美国长期护理保障的筹资危机、应对策略及经验教训

The Funding Crisis of America's Long-term Care Insurance,Its Coping Strategies, and Lessons Learned from It

随着美国"婴儿潮"一代步入老年期,民众的长期护理需求不断增加,美国的长期护理面临筹资危机。Medicaid承担了中低收入阶层长期护理的主要开支,逐渐背离了其作为社会救助机制的兜底角色,财政负担沉重。商业长期护理保险因保费、核保、社会保障挤出效应等因素而难以吸引投保。个人储备则渠道狭窄,准备不足。这些因素促使美国在长期护理保障政策调整、保险产品创新等方面另寻出路。有鉴于此,我国在构建长期护理保障体系时,应在构建缴费型长期护理社会保险的基础上,充分发挥商业保险的补充作用,探索商业保险与社会保险的融合发展,并对奠基于传统文化的家庭护理给予充分的政策支持,充分发挥家庭在长期护理保障体系中的支撑作用。

As baby boomers in the United States age, their demands for long-term care also increase, which triggers a funding crisis of the country＇s long-term care insurance. Medicaid has been misused as a main support for the long-term care of low and middle income citizens, deviating from its role of the last-resort social assistance program. This engenders fiscal burden. Besides, people are reluctant to buy commercial long-term care insurance due to the high premium, the difficulties of underwriting, and the crowding-out effect of Medicaid. Individuals and families lack proper ways to save enough to pay for the long-term care. This urges the US government to find a way out through policy adjustments and insurance product innovations. Therefore, China should, on the one hand, establish a contributory long-term social insurance system, and on the other, encourage commercial long-term insurance to play a complementary role, and integrate the development of the two. Moreover, policy support should be provided to the traditional home care.