Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Building Long-Term Care Insurance System in China

The objective is to explore the foundation of the elderly long-term care insurance system in China, which is to face the problem resulted from aging of the population. Adopting the contrastive analysis to introduce briefly the long-term care insurance system in German, Japan and America for our learning. Therefore, China＇s long-term care insurance system could not totally indiscriminately imitate the mandatory long-term care insurance system in German and Japan, it also could not copy the business model of nursing insurance system in America. The conclusion is that long-term care insurance system in China should use the experience of developed countries based on the basic national conditions, doing some relative works, such as establishing policies and regulations, strengthening personnel training, and improving the market specification.

Research on the institutional design of the long-term care insurance in Shanghai

Shanghai went into the ranks of the aging society in 1979, as the first area which entered into the aging society in China. Along with the arrival of the ageing, the nursing problems of the old man and disabled elderly become the important factors which affect social development. The establishment of the legal system, System integration to realize resource optimal allocation, Division of multilevel optimization services provide new pattern can make it happen.

Analysis of the necessity of Shanghai＇s long-term care insurance

The aging population of Shanghai is China one of the most serious city, is also one of the cities of the aging problem is prominent. As a result, the city＇s endowment pressure also with aging and aging aggravate gradually increased, especially the old man nursing problems become the main problem in society. Study abroad to establish a long term care insurance comprehensive factors, considering the feasibility of the long-term care insurance in Shanghai, alleviate the pressure of the pension, the construction of a harmonious society.

Performance of Rural Municipalities After the 2015 Reformation of Long-Term Care Insurance in Japan

Worldwide,welfare is trending from a welfare state model to social participation to ensure the sustainability of health care systems.Japan,where the aging rate will reach 40%by 2060,reformed public Long-Term Care Insurance(LTCI)on a large scale in 2015 and started the Comprehensive Service project(CS project),which emphasizes the prevention of long-term care through social participation in the community.Through this project,communities work to develop prevention efforts revolving around the community salon/caféand mutual support,including all daily tasks that previously were the purview of family members.Each municipality has an obligation to promote a CS project through new community development initiatives among community members.The purpose of this study is to investigate the CS projects performed by rural municipalities and to explore the important factors for their success.The authors used a case study methodology and constant comprehensive methodology for analyzing interview data to pull out the elements of successful initiatives.The study shows that the following factors influence success:recognition of demographic risk,recognition of the ineffectiveness of LTCI services,developing a passionate philosophy and strategy as a municipality,developing community members’initiative,and having many assets and full participation in the community.These factors imply that community development is a critical part of any successful CS project.

Research on the development mode of long-term nursing insurance ——taking Qingdao as an example

With the gradual development of society, scientific and technological progress, aging gradually aggravated, has become a hot topic of society. People to old age, self-care ability than in the past, not only suffer from disease, life has become difficult, coupled with the large number of empty nest family, the cost of care is also very high, whether it is to receive home care or professional institutions of care have great difficulties. Therefore, the community should be a large number of people with long-term care needs of the appropriate economic compensation, in this context, long-term care insurance is born. As a leading city in Shandong Province, Qingdao has introduced long-term care insurance and achieved good results. This paper analyzes the practical problems faced by Qingdao, that is, the development background of Qingdao long-term nursing insurance model, obtains the deficiency of Qingdao long-term nursing insurance, and then puts forward the corresponding countermeasures, and then ponders how to choose the long-term nursing insurance model of our country＇s future development.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Long-term care policy simulation of disabled elderly

With the accelerating process of population aging in our country, the physical function of the elderly will decline, the possibility of suffering from acute and chronic diseases will increase, and the occurrence of disability will become more common and normal. The potential demand for elderly care is rapidly increasing. With the growth, the care of the disabled elderly has become increasingly acute. At the same time, due to the intensification of family miniaturization and population migration, the traditional family-based long-term care has been difficult to sustain. How to incorporate long-term care into our social security system as soon as possible has become the focus of the whole society. The thesis through the combination of public policy simulation methods and the research data, the long-term care insurance system implemented at the beginning of 2018 in Shanghai is a policy blueprint. It uses statistical software SPSS, MATLAB, etc. to achieve data collation, analysis and prediction, and at the same time integrates the pilot of the long-term care insurance system. The implementation of policies in cities such as Qingdao and Nantong has been simulated. Finally, on the basis of simulation results, suggestions have been made for the future development of China＇s long-term care insurance system.

广州市长期护理保险试点现状、问题及对策分析

广州市自2017年试点运行长期护理保险以来,在参保人群范畴、筹资与待遇、失能认定与护理服务等级划分、护理服务项目、服务定点机构以及监督管理体系等方面进行了积极探索,取得了长护险制度逐步优化、服务主体产业化、社区居家模式逐步成熟、服务及管理水平提升等成效。广州市长期护理保险目前尚存在人口老龄化趋势与长护险定点机构区域发展失衡、部分定点机构服务监管质量欠佳、服务实践覆盖面有待提升等问题。结合国家保险制度政策及信息化发展,提出了优化提升长护险服务主体空间布局、扩大长护险服务保障项目范围、灵活长护险给付制度、监管制度闭环体系和智慧化运行体系等建议。

基于SFIC模型的养老事业与养老产业协同发展路径研究

养老事业与养老产业同属于养老服务体系的组成部分,充分发挥其作用重在二者协同发展,即二者相互协作实现养老服务的充分供给且达到二者共同发展的双赢效果。通过创新性地将SFIC模型用于养老服务体系发展分析,构建养老事业与养老产业协同发展分析框架,从星光老年之家、公建民营养老机构、政府购买养老服务、长期护理保险制度试点四个案例比较剖析养老事业与养老产业协同的起始条件、助成性领导、制度设计、合作程序,提出改善养老事业与养老产业协同发展的起始条件、发挥助成性领导对养老事业与养老产业协同发展的创造性作用、优化养老事业与养老产业协同发展的制度设计、在养老事业与养老产业协同发展中实现良性合作四个养老事业与养老产业协同发展的路径。

两批试点城市长期护理保险政策比较——基于政策工具-福利要素的二维框架

构建长期护理保险政策工具-福利要素二维分析框架,对两批共28个国家级长期护理保险试点城市的长期护理保险政策文本进行计量分析。研究发现,政策工具维度呈现出使用频次差异大且内部结构不均衡的特点;福利要素维度呈现出要素完整且内部结构较为均衡的特点;各政策工具与福利要素耦合度有待提高;两批试点城市长期护理保险政策差异较小,发展阶段具有相似性。对此,提出合理调整三大类政策工具,优化次级政策工具结构;科学配置政策福利要素,完善要素内容;增强政策工具和福利要素耦合度,整合资源协调发展的优化建议。

长期护理保险制度是否促进了居民幸福感?——基于fsQCA的试点案例分析

完善长期护理保险制度是人口老龄化、健康中国战略和二十大报告背景下增强人民幸福感的重要举措。制度自2016年首次试点以来,各地多样化的制度设计是否以及如何增强了居民的幸福感?哪种制度设计对长护险未来在全国推广开来更具启迪?回答好这些问题对于寻找长期护理最优解与更大范围内的政策调整有着非常重要的意义。文章运用模糊集定性比较分析方法(fsQCA)揭示了长期护理保险制度设计影响幸福感的条件组态,发现制度设计中的单一因素不能独立触发居民幸福感,基本要素综合联动、商保参与经办、受益—待遇驱动分别是制度促进居民幸福感的主要、关键和边缘路径。

Healthcare Needs of the Elderly People over 85 Years Living Alone on the Island Area in Japan: A Descriptive Study

Background: Japan has the highest aging people accounting 33.8 million with the rate of 26.7% in 2015. Although, public long-term care insurance services support people age 40 years and above, most of the users are 85 years and over due to their more vulnerability for getting sick. This study describes the physical, mental and social status of the elderly people aged 85 years and over, who were living alone at home. Method: A cross-sectional study was conducted between November 2016 and March 2017 in the island of Kure city, Hiroshima, Japan. A structured questionnaire and scales were used for data collection and documentation of physical measurements. Descriptive analysis was used. Result: A total of 190 subjects were participated, and the data were analyzed. The age range of the subjects was 85 to 98 years, and 68.4% of them were 85 to 89 years old. Male and female ratio was 21.6% vs 78.4%. Subjects of 17.4% continued their occupation at the time of the study period and most of them involved in agricultural work (93.9%). A certain percentage of the subjects had abnormal physical, mental and social difficulties and need additional support from family, friends, relatives, and community. Conclusion: Early detection and intervention such as disease management, nutritional support, and human support are required. The findings suggested policy makers to predict the burden and provide necessary care for these elderly people. It is necessary to aware family, friends, relatives, community and government supporting staff to provide information on correct recognition and usages of long-term care insurance services for these elder people.

我国长期护理保险试点方案差异研究——基于公众满意度视角

老年失能风险的社会化导致多国建立现收现付筹资的社会保险制度——长期护理保险。本文以青岛、上海、石河子、承德的长期护理保险试点方案为研究对象,通过问卷调查获取数据资料,运用交叉分析与有序多分类Logistic分析识别4个方案相关参数的公众满意度评价的差异性。回归分析结果显示,除护理服务质量公众满意度评价的地区变量影响不显著外,缴费水平、保障内容、保障水平、经办服务水平的公众满意度评价都存在显著的地区差异。基于回归分析结果,并结合4个试点方案相关参数设计特点,本文提出契合需求的长期护理保险制度相关参数构成建议。

我国长期护理保险制度试点运行的地区差异分析——基于49地的调研数据

自2016年以来,我国长期护理保险制度试点地区数不断增加,参保人数和基金收支规模不断扩大,但制度运行的地区差别较大。基于调研获取的有效数据,按照“收入支出比/参保受益率”将制度运行状况分为基金承压、相对平稳、基金冗余三类,通过比较它们的“参保受益率”和“收入支出比”,发现试点地区的制度覆盖与基金支撑能力、基金收入与基金支出之间都缺乏显著的线性关系。造成这些问题的原因具有复杂性,既包括医保基金划转能力有差异、长期护理服务供给不足等客观原因,也包括试点地区对长护险制度的定位有差别、地方政府对长护险政策解读不同等主观原因。据此,从完善制度内容和规范基金管理两方面提出政策建议。

基于政策工具类别的长期护理保险政策扩散特征分析

目的:基于量化视角挖掘试点政策内容,探求长期护理保险政策扩散特征及扩散规律。方法:基于政策工具对长期护理保险政策进行量化分析,将两批试点地区分为均衡型、高需求型、高供给型、高环境型并分析其政策扩散特征。结论:长期护理保险环境型政策工具使用偏好明显,需求型政策工具最少;两批试点政策由高供给型向均衡型和高环境型转变;政策扩散呈现空间邻近与社会邻近交互的邻近扩散效应、垂直扩散与水平扩散交织的层级扩散效应以及自下而上与自上而下的“吸收—辐射”互动效应。建议:应注重政策工具的使用与政策扩散的多重效应的紧密联系,完善政策工具结构;中央鼓励、支持、引导地方自主政策创新,学习邻近经验与本土创新相结合。

透视长期护理保险经办:试点比较与政策优化

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。

政策生态视角下长期照护保险案例分析及政策建议

在长期照护保险试点范围逐渐扩大、试点经验逐渐积累的背景下,文章基于生态学和政策学的观点,构建了一个政策生态分析框架。依托此框架,以具有突出典型性的江苏省南通市为例,从更为综合全面的视角对南通市长期照护保险政策进行了探析。立体式地呈现了长期照护保险政策的现行实施运作情状和突出特点,同时也诊断出长期照护险政策目标设定待升级、政策工具使用结构待优化、政策主体互动不畅、部分政策资源有短板等问题。提出了完善政策目标体系,引入整合照护;优化政策工具应用结构;构建平衡有力的政策共同体;补齐政策资源短板等政策建议。

发展型社会福利理论视域下的长护险试点经验与启示——基于广西南宁的实证分析

建立长期护理保险制度是我国积极应对老龄化、失能化问题的重要措施。本文基于发展型社会福利理论,选取长期护理保险第二批试点城市中的广西南宁作为研究对象,从参保对象、政策保障、资金筹集、待遇保障和定点机构管理等五个方面梳理南宁市长护险试点做法,发现南宁市长护险试点建立了相对高效的社商合作机制,基本实现独立筹资,提高了照护资源供给能力并推动了长护险相关产业发展。但是在长护险实施过程中,仍存在保障对象覆盖面窄、多元主体共识缺失和制度供需失衡等问题。因此,为进一步推进长护险制度建设,应协调经济增长与社会发展关系、制定中长期发展政策、构建多元主体治理模式和加强人才资本投资等。

我国长期护理保险的政策比较与优化路径研究

人口老龄化背景下,长期护理保险是解决失能老人护理需求的重要途径。2016年我国开展了长期护理保险的第一批试点。文章从覆盖范围、给付方式、筹资模式、待遇支付四方面对首批试点城市的制度实践进行了系统比较,提出推动长期护理保险进一步发展,应当立法先行、加快长期护理保险的法律体系建设;拓宽资金来源,统一筹资标准;逐步扩大保障对象范围;加强长期护理服务行业建设。