应对人口老龄化的长期护理保险的理念与路径

Long-term Care Insurance in Response to an Ageing Population:Legislative Philosophy and Expansion Path

长期护理保险是国家为了应对人口老龄化作出的重要制度安排,其以保障老年人的护理需求为宗旨。不同于“失能”这一针对个体权益的单向性概念,护理需求以依赖风险为核心,涵摄了风险的两个面向:护理依赖者与被依赖的家庭成员。长期护理保险旨在预防该风险给护理依赖者及其家庭成员带来的不利后果,其应当作为家庭责任的分担机制而非替代机制。在制度设计上,应以重视与支持家庭为基本理念,充分考虑护理需求在家庭内部获得满足的可能性,为家庭护理提供相应的支持。现阶段,宜将老年人作为制度的主要保障对象,以老年人的护理需求为中心提供保障,明确居家护理优先原则,在减轻个人、家庭护理负担的同时,提升家庭承担护理责任的能力。

Long-term care insurance is an important proactive institutional arrangement by the State in response to population aging,and it is designed to fulfill the lifting demand for elderly care.Unlike the unidi‐rectional concept of disability which points to the rights and interests of individuals,care needs are centered on the risk of dependence,which encompasses both sides of the risk:the dependent elderly and their family members.Long-term care insurance aims at preventing the negative consequences of this risk for persons in need of care services and their family members,but it should be considered as a mechanism for sharing fami‐ly responsibilities rather than as a substitute.The design of the system should be based on emphasizing and supporting the family,giving full consideration to the possibility of care needs being met within the family and providing appropriate support for home care.At the present stage,it is appropriate to make the elderly the main beneficiaries of the system,which is centered around the demand for elderly care.Home care is to be prioritized,enhancing household affordability for home care while reducing the nursing burden for individu‐als and families.