透视长期护理保险经办:试点比较与政策优化

Penetrating Transaction Management of Long-Term Care Insurance:Pilot Comparison and Policy Optimization

长期护理保险经办管理贯穿长期护理保险制度落实的全过程,关系到长期护理保险的经办责任主体、资金筹集、失能等级评定、定点护理服务机构、待遇给付和费用结算等方面的具体经办业务,是长期护理保险制度平稳高效运行的强有力保障。本文对中国五个试点地区(选取青岛、上海、长春、南通、广州五个城市)的长期护理保险经办管理实践进行详尽深入的对比分析,并总结出中国长期护理保险制度两类典型的经办管理模式:社会统筹经办模式与多元协作经办模式。在深入分析中国长期护理保险经办管理目前存在主要问题的基础上,提出中国长期护理保险经办管理进一步发展完善的若干建议,以期促进长期护理保险经办管理水平的提升及其由点到面进程的加速发展。

The acceleration of population aging puts forward higher requirements for the overall development of long-term care insurance.The transaction management of long-term care insurance runs through the whole implementation process of the long-term care system,and is related to the specific experience of long-term care insurance fund raising,disability level assessment of insured persons,audit management of designated service agencies,benefit payment,and expense settlement.It is a strong guarantee for the smooth and efficient operation of the long-term care insurance system.On this basis,this paper combs and summarizes the existing relevant literature and policy documents,and takes the lead in building a comparative framework for the pilot program of long-term care insurance in China based on Matland's ambiguity-conflict policy implementation model.Moreover,it uses this framework as a concrete basis for qualitative classification of China's long-term care insurance,thus underpinning the analysis and optimization of China's long-term care insurance policy.This paper comparatively analyzes the management practices of long-term care insurance in five typical pilot cities in China,involving the main body of responsibility for long-term care insurance,fund raising,disability rating,treatment payment process,designated service agencies and fee settlement agencies.It aims to sum up two typical modes of long-term nursing insurance management in China:social pooling mode and multiple cooperation mode.On the basis of multi-dimensional comparison of the pilot practice,this paper discusses the main problems in the process of transaction management in depth,including the strong subordination of the long-term care insurance transaction management,the imperfect access and exit mechanism of the relevant subjects in the transaction management,the lack of a unified and efficient long-term care insurance treatment handling procedure,the diversity of long-term care insurance settlement standards leading to the need to improve the efficiency of fund utilization,and the limited effectiveness of commercial insurance institutions in long-term care transaction management.Finally,suggestions for the further development and improvement of China's long-term care insurance transaction management are put forward from the following four aspects:building a'six in one'long-term care insurance handling system,strengthening the quality management and risk management of long-term care insurance transaction management,establishing a unified and efficient long-term care insurance payment handling procedures,and building a multi-level long-term care insurance transaction management system under the leadership of the government.As a result,it is expected to promote the improvement of the management level of long-term care insurance and establish a sound long-term care insurance transaction management system.The contributions of this paper are as follows.It returns the pilot program of long-term care insurance from mechanism innovation to the policy implementation attribute.Based on Matland's ambiguity-conflict policy implementation model and China's characteristic governance situation,it proposes a comparative framework for the pilot program of long-term care insurance in China.This paper provides systematic recommendations on optimizing China's long-term care insurance pilot policies and accelerating the full implementation of long-term care insurance.