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.

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.

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.

长期照护保险对农村家庭消费水平的影响——基于CHARLS数据的实证分析

基于预防性储蓄等理论,运用双重差分法,依据中国健康与养老追踪调查(CHARLS)2011—2018年四期面板数据,考量长期照护保险政策对农村家庭消费水平的影响效应。结果显示,长期照护保险使得农村家庭消费水平总体提高了5.2%,这种消费促进效应突出地体现在食品消费、日用品消费、通信消费中,对文化娱乐消费和衣着消费影响不明显。异质性分析显示,非独生子女、收入高以及过去一年内有住院经历的农村家庭受长期照护保险政策的影响程度更大。机制分析表明,预防性储蓄、居民健康和代际经济支持是长期照护保险影响农村家庭消费的重要途径。鉴于此,应通过扩大城乡试点范围、建立多元筹资渠道、构建服务供给体系等方式,推动长期照护保险实现城乡全覆盖。

城乡居民养老保险对家庭双代经济流动的影响——基于中国健康与养老追踪调查数据

利用“中国健康与养老追踪调查”(CHARLS)数据,通过构建多元线性模型,实证分析城乡居民养老保险对家庭内部亲子代经济流动的影响。结果发现,“经济面向”的城乡居民养老保险挤出了子代向亲代提供的经济支持,但对亲代的经济“逆反哺”并无显著影响;双代婚姻状况、受教育水平和亲代家庭资产均正向显著影响家庭代际经济的双向流动;子女之间存在“攀比效应”和“示范效应”;子代家庭收入正向影响向上代际经济支持。因此,老年人养老水平的提高需要从国家、社会和家庭层面共同着力:国家提高城乡居民养老保险的保障水平,鼓励老年人隔代照料孙子女;市场进一步完善养老服务;家庭发挥情感保障作用,关照独子女失能老人。

我国农村地区建立长期照护体系的紧迫性、可行性及其对策建议

为实施积极应对人口老龄化国家战略,国务院发布了《国家积极应对人口老龄化中长期规划》,制定了《“十四五”国家老龄事业发展和养老服务体系规划》,拟在我国稳步推进长期护理保险制度,逐步建立起“覆盖城乡、惠及全民、均衡合理、优质高效”的长期照护服务体系。由于历史的原因,我国城乡差别大、农村老龄化率超高,而医疗和照护资源却严重不足,将成为实现上述目标的主要障碍。但这个问题尚未引起各级政府及社会的足够重视。本文以青岛市为例,对农村地区建立长期照护体系的紧迫性和可行性进行系统分析,并提出对策建议。

长期护理保险与农村老年群体消费扩容提质效应分析

目的:分析长期护理保险(长护险)试点对农村老年群体消费的扩容提质效应。方法:基于CHARLS四期调查面板数据,运用双重差分模型实证检验长护险对农村老年群体消费的影响。结果:长护险主要通过降低暂时性收入波动和随机性健康支出的不确定性,对农村老年群体消费产生扩容提质效应,且在多元筹资模式、失能家庭和老龄化程度较高地区的扩容提升效应更为明显。结论:长护险试点对农村老年群体消费具有显著的扩容提质效应,应持续扩大长护险试点和待遇覆盖范围,加强社商合作,制定差异化长护险制度,充分满足农村老年群体的消费需求。

积极老龄化视角下农村长期护理保险建设必要性及优化路径

长期护理保险作为应对人口老龄化重要举措,能有效保障失能、失智人员基本生活质量,缓解农村养老压力。基于积极老龄化视角,从健康、保障和参与三大支持体系构建分析框架。依托此框架并结合农村实际,深入剖析农村长期护理保险建设的必要性。发现农村长期护理保险建设中存在农村居民参保意识淡薄、农村长期护理保险服务体系不健全、专业护理人才资源匮乏、农村长期照护保险筹资机制不稳定及监督管理机制不完善等现实阻碍,由此提出加大长期护理保险宣传力度、构建农村长期护理保险服务体系、加强护理人员队伍建设、探索建立多元筹资机制及完善农村长期护理保险监管机制的优化路径。

福建发展农村长期护理保险助力乡村振兴的探索分析

【目的/意义】我国老龄化加剧带来失能人口养老照护的巨大需求已引起各界的广泛关注。农村老龄化更甚于城市老龄化,在乡村振兴的背景下推行农村长期护理保险已成当务之急。【方法/过程】分析发展农村长期护理保险的迫切性、应用价值和制度特征,结合福建省县域集成改革试点之一的晋江市农村长期护理保险的开展情况,提出福建发展农村长期护理保险助力乡村振兴的对策建议。【结果/结论】通过理论分析,得出农村长期护理保险是一种准公共产品,在供给上应该通过“政府+市场+社会”的路径。通过实践考察,认为福建省发展农村长期护理保险存在资金、服务、管理等方面的制约因素,需要因地制宜地建立农村长期护理保险的多元筹资模式、“软硬兼施”提高农村长期护理保险的服务供给能力、科技赋能提升农村长期护理保险的监督管理实效。

长期护理保险对农村老年居民多维贫困的抑制效应分析

作为农村困难群体的典型代表,农村失能老人因病返贫致贫问题的解决对巩固脱贫成果、推进共同富裕非常重要。而长期护理保险的实施成为抑制农村老年居民因病返贫致贫的重要保障。据此本文构建了农村老年居民多维贫困指标体系,利用A-F法结合CHARLS2020年数据进行实证分析,探究长期护理保险对农村老年居民多维贫困的影响。研究发现,长期护理保险使农村老年居民的多维贫困指数显著下降了0.028,且能够显著降低农村老年居民陷入经济贫困和健康贫困的风险,进而提出扩大长期护理保险制度的实施范围、优化长期护理保险的筹资机制、引入专业上门护理服务等建议。

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.

城乡养老保险统筹是否影响子女经济支持?--基于CHARLS的经验分析

基于CHARLS数据,使用双重差分法评估城乡养老保险统筹对子女经济支持的影响。结果表明:城乡养老保险统筹使农村老年人收到的子女经济支持总额增加24.9%,这种提升作用主要通过降低农村老年人劳动供给时间、增加照料孙辈的时间得以实现。同时城乡养老保险统筹对子女经济支持的促进效应在与子女同住、经济支持来源于儿子的农村老年人中更加显著。鉴于此,政府应逐步提高养老保险统筹层次,有序缩小城乡居民的养老保险待遇差距。

城乡居民基本养老保险对隔代抚育的影响研究

隔代照顾是中国较为普遍的儿童照顾方式,但这一照顾方式的占比却在不断下降。社会养老保险制度不断健全可能是其中的原因之一。通过构建祖辈闲暇时间与消费决策的效用模型,并基于2018年中国健康与养老追踪调查(CHARLS)数据的实证研究发现,祖辈领取城乡居民基本养老保险金对孙辈的时间照顾及其劳动力供给均产生“挤出”效应,但在对孙辈的经济照顾维度上则产生“挤入”效应;且城乡居民基本养老保险金对隔代抚育的影响存在城乡间、性别间的异质性。鉴于此,需通盘统筹考虑“一老一小”问题,一方面加强政策设计,明确隔代抚育的社会经济价值,实现抚育—养老服务的有序转换,另一方面着力营造包容性政策环境,促进托育服务多元化有效供给。

互联网保险发展对居民医疗保健支出的影响研究——基于城乡视角

目的:探究互联网保险的发展对居民医疗保健支出的影响。方法:基于我国31个省份2011~2020年的面板数据,分别以城镇、农村为视角,采用固定效应模型进行实证分析。结果:互联网保险发展指数每增加1%,城镇人均医疗保健支出及其在消费性支出占比分别降低0.036%(P<0.05)和0.031%(P<0.1),且在中部地区较为显著(P<0.1),而东部、西部和东北部不明显;但互联网保险发展指数对农村地区的影响并不显著;机制分析中,以城镇人均医疗保健支出为被解释变量,保险购买意愿为机制变量时,中介效应显著存在(P<0.1)。结论:互联网保险的发展有效缓解了城镇居民医疗保健支出压力,且存在区域异质性,但对农村地区未起到显著作用。保险购买意愿是互联网保险发展影响城镇人均医疗保健支出的重要渠道。相关政府部门应尽快弥合城乡之间的“数字鸿沟”,并对各区域相关保险方案做出合理调整,充分发挥互联网保险优势,缩小城乡差距,促进区域协调发展。

医保财政补贴能否促进城乡居民的医疗服务利用

作为促进社会公平的转移支付手段,政府为城乡居民医保提供的财政补贴,能否促进城乡居民的医疗服务利用?文章基于样本地区大规模医疗保险数据研究表明,财政补贴对城乡居民的门诊和住院服务利用均有显著影响。其中,对老年人的影响大于中青年人,对农村居民影响大于城镇居民,对特定门诊(针对慢性病和重大疾病)服务利用的影响大于普通门诊。老年人主要体现在住院服务利用的提高,而农村居民的门诊和住院服务利用均得到显著提高。进一步分析发现,财政补贴强化了居民就医时的大医院偏好,显著提高了住院(而非门诊)保障水平。上述结论对于完善城乡居民医保补偿机制和财政补贴的再分配机制有着重要的政策价值。