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.

The Newly Established Unified Healthcare Fund (EOPYY): Current Situation and Proposed Structural Changes, towards an Upgraded Model of Primary Health Care, in Greece

Background: The National Organization for Healthcare Provision (EOPYY) constitutes simultaneously the monopsonistic healthcare insurer and a main provider of PHC in Greece. Currently, EOPYY is threatened by financial distress hence emerging a critical discussion on structural issues, providers’ reimbursement and gatekeeping revision. Objectives: To conduct a detailed analysis of the Greek social health insurance and PHC in order to propose consolidation policies. Methods: Search for raw data domestically and best practices internationally. Results: In Greece, PHC provision is fragmented leading patients to more expensive hospital care. Family physicians are a small portion of total physicians which, in combination with the free choice policy, results in non-gate-keeping despite growing co-payments. This necessitates the creation of a PHC network between EOPYY’s and NHS’s units and contracted professionals. This first evaluation has also revealed an irrational use of consolidated resources, which we propose to normalize through a new global budget system. Conclusions: Greek health insurance needs an immediate reform through which EOPYY would become an efficient pool of public and social health inflows. Besides, we suggest gate-keeping to be activated, proclaiming new EOPYY contracts with general practitioners and family pediatricians, applying a stricter referral system and reforming the reimbursement system.

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.

长期护理保险筹资政策有效性研究--基于49个试点城市的实证分析

随着人口老龄化的加深与家庭结构的变迁,失能失智老年人群的照护需求增加,而长期护理保险是解决我国老年人照护难题的关键。在建立长期护理保险体系过程中,资金筹措是迫切需要解决的核心问题。文章以长期护理保险49个试点城市政府公开发布的57份政策文本为研究对象,利用文本挖掘手段分析政策内容,并参考PMC模型相关研究的评价指标,构建了长期护理保险筹资政策的量化评价指标体系,分别从人口老龄化程度与空间视角对各试点城市政策文本进行量化评价与对比研究。为更全面地了解长期护理保险筹资政策的演进过程,选择了典型试点城市更新前后的政策文本进行实证研究。研究表明,长期护理保险筹资政策的整体评级合格,但存在一定程度的政策供需错配问题,一是政策有效性与人口老龄化水平之间存在错配,二是在“参保范围”和“支付范围”等方面存在较大的改进空间。从空间区域的角度看,我国长护险试点政策的有效性与一致性呈现出“北高南低”的特征。从政策延续性方面则发现同一试点城市更新前后的长期护理保险政策在筹资方面改善不大。文章通过对长期护理保险筹资政策的细致研究,为我国建设更为完善和适应性强的长期护理保险体系提供了有益的政策建议。深入了解政策的强项和薄弱点,有助于更有针对性地改善政策,以应对不断变化的老龄化社会的挑战。

异地就医下医保基金监管困境及应对策略的质性研究

目的对异地就医下医保基金监管困境进行分析,提出应对策略,为提升我国异地就医监管效率提供理论参考。方法系统检索异地就医下医保基金监管相关文献,检索时间为建库至2023年12月。采用NVivo 12 Plus软件对纳入的文献进行编码和分析。结果通过检索筛选,最终保留38篇文献纳入质性研究。提炼出53个初始概念、18个初始范畴及5个主范畴,得出异地就医基金监管在监管机制不健全、监管法律不完善、监管手段单一、监管主体能力不足以及监管对象道德风险5个维度的困境节点。结论异地就医下医保基金监管受多种因素制约:完善、健全的监管机制是其中最核心的问题,监管法律完备、有效是监管的重要依据,创新监管手段、促进监管效力提升则是异地就医下医保基金监管的重要手段,制约就医地机构和参保人员的道德风险则是监管过程的关键环节。

不同筹资模式下长护险可持续性研究——以长三角地区为例

长护险基金收支平衡是实现制度可持续发展的重要条件。本文以长三角地区采用比例筹资的上海和定额筹资的苏州作为研究对象,在假设政策条件不变的情况下,利用灰色预测模型GM(1,1)对这两个城市未来10年(2023年—2032年)的基金收支平衡状况进行预测。通过实证分析,本文得出如下结论:第一,比例筹资形式下,上海市长护险基金收入年均增长速度显著高于支出增速,基金结余率在80%-97%之间,基金结余率明显偏高;第二,采用差异化定额筹资形式的苏州,基金收入年均增长速度略高于支出增速,基金结余率在28%-35%之间,基金结余率较为合理,收支更接近平衡状态。两个城市基金结余率的差异可能受筹资、待遇给付等因素影响,本文认为可以采用混合筹资形式,建立多渠道独立筹资机制,完善长护险待遇给付机制,避免基金浪费,以期为长护险制度可持续发展提供借鉴。

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.

保险业参与养老产业的政策与建议

在我国老龄化日趋严重的背景下,保险业需要积极参与养老产业,完善我国养老保障制度。我国要借鉴美国、日本、中国台湾地区等经验,可以从保险公司组建专业养老投资基金、开发多样和个性化金融养老保险产品、提升自身治理水平、成立养老投资专业机构、政府加强保险业参与养老产业的相关政策与立法建设等方面找到保险业参与养老产业的路径,以期起到鼓励保险业参与养老产业的作用。

长期护理保险“整体化”路径设计研究——基于29个试点城市基金可持续性测算

2016年以来,中国先后两次开展长期护理保险制度试点,探索制度框架设计和政策体系建设,试点工作取得卓越成效。随着试点政策的推进和更迭,长期护理保险“碎片化”特征显现,阻碍资源高效配置和制度功能建设,甚至囿于“再碎片化”陷阱,亟待设计“整体化”路径。本文从长期护理保险基金可持续性角度出发,运用齐次性Markov过程和2015—2018年CHARLS数据,计算中国老年人健康状态转移概率矩阵,并通过构建长期护理保险基金精算模型,预测29个试点城市2021—2050年基金可持续性状况;同时采用中国第七次人口普查数据和队列要素模型,预测中国未来城乡人口,并根据国际长期护理保险发展趋势,从“碎片化”政策中提炼“整体化”路径。研究结果显示,第二批试点城市总体可持续性优于第一批试点城市,试点方案与当地发展的适配性进一步提升。针对未来制度可持续性,我们建议中国长期护理保险“整体化”路径如下:全民参保,将中、重度失能人员纳入保障范围,保障水平维持在70%左右,0.7%—1%的城镇职工缴费率,0.6%的城乡居民缴费率,财政为城乡居民补充其可支配收入的0.3%—0.6%。

南宁市长期护理保险筹资水平测算及分担机制研究

目的:通过实证分析对南宁市长期护理保险筹资水平和分担机制进行测算检验,为我国全面推行长期护理保险提供理论依据。方法:采用ILO筹资模型对南宁市长期护理保险的筹资水平进行测算,并运用Eviews软件对个人责任分担进行可行性检验。结果:经测算南宁市长期护理保险职工筹资比例为0.17%,与该市现行的长期护理保险职工筹资比例0.15%相近,测算具有一定合理性;职工个人社保总缴费比例远低于个人最大承受水平,说明城镇职工缴纳长期护理保险目前具有一定可承担性。结论:南宁市长期护理保险制度应从制度层面完善顶层设计,建立责任共担的多元筹资渠道,结合各地区具体情况合理确定筹资水平。

长期护理保险对医疗费用及医保基金可持续性的影响研究

本文基于CHARLS2011年、2013年、2015年和2018年共四年数据,运用成本-收益分析法,研究长期护理保险对医疗费用及基本医保基金可持续性的影响。本文发现长期护理保险通过减少个体年门诊次数等机制降低了医疗总费用。由于长期护理保险部分筹资源于基本医保基金,本文将这部分从基本医保基金中提取的金额定义为成本,将长期护理保险通过降低医疗费用而节省的医保基金支出金额定义为收益,探究长期护理保险对基本医保基金可持续性的影响,即成本与收益的差值。研究发现在以中方案人口数量预测为基础数据、“90+10”方案为照护模式、全体失能老人为保障对象、70%为报销比例的模式下,长期护理保险可为基本医保基金人均节省65.44元—105.05元。同时,本文从人口预测方案、护理模式和报销比例等角度进行敏感性分析,发现当长期护理保险报销比例一定时,选择以居家护理为主的老人占比越高,长期护理保险对基本医保基金可持续性的正向影响越强。以往研究大多讨论长期护理保险制度对基本医疗保险制度的负面作用,缺少长期护理保险制度对基本医疗保险制度正面作用分析。本文以此为出发点进行探究,为国家和地方政府完善长期护理保险制度、探究长期护理保险与基本医疗保险互馈机制等内容提供理论依据。

保险受托人的法律构造——以保险金信托为视角

保险金信托系将人身保险与信托制度进行嫁接的金融产品,因设立保险的主体不同导致保险金信托的产品在结构上存在不同的组合方式和法律问题。为便于信托公司主张保险金请求权以及领取保险金,将信托公司列为人身保险的受益人系当事人的唯一选择。在传统人身保险合同关系中,被保险人之外的第三人作为受益人,其受益权源自被保险人的赠与,受益人在保险事故发生后享有保险金请求权,受益人对于保险金请求权可以自由处分,也不承担任何保险合同的义务。而在保险金信托模式中,信托公司占据保险受益人的地位,由于受益人对保险金请求权可以自由处分,如果信托公司怠于请求保险公司给付保险金,则信托目的可能无法达到;保险金的真正受益人游离于保险合同之外,保险制度中道德风险防范机制失灵。造成这种局面的原因在于,商业人身保险不单是风险规避的工具,更是兼具投资理财与财产传承功能的金融产品。监管对混业经营的禁止以及保险金给付条件的限制,导致人身保险无法满足当事人对保险金按照意愿分配的需求,当事人在通过信托制度解决上述问题时导致法律关系失衡。在保险金信托模式中,信托公司作为保险受益人实质上是领取保险金的受托人,而非保险金请求权的受赠人。

可持续视角下长期护理保险基金收支状态评量

长期护理保险的基金筹集是影响制度可持续性的关键环节,在支付引导筹资的基本前提下,制度的保障人口数量、保障水平高低、保障持续时间、国家的财政实力、企业和个人的承受能力、社会支持力度等均对长期护理保险的可持续发展产生影响。通过对影响长护险基金收支各因素进行现状分析,并基于此构建长期护理保险收支模型,借助全国各地试点方案中的规定对各因素进行赋值并进行仿真模拟,获得筹资及支付的大致水平及比较结果。研究结论表明,短期内,在现有较低失能失智率水平之下,筹资水平保持在较低水平(0.15%~0.2%)即可满足支付需求,且基金结余相对比较充裕;长期来看,随着失能失智率的不断提高,筹资比例需维持在较高水平(0.2%以上)才能满足支付需求,且基金结余相对比较紧张。因此,应尽快开展长期护理保险制度顶层设计,以促进形成全国一体化长期护理保险制度、明确制度的筹资主体和责任划分、合理确定制度的待遇水平、建立制度基金的动态监督机制等。

德国强制性长期护理保险概述及启示

德国从1995年开始实施强制性长期护理保险制度,长期护理满足全体居民潜在的、基本的护理需求。从筹资安排、护理服务等级评定以及责任范围三方面阐述了它的发展现状。在借鉴德国经验的基础上提出了我国发展长期护理保险时基金的筹资方式以及基金管理的建议。