我国长期护理保险试点地区筹资机制比较研究

Comparative research of the financing scheme for long-term care insurance in pilot areas in China

目的梳理我国15个长期护理保险(以下简称“长护险”)试点地区的筹资制度。方法收集我国15个试点地区的政策,并进行了关键知情人访谈对所收集信息进行验证。结果15个试点地区中,长护险的参保人分为两类,8地从城镇职工基本医疗保险/职工基本医疗保险/职工社会医疗保险(以下简称“职保”)起步,其余7地的长护险参保人则包括职保参保人和城镇居民基本医疗保险/城乡居民基本医疗保险/居民社会医疗保险参保人。筹资渠道主要为医疗保险(以下简称“医保”)划转和政府补贴,筹资标准采用定比或定额的方式确定,采用定额法的地区,人均筹资额30~180元/年不等。受益对象采取Barthel量表或定制量表进行评估。长护险基金独立于医保,设立财政专户。结论我国15个试点地区初步形成了“医保划转为主、财政划拨为辅、个人和社会参与”的长护险独立筹资机制。但在筹资标准的测算方法、受益对象的评定标准和年龄限制、筹资的可持续性上还存在一定的完善空间。

Objective To summarize financing schemes in 15 long-term care insurance(LTCI) pilot areas in China.Methods Implementation policies of LTCI in the 15 pilot areas in China were collected and analyzed,and in-depth interviews were conducted to verify information collected from these policies.Results Among 15 pilot areas,some LTCI (8 areas) covered the insured population of basic medical insurance system for urban employees(BMIUE),others(7 areas) covered the insured population of both BMIUE and basic medical insurance system for urban residents(BMIUR).Financing channels included the payment from BMIUE,BMIUR and government subsidy.The fund-raising standard was determined by fixed ratio or fixed amount.In areas where the fixed amount policy was adopted,the per capita fund- raising amount ranged from 30 yuan to 180 yuan per year.Barthel Index and other specific customized scales were used to assess the applicants to determine the beneficiary.Independent fiscal accounts were set to manage LTCI funds,which were only used to pay for long-term care.Conclusion In 15 pilot areas in China,an independent fund-raising mechanism for long-term care insurance has been formed,where the main funding resources come from the medical insurance fund,are supplemented with the fiscal fund,and involve the social and individual funds.However,there is still room for improvement in the measurement methods of fund-raising standards,the evaluation criteria and age limits of beneficiaries,and the sustainability of LTCI financing.