我国长期护理保险制度发展研究

Research on the Development of China's Long-term Care Insurance System

随着人口老龄化的到来,长期护理服务已经成为应对社会老龄化的重要手段。长期护理服务保险制度作为社会保险体系内容之一,是应对人口老龄化的重要制度体系。我国从2016年开始在15个城市开展长期护理保险制度试点,2020年又新增14个城市,就试点的情况看,存在参保对象不一、基金筹措渠道及义务不一及保险待遇差异较大等问题。德国福利化的制度构造路径和日本社会化的制度构造路径对我国构建长期护理保险制度有一定的借鉴意义,但两国的教训也应当汲取。对于我国而言,长期护理保险制度的功能定位不是转移家庭责任,而是弥补家庭护理能力的缺陷。因此,要构建全国统一性的护理保险制度,参保对象上应不分年龄,面对城乡所有居民。基金筹措上,建立参保人自行缴纳为主、政府承担为辅的机制。保险待遇方面,给付对象应先从重度失能者循环渐进到其他失能者,并完善给付对象认定标准;给付方式应让参保人在实物给付和现金补贴中自由选择,并不断完善社区护理服务为主导的护理体系及家庭成员无薪休假照护制度;给付标准上,现金补贴采取定额支付规则,实物给付按照比例限额支付,但居家护理、缴费年限长可以适当提高支付比例。

With the advent of the aging population,long-term care services have become an important means to deal with the aging society.As one of the contents of the social insurance system,the long-term care service insurance system is an important system to deal with the aging of the population.China started to pilot long-term care insurance systems in 15 cities in 2016,and another 14 cities were added in 2020.In terms of the pilot situation,there are problems such as different insured objects,different fund-raising channels and obligations,and large differences in insurance benefits.The system structure path of German welfare and the system structure path of Japan's socialization have certain reference significance for the construction of long-term care insurance system in China,but the lessons of the two countries should also be learned.For China,the functional positioning of the long-term care insurance system is not to transfer family responsibilities,but to make up for the shortcomings of family care capabilities.Therefore,we need to build a unified nationwide long-term care insurance system,which should cover all residents in both urban and rural areas regardless of age.In terms of fund raising,a mechanism in which the insured person pays mainly by himself and the government undertakes as a supplementary should be established.In terms of insurance benefits,the payment objects should first cycle from severely disabled persons to other disabled persons,and the identification standards for payment objects should be improved.The payment method should allow the insured to choose freely between in-kind payment and cash subsidy,and continuously improve the community nursing service-led long-term care system and the unpaid leave care system for family members.In terms of payment standards,the cash subsidy should adopt a fixed payment rule,and the payment of inkind benefits should be paid according to the proportional limit,and with the extension of home care and payment period,the payment ratio can be appropriately increased.