日本长期护理保险2005—2017年改革述评与启示

Review and Enlightenment of Japan's Long-term Care Insurance Reform in 2005-2017

日本于2017年6月颁布的长期护理保险法修正案,是该制度自2000年4月实施以来的第5次改革。虽然历次改革的内容不尽相同,但改革的主要动因和措施是相同的。改革的主要动因是为应对人口快速老龄化所带来的护理需求压力和不断攀升的护理支出成本。改革的主要措施一是通过上调被保险人的保险缴费率和个人自付比例来增加保险收入;二是通过增加预防性保健服务、大力发展成本低廉而高效的居家、社区护理服务和限制成本高昂的机构护理服务来控制保险支出。即遵循以收定支、收支均衡原则,实现制度的可持续发展。日本长期护理保险制度历次改革启示我们,我国长期护理保险的制度建设应当建立具有可持续性的筹资机制、严格控制资金给付条件以及构建优质便捷的服务体系。

The amendment of the long-term care insurance law in June 2017 is the fifth revision since its implementation in April 2000. Although the contents of previous reforms are different,the main motivations and measures are the same. The main motivation of all previous reforms was to cope with the pressure of nursing demand caused by the rapid aging population and the rising cost of nursing expenditure. One of the main reform measures is increasing the insurance income by raising contribution rate and individual payment ratio of the insured; the other is controlling the insurance expenditure by increasing preventive health care services,vigorously developing the low cost and high efficiency of in-home and community care services and limiting the high cost institutional care services. That is,we should balance the revenue and expenditure of long-term care insurance,so as to realize the sustainable development of the system. The previous reforms of Japan＇s long-term care insurance system tell us that the construction of long-term care insurance system should establish a sustainable financing mechanism,strictly control the payment of funds and develop high quality and convenient service system.