长期护理保险财务可持续性——基于微观仿真方法和保险报销数据的评估研究

Financial Sustainability of the Long-term Care Insurance——Based on Microsimulation and Claims Data

财务可持续性是长期护理保险(长护险)健康发展的必要条件。现有评估研究多以社会调查数据为基础,对长护险实际运行数据的利用不足。除了数据可得性外,分析技术的瓶颈也是问题之一。本研究旨在构建一套基于微观仿真方法和报销数据的长护险财务可持续性评估模型(LTCI-MC);进一步,以江西省上饶市长护险为例,检验模型有效性,评估2020~2040年长护险财务可持续性。结果表明:上饶市长护险财务的微观仿真结果和实际数据间无显著差异,LTCI-MC预测效果理想。同时,在筹资和待遇水平保持不变或同步变化时,上饶市长护险将保持较高的结余率,财务赤字风险低;当筹资和待遇水平不同步变化时,两者的年均增长率需要满足研究推导的收支平衡约束条件才能避免财务赤字。LTCI-MC具有较高的可行性和有效性,适用于其他长护险试点的财务可持续性评估,有利于为我国在十四五期间择优推广试点经验提供实证支持。

The financial sustainability is the prerequisite for the healthy development of long-term care insurance(LTCI).The majority of existing studies use social survey data,instead of claims data.In addition to data availability,analytical technique is also a major factor.This study aimed to propose an evaluation model for LTCI financial sustainability based on microsimulation and claims data(LTCI-MC).It examined the model effectiveness using Shangrao city,Jiangxi Province as an example;and evaluated the financial sustainability of LTCI during 2020 and 2040 for this city.The results show that there is no significant difference between the model results and the actual financial data,indicating satisfying effectiveness of LTCI-MC.From 2020 to 2040,if the level of financing and benefits remains unchanged or change simultaneously,the Shangrao LTCI will maintain a relatively high balance rate,and the risk of financial deficit is quite low.If the two parameters do not change simultaneously,their annual average rates of increase need to meet the derived constraints to avoid financial deficit.Due to its high applicability and effectiveness,the LTCI-MC is also applicable to other LTCI programs,which may facilitate the selection and promotion of sustainable pilot programs during the 14 th Five-Year period.