

Discussion on the Operation Mode of Designated Nursing Institutions under the Long-term Care Insurance System

长期护理保险制度是我国老龄化背景下应对家庭照护资源不足、社会保障支持欠缺的重要政策。该制度在我国尚处起步阶段,需要进一步总结试点地市的实践经验。通过对青岛市、潍坊市和聊城市6个定点专护机构16位被访者进行实地访谈,探讨医疗专护制度的运行模式特征。结果表明,定点专护机构以基层单位为主;除青岛市外,试点地市的目标人口仅覆盖职工医疗保险,且均存在户籍限制;服务项目排除生活护理,抑制了照护服务需求;生活护理管理模式影响专护服务质量;结算标准比例与不断变动的医疗服务价格不吻合。探讨生活护理员的管理模式、筹资机制的顶层设计以及政府多部门协同是解决上述问题,确保长期护理保险制度可持续运行的根本点。

Long- term care insurance system is an important policy to deal with the shortage of family care resources and the lack of social security support under the background of aging in China. The system is still in the initial stage in China, need to further sum up the practical experience. The study of interview by 16 respondents in the 6 tutions from Qingdao designated pilot cities of nursing insti- , Weifang and Liaocheng, to explore the characteristics of nursing medical system operation mode. In addition to only the medical insurance, which are Qingdao city , the target population of pilot cities covers the household registration restrictions;Exclusion of life care servicescurb the demand for care services;Life care services ; The proportion of settlement standards care management model affect the quality of does not match the changing prices of medical services. To explore the management mode of life nursing staff,the top design of financing mechanism and the multisectoral coordination of government are the fundamental points to solve above problems and ensure the sustainable operation of longterm care insurance system.