我国长期护理保险费率研究

发布时间：2018-04-04 05:34

本文选题：长期护理保险　切入点：基金平衡法　出处：《南京财经大学》2014年硕士论文

【摘要】：我国从2001年正式迈入老龄化社会以来,老年人口不断增加,老年人口抚养比不断加重,老龄化速度远快于其他国家。人口出生率持续降低,家庭规模缩小,妇女外出工作率提高,农村劳动力外出务工,两代人分居等现象,使得传统的家庭养老承载的护理职能不断弱化。同时随着生活水平和医疗技术的提高,老年人平均寿命延长。但老年人是慢性疾病的高发人群,由此引发的医疗费用支出给老年人自己和国家财政都带来了巨大的经济压力。此外,由慢性疾病引发的老年人失能或残障几率远高于普通人,老年人对护理服务的需求不断上升。长期护理保险是国外解决老龄化问题的一个新险种,是指老年人在遭受疾病、意外事故以及认知功能障碍造成身体失能,缺乏日常生活自理能力时为其提供护理服务的保险制度。本文拟对我国长期护理保险费率测算问题进行研究,从费率分担的角度说明长期护理保险在我国的财务可行性。本文综合比较了国外已实行的三种长期护理保险模式：国家长期护理津贴计划、长期护理社会保险和补缺型长期护理保险,结合我国当前人口结构、经济发展水平、保险业发展状况等实际情况,认为长期护理社会保险模式应该是我国最佳的选择。本文基于我国老年健康影响因素跟踪调查(CLHLS)数据测算出我国老年人口的失能状况,同时依据联合国对我国的人口预测数据估算出未来失能老人人口规模。在深入比较德日韩三国的护理保险对象、给付人群、需求划分和保险费给付的基础上确定我国长期护理保险的给付对象、给付人群和给付标准。然后利用成本结构法研究了居家护理、社区护理和机构护理三种护理方式的总成本和人力成本的比例关系,结合设定的护理给付标准、护理方式使用率和估算的失能人群计算出我国当前和未来护理需求费用的总额。最后,本文拟定以16岁以上城乡全部就业人口为参保缴费对象,以城乡就业人员全部工资收入作为缴费基数,利用现收现付制下的基金平衡法测算出我国当前的总体费率水平。本文按照使用者是否承担费用,企业和员工分担比例(n=1,2,3)分六种情况计算企业和员工的缴费费率。结果表明,从短期来看,当前企业承担的费率范围为0.46%-0.765%,企业员工承担的费率范围是0.23%-0.5]%。由于城乡工资差异,城镇就业人员每月需缴费8-17.8元,乡村就业人员每月需缴费2.6-5.7元,均在可承受的范围内。从长期来看,2050年左右企业承担的最高费率将达到2.01%,个人承担的最高费率达到1.34%,对企业和个人都将是一个不小的压力。针对当前开展护理保险和未来运营可能存在的问题,文章最后提出一些参考性的政策建议。
[Abstract]:Since China entered the aging society in 2001, the elderly population has been increasing, the dependency ratio of the elderly population has been increasing, and the speed of aging is much faster than that of other countries.The birth rate is decreasing, the family size is shrinking, the rate of women going out to work is increasing, the rural labor force is going out to work, and two generations are separated, which makes the nursing function of the traditional family old-age support weakening.At the same time, with the improvement of living standards and medical technology, the average life expectancy of the elderly is prolonged.But the elderly are the high incidence of chronic diseases, resulting in medical expenditure on the elderly and national finances have brought enormous economic pressure.In addition, the rate of disability or disability caused by chronic diseases in the elderly is much higher than that of the ordinary people, and the demand for care services is increasing.Long-term care insurance is a new type of insurance to solve the problem of aging in foreign countries. It refers to the physical disability caused by diseases, accidents and cognitive impairment in the elderly.An insurance system that provides nursing care when it lacks the ability to take care of itself in daily life.This paper intends to study the calculation of long-term nursing insurance rate in China and explain the financial feasibility of long-term care insurance in China from the perspective of rate sharing.This paper comprehensively compares three kinds of long-term nursing insurance models that have been implemented abroad: national long-term nursing allowance plan, long-term nursing social insurance and long-term nursing insurance, combined with the current population structure and the level of economic development in China.It is considered that the long-term nursing social insurance model should be the best choice in our country.Based on the CLHLS data, this paper estimates the disability status of the elderly population in China, and estimates the population size of the future disabled elderly population based on the population forecast data of the United Nations.On the basis of deeply comparing the object of nursing insurance in Germany, Japan and Korea, the distribution of demand and the distribution of insurance premium, the object, population and standard of long-term care insurance in our country were determined.Then the cost structure method was used to study the proportion of total cost and manpower cost of home nursing, community nursing and institutional nursing, and combined with the established nursing payment standard.The utilization rate of nursing mode and the estimated population of disabled people calculated the total cost of nursing demand in our country at present and in the future.Finally, this paper proposes to take the whole urban and rural employment population over the age of 16 as the object of insurance payment, taking the total wage income of urban and rural employment as the payment base, and using the fund balance method under the pay-as-you-go system to calculate the current total rate level of our country.In this paper, according to whether the user bears the expenses and the proportion of enterprises and employees is divided into six situations, the contribution rates of enterprises and employees are calculated.The results show that, in the short term, the current enterprise bear the rate range of 0.46-0.76555, the enterprise employees bear the rate range is 0.23-0.5].Due to the wage difference between urban and rural areas, urban employees need to pay 8-17.8 yuan per month, and rural employees 2.6-5.7 yuan per month, which are within the range of affordability.In the long run, the highest rates for companies and individuals will reach 2.01and 1.34 respectively, which will be a great pressure on both enterprises and individuals.In view of the possible problems in the development of nursing insurance and future operation, this paper finally puts forward some policy suggestions for reference.
【学位授予单位】：南京财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.6

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