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.

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.

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.

失能老人长期照护体系的构建与公共健康治理创新

失能老人的长期照护不仅对医学提出了难题,更对当前的社会治理和公共政策形成了严峻挑战。需要从公共健康治理的视角重新审视,基于价值、结构、工具维度建构分析框架,识别公共健康治理的价值共识、协同共治结构和政策工具。以青岛和上海试点的长护险制度为例,探索其背后呈现的公共健康治理的逻辑可以发现,健康议题的价值回归驱动了公共健康治理创新,治理权向多元化主体的扩散形成了健康问题协同共治的基础,长护险制度及其所包含的多元化政策工具使用共同促进了健康服务的共同生产。

A Study on the Public Awareness of Hierarchical Medical System in Taiwan

The purpose of hierarchical medical system is to lead in terms of improving efficiency, differentiating healthcare services and promoting labor division by changing the healthcare seeking behavior. The purpose of this research aims to discuss the public awareness of hierarchical medical system in Taiwan for the reference of health policy makers. We obtained our research data using a questionnaire survey;the total number of qualified patients was 1340. This research finds that more subjects agreed to the hierarchical medical system and medical referral system, but many people still disagreed with changes to their healthcare seeking choices due to policy promotion. Subtle changes, therefore, are observed that imply a crisis in terms of the trust in healthcare. The healthcare seeking behavior will not change if there is a difference between the medical awareness of patients and policy implementation, and the government needs to be concerned with this result when making policies.

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。

社会福利筹资与公共财政支持

本文在简要分析社会福利筹资基本理论的基础上,梳理了中国社会福利筹资的历史演变,从社会保险、优抚和社会福利救济、医疗卫生、教育保障和住房保障等方面重点分析了中国社会福利筹资的现实情况,特别是公共财政支持社会保障和福利体系发展建设的情况,并对中国政府财政如何支持社会福利筹资提出了基本的看法,分三种假设方案预测了未来中国财政对社会福利筹资的支持能力。

商业健康保险在医疗保障体系中定位的理论阐释

本文从卫生筹资机制、信息不对称理论以及公共选择理论出发,探讨了商业健康保险和社会医疗保险应该协调发展,致力于构建商业健康保险与社会医疗保险相互补充、相互配合和共同发展的医疗保障新模式。商业健康保险绝不仅仅是社会基本医疗保险有限的、简单的补充,而应该成为我国医疗保障体系中必不可少的重要组成部分。

公私合作(PPP)视角下我国长期护理保险制度的模式探索

随着我国人口老龄化程度的日益严重,加之我国传统家庭的规模变得越来越小,家庭的人均赡养比在不断的降低,导致我国老年人的护理费用越来越高,致使老年人不堪重负。理论界和实务界也越来越关注老年人的长期护理保险问题,长期护理保险也成为一个引起多方关注的社会问题。如何构建符合中国特色并且借鉴国外发达国家在长期护理保险方面成熟的做法,形成与中国的人口老龄化这样的实际相适应的长期护理保险模式已经成为一项迫在眉睫的任务。我国的长期护理保险必须立足我国国情,坚持国家、社会和个人三方共同参与的发展模式。

德日韩三国护理保险制度比较及启示

人口老龄化及其引起的老年人长期护理问题不仅给西方发达国家,也给拥有家庭养老传统的亚洲国家带来巨大冲击。继德国之后,日本和韩国也建立了护理保险制度。通过对各国制度产生背景和内容的比较发现,日本借鉴德国经验,韩国借鉴德国和日本经验,因此三国之间既有共性又各具特色。对其进行比较目的是为我国提供启示。

中国医改的焦点、难点和痛点

当前,中国医改的焦点集中在迄今没有解决的关键问题:一是"看病难、看病贵"问题,二是"三医联动"问题,三是"强基层、保基本、建机制"问题。要解决这些关键问题,需要全面正确评价卫生系统改革,认识到当前中国医改的难点(医疗保险可持续难、基本药物政策执行难、公立医疗机构改革难)和痛点(医患矛盾之痛、医师多点执业之痛、基层人才流失之痛),中国医改还有很长的路要走。

日本护理保险制度改革及启示

随着寿命延长和疾病构成向慢性及退行性疾病转变,老年护理问题成为人口老龄化国家共同面临的严峻课题。日本通过实施护理保险制度改革成功构筑了社会全体支撑的护理保障体系,推进了医疗.保健.福利服务的整合。分析日本护理保险制度的现状、改革措施及成果,在此基础上提出对构建我国老年护理保障体系的启示。

长期护理保险制度公平性探讨

长期护理保险制度是保障民生的重要公共政策安排。研究发现,中国当前的长期护理保险制度存在着诸多问题,如价值理性与工具理性存在冲突、制度程序缺乏民主性、制度内容存在新的不公、以人为本的理念不足等。为完善长期护理保险制度的公平性,建议协调价值理性与工具理性以完善制度目标的公共性,五位一体以完善制度程序的民主性,健全社会公平保障体系以完善制度内容的公平性,转变发展思路来完善以人为本的制度理念。

对突破我国医药卫生体制改革瓶颈的思考

我国医药卫生体制改革的进展主要体现在全民医疗保险制度的初步建立上,但医疗机构和医药生产流通体制的改革不到位。深化我国医药卫生体制改革,应以政府主导为基本取向,政府不仅要在构建全民医疗保险方面发挥主导作用,还应在构建公共基本医疗服务供给体系上发挥重要作用。在确立基本医疗卫生服务的公益性并且实现医保制度全覆盖后,改革的瓶颈和重点在于如何提高全民医疗保险的质量,推进医疗服务机构和医药生产流通体制的改革,改革的突破口则在于公立医院的改革。

基本医保基金经办机构与公立医院之应然关系——理论及其对公立医院改革的启示

基本医疗保险基金经办机构与公立医院之间的关系,实质上是医疗服务需求方和供给方的关系。消费者主权理论、管理型竞争理论、花钱矩阵理论,可以为理顺基本医疗保险基金经办机构与公立医院之间的应然关系提供理论依据。公立医院彻底地去行政化和赋予其独立的市场主体地位、基本医疗保险基金经办机构与公立医院就其提供的基本医疗服务进行谈判购买、基本医疗保险基金支付方式走向按绩效付费、公立医院与公立医院以及与其他非公立医疗机构之间开展市场竞争、强化医药分家后对医疗行为的行业监管、基本医疗保险基金经办机构在药品招标采购中居于主导地位、加强区域医疗资源规划、优化基本医疗保险基金经办机构管理应该成为公立医院未来改革努力的方向。

正确处理好医卫公益性与医保基础性的关系

深化医改要以健全医保体系为基础,推进公立医院改革要以完善医保支付制度为重要推手。深化医改与推进医保能否协调同步,关键在于能否处理好医疗服务的公益性与基本医保的基础性关系。

医疗卫生体制改革的回顾与新思考——以山西为例

经过30多年的努力,山西医疗体制改革在农村和城镇以及公共卫生服务等方面都取得了很大成就,医疗服务的可及性大大增强。但随着医疗卫生体制改革的发展,诸多新问题也日益显现出来,如医疗资源的不平衡和看病难、看病贵等。2009年新的医疗体制改革全面启动,但也将面临着重重困难,道路不是一帆风顺。

突发公共卫生事件伤亡人员的社会保障适用研究

突发公共卫生事件下所致的伤亡,应根据伤亡情形和人员的类别予以不同的社会保障。医护人员履行预防救护职责伤亡的,应以职业病认定工伤享受工伤待遇;国家机关工作人员参与抗疫伤亡的,应认定为工伤享受工伤待遇;其他人员参与抗疫伤亡的,按视同工伤享受工伤待遇。社会保障法制建设完善后,参与突发事件应急处理工作伤亡的人员应享受社会优抚保障。社会公众感染疫病的,适用医疗保险制度予以保障。应健全、完善社会保险、社会优抚、社会救助等制度的顶层设计和法制建设,确保社会保障制度能向社会公众提供清晰、稳定的安全预期。

长期护理保险公众满意度的影响因素研究

为剖析长期护理保险公众满意度的影响因素,从提升公众满意度视角探讨我国长期护理保险制度相关参数设计构成,本文选取上海、青岛、承德和石河子4个典型试点城市开展问卷调查,利用二元Logistic回归模型进行统计分析后发现:公众对于长期护理保险的满意度总体水平较高;2个个体特征层因素——受教育程度和健康状况,5个政策设计层因素——缴费水平、经办服务、护理质量、护理种类和报销水平,均对满意度评价具有显著影响,其中报销水平的影响程度最高。据此提出从筹资模式、支付模式和管理模式三方面完善长期护理保险参数设计的建议。