长期照护保险制度的脆弱性分析——日本的启示与我国的反思

Vulnerability Analysis of Long-term Care Insurance System——The Enlightenment of Japan and Reflections on China

实施长期照护保险制度是许多国家应对老龄化的一种政策选择。但长期照护保险并不是万能的,它有天然的脆弱性。本文从资金的可持续性、管理、服务、评价科学性方面考察了日本长期照护保险在发展中存在的问题,并从保险制度结构、服务内容、三险关系、管理运行角度分析我国在长期照护保险制度试点过程中出现的问题,明确指出我国长期照护保险的脆弱性及所面临的风险。根据长期照护保险的制度特点,提出对策建议:在制度结构上保证统一性和差异化并存,中央和地方权责对等、界限分明;在服务层面要标准化和多元化并存,注重预防体系的构建,发展和扶持相关产业,细化照护机构功能性分类和层次性分级,制定科学的服务标准;界定医养结合相关概念,促进医养结合发展。

Implementing a long-term care insurance system is a policy choice for many countries to address ageing.But long-term care insurance is not a panacea.it has natural vulnerability.This article summarizes the issue of long-term care insurance in Japan from the aspects of funding sustainability,management,service,and scientificevaluation.Furthermore,itanalyzes the problems in the structure of insurance system,the content of service,the relation of three typesof insurance and the management in the pilot of long-term care insurance system in China.It points out the vulnerability and risks of the operation of long-term care insurance in China.According to the characteristics of long-term care insurance system,itputsforward countermeasures and suggestions:ensure coexistence of unity and difference,equality of rights and responsibilities with clear boundaries in institutional structure;pay attention to the construction of prevention system,develop and support related industries at the service level;refine the functional classification and hierarchical classification of care institutions,and make scientific service standards;define the conceptand promote the development of integration of medical services and elderly.