长期护理保险待遇的混合给付模式何以实现?——基于广州市的实证研究

Long-term Care Provided as Benefits in Kind and in Cash in China:A Case Study of Guangzhou

在我国长护险推行的试点阶段,虽然部分试点开始了混合给付模式的本土化探索,但是单一的服务给付模式依然是不少城市的现行选择,这与国际主流的混合给付模式并不相符。对此,本文以广州市为研究案例,探讨我国长护险待遇的混合给付模式是如何实现的。研究表明,从单一的服务给付到灵活的混合给付,长护险待遇给付模式的转变是地方政府在试点模式下的探索。在路径依赖机制的影响下,“医保逻辑”和生产主义逻辑分别塑造了地方政府对服务给付和现金给付的偏好,广州市引入“替代型现金给付”的灵活混合给付模式,有效地促进了长护险政策目标的实现。广州市的案例表明,我国长护险的混合给付模式是可行且可取的。基于此,应当在国家的法律层面上把长护险设立为独立险种,降低长护险对医保的依附程度,构建起长护险的混合给付模式,并完善相关配套体系。

With the proceeding long-term care insurance pilot programme in China,there has not been consensus on the most appropriate method for providing the benefits,given the diversified benefit-paying methods opted in the pilot cities.It differs from the most popular choice for long-term care worldwide which allows the public to access both cash benefits and benefits-in-kind.Taking Guangzhou as the case study,this paper investigates how long-term care is provided in China.It reveals that it is the practical exploration of the local government to transform the single benefit-in-kind method to the mix of providing care as the benefit-in-kind and cash benefit under the long-term care insurance policy experimentation.Path dependence is explanatory of the impact of public healthcare insurances and productivist ideology on benefit-paying methods at the local level.The Guangzhou case affirms the necessity and feasibility of providing long-term care as benefits in kind and in cash in the Chinese context.Therefore,long-term care insurance should be established as a new national insurance with declined dependence on public health care insurances.Long-term care should be provided as both benefit-in-kind and cash benefits along with optimising related policies to support long-term care insurance development.