长期护理保险筹资机制的省级层面实证分析

Empirical Analysis on Financing Mechanism of Long-term Care Insurance at the Provincial Level

山东省在全省范围内开展长期护理保险试点,各地市均建立了各具特色的长期护理保险筹资机制。参保对象以城镇职工为主,部分地市扩大至城乡居民;筹资来源以医疗保险统筹基金为主,还包括基金、个人账户基金、财政资金及福彩公益金等;各地市筹资水平各异,年人均筹资额在75~115元;筹资方式各具特色,制度外补贴资金主要方式是总额补贴和按人头补贴,制度内筹集资金方式主要是定额筹集、定比筹集及混合筹集。分析发现,山东省长期护理保险的筹资水平低于当地经济发展水平、待遇支付能力较弱、基金的可持续性不足,以及城乡之间存在不公平性等问题。因此,应尽快优化长期护理保险的筹资机制,加强制度的省级层面设计,建立独立筹资机制及动态筹资机制,推进城乡居民长期护理保险的筹资公平性。

Shandong Province has carried out long-term care insurance pilot projects across the province,and each cities have established its own distinctive long-term care insurance financing mechanisms.The insured objects are mainly urban workers,and some cities have expanded to urban and rural residents;The sources of financing are mainly the Medical Insurance Co-ordination Fund,including funds,individual account funds,financial funds and lottery public welfare fund,etc;the level of financing varies from prefecture to city,with an annual per capita fund of 75~115 yuan.Fund-raising methods have their own characteristics,the main ways of out-of-system subsidy funds are total subsidy and per-person subsidy,and the main ways of fund-raising in the system are fixed fund-raising,fixed ratio fund-raising and mixed fund-raising.It is found that the financing level of long-term care insurance in Shandong Province is lower than the local economic development level,the ability to treatment payment is weak,the sustainability of the fund is insufficient,and there are some problems such as unfairness between urban and rural areas.Therefore,we should optimize the financing mechanism of long-term care insurance as soon as possible,strengthen the design of the system at the provincial level,establish independent financing mechanism and dynamic financing mechanism,and promote the financing equity of long-term care insurance for urban and rural residents.