社会长期护理保险制度:国际经验和中国模式

发布时间：2019-05-16 03:01

【摘要】：当前,探索稳定、可行的长期护理保险制度是我国亟待完成的任务。社会长期护理保险在我国是新生制度,亟待总结国内外的相关经验。首先综述国际上长期护理保障制度理论和实践中的模式,发现虽然长期护理保障制度按筹资来源可分为财政支持、社会保险、私营保险和依托医疗保障计划筹资四种,但大多国家实行混合制度;继而总结了国际长期护理保险制度的发展趋势。随后,选取德国、荷兰、日本、韩国四个国家作为典型案例,对四国长期护理保险制度的制定背景和政策细节(保险人、被保险人、缴费机制、财务结构、给付对象、护理等级分类、等级评定机构和流程、待遇给付方式和内容)进行比较研究和归纳。在此基础上,按照同样逻辑,比较研究国内先行自发探索长期护理保险制度的青岛、上海、长春和南通四个城市的制度政策细节。最后,认为我国在长期护理保险制度实践中应考虑如下问题:应该建立面向全民的长期护理保障制度;应依附于基本医疗保险,由医疗保险经办机构承担长期护理保险经办业务;大部分地区短期内应建立职工和城乡居民不同的筹资和待遇体系;待遇确定机构应为多方面利益代表联合组成的委员会,适宜采取经办机构派员入户评估、医生审查、委员会复核的三段式方式;待遇供给方面,短期内应以老年人为主要服务对象,进而考虑失能人群、再考虑失智人群,有条件的地方可以全覆盖;待遇内容设计的原则应该是强调保基本、鼓励家庭履行照护义务、鼓励社区护理服务、强调前期预防保健和康复。
[Abstract]:At present, exploring a stable and feasible long-term nursing insurance system is an urgent task in our country. Social long-term nursing insurance is a freshman system in our country, and it is urgent to sum up the relevant experience at home and abroad. First of all, this paper summarizes the theory and practice model of long-term nursing security system in the world, and finds that although the long-term nursing security system can be divided into four kinds according to the source of financing: financial support, social insurance, private insurance and financing based on medical security scheme. However, most countries have a mixed system; Then it summarizes the development trend of international long-term nursing insurance system. Then, four countries, Germany, Netherlands, Japan and South Korea, are selected as typical cases, and the background and policy details of the long-term care insurance system in the four countries (insurer, insured, payment mechanism, financial structure, object of payment) are selected as typical cases. The classification of nursing grade, the organization and process of grade evaluation, the way and content of treatment and payment) were compared and summarized. On this basis, according to the same logic, this paper makes a comparative study on the institutional policy details of Qingdao, Shanghai, Changchun and Nantong, which spontaneously explore the long-term nursing insurance system in China. Finally, it is considered that the following problems should be considered in the practice of long-term nursing insurance system in China: a long-term nursing security system for the whole people should be established; It should be attached to the basic medical insurance, and the medical insurance agencies should undertake the business of long-term nursing insurance. In most areas, different financing and treatment systems for workers and urban and rural residents should be established in the short term. The treatment determination organization should be a committee composed of representatives of various interests, and it is appropriate to adopt the three-stage way of sending staff to evaluate, examine by doctors and review by the committee. In terms of treatment and supply, the elderly should be taken as the main service object in the short term, and then the disabled population should be considered, and then the mentally retarded population should be considered. The principle of treatment content design should be to emphasize the basic protection, to encourage the family to fulfill the duty of care, to encourage community nursing services, and to emphasize preventive health care and rehabilitation in the early stage.
【作者单位】：中华人民共和国人力资源和社会保障部社会保障研究所;湖北中医药大学管理学院;
【基金】：国家软科学研究项目留学归国人员择优资助科技项目
【分类号】：F841.3

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