美国多支柱长期护理保障体系筹资及待遇保障机制研究

The Financing and Benefit Mechanism of Multi-Pillar Long-Term Care Security System in the United States

目的:为我国长期护理保险制度的建立和发展提供经验借鉴。方法:根据美国联邦卫生部门和地方部门的政策文件,结合学者研究和行业分析成果,追溯美国长期护理保障体系发展历程,梳理筹资来源和待遇保障内容。结果:美国长护制度在保障人群和保障内容上分工明确,引导居家/社区照护逐渐替代机构照护服务,实现控制支出的目的。但也面临筹资压力大、商业保险发展艰难、待遇保障需要平衡机构和非机构护理等问题。结论:建议我国建立多支柱多层次长期护理服务保障体系,明确制度定位和保障内容,充分平衡机构护理和非机构护理发展以提高制度运行效率。

Objective:The paper attempts to provide a experience for the establishment and development of China's long-term care insurance system.Methods:Based on policy documents from the US federal and local health departments,combined with academic research and industry analysis,the paper traced the development process of the long-term care security system in the United States and analyzed the financing sources and benefits covered in the system.Results:In the United States,there was a clear division of labor among the various systems in terms of the people and benefit content.At the same time,in order to control the long-term care expenditure,institutional care services was gradually substituted by HCBS.However,there are also issues such as high funding pressure,difficulties in the development of commercial insurance,and the need to balance institutional and non-institutional care for benefits.Conclusion:It is suggested to establish a multi-pillar and multi-level long-term care service security system in China,clarify the system positioning and benefit content,and balance the provision and usage of institutional nursing services and non-institutional nursing services to improve the efficiency of the system.