嵌入医保：我国长期护理保险的模式选择

发布时间：2018-03-12 20:15

本文选题：长期护理保险　切入点：嵌入医保　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：随着我国人口老龄化的加剧,老年人口不断增多,尤其是高龄老人占老年群体的比重逐渐加大,一方面是身体机能的自然衰退,另一方面是老年疾病、慢性病高发,还有少数其他因素,导致失能、半失能老人的数量也不断上升。这一现象同时激发了关于老人的日常生活照料、康复保健式护理、精神慰藉等方面需求的增长。与此同时,家庭结构小型化、妇女职业化、人口社会流动的加剧,导致家庭在供养老人(尤其是服务供给)方面日趋乏力。老人大量的护理需求或者被抑制或者需求家庭以外的方式来满足。在现有的护理模式中,无论是医院护理还是护理院护理,不仅价格昂贵且数量不足,虽然商业护理保险发挥了一定的保障功能,但是因其覆盖范围狭小,费率较高、易发生道德风险,所以无法满足老人普遍性的护理需求。面对严峻的现实,学界正在不断探索将护理服务纳入到保险保障范围,发展社会性的长期护理保险以便更好地解决失能、半失能老人的护理问题。简而言之,老人护理的主要责任已经由家庭转向社会,如何保障老年人的生活质量、心理健康和生命尊严,满足老年护理需求,对长期护理保险的建立和发展提出了挑战。在当前的社会经济环境下,对于长期护理保险的发展模式,学术界普遍认为需要制度创新,但对于如何创新存在分歧,主要围绕着长期护理保险独立成体系、嵌入养老保险、嵌入医疗保险和三险合一四种模式产生争论。本文以我国失能半失能老人比重不断上升而产生的长期护理服务供给不足、价格昂贵为主要问题,以长期护理保险的最优模式选择为研究目标,查阅了国内外相关文献资料,运用制度创新理论、社会分工论和生命周期假说三种理论分析了我国推行长期护理保险制度模式的必要性和紧迫性,主要包括居民老有所养的需要、保险制度自身创新的需要和资源优化配置的需要。在详细阐述目前关于长期护理保险的四种构建模式的起源和特点的基础上,对比分析了四种创新模式的优势和不足,得出结论:将长期护理保险制度嵌入医疗保险是符合当前社会经济发展阶段的最优模式选择。进而,通过借鉴国外成熟的发展经验和国内试点经验,总结长期护理保险制度发展的一般规律,探寻长期护理保险与医疗保险的结合点,从立法规范、多元主体参与、保障范围、筹资模式、待遇给付和质量控制等方面设计长期护理保险嵌入医保的具体模式,并对模式构建进程中可能出现的问题做出预测并提出应对之策。
[Abstract]:With the aggravation of the aging population in our country, the elderly population is increasing, especially the proportion of the elderly people in the elderly population is gradually increasing. On the one hand, the natural decline of the body function, on the other hand, is the disease of the elderly, the high incidence of chronic diseases. There are a few other factors that lead to disability and the increasing number of semi-disabled elderly people. This phenomenon has also stimulated an increase in the demand for daily care, rehabilitation care, psychological comfort, etc. The miniaturization of the family structure, the professionalization of women, the intensification of social mobility, As a result, families are becoming increasingly weak in providing for the elderly (especially in the provision of services). A large number of nursing needs of the elderly are either suppressed or met in ways other than the family. In the current care model, Both hospital nursing and nursing care are not only expensive and insufficient in quantity. Although commercial nursing insurance plays a certain protective role, it is prone to moral hazard because of its narrow coverage and high rates. Therefore, the universal nursing needs of the elderly cannot be met. In the face of the severe reality, the academic community is constantly exploring the integration of nursing services into the scope of insurance protection, and developing social long-term care insurance in order to better solve the problem of disability. In short, the primary responsibility for the care of the elderly has shifted from family to society. How to ensure the quality of life, mental health and dignity of life of the elderly and meet the needs of elderly care, It is a challenge to the establishment and development of long-term nursing insurance. In the current social and economic environment, the academic community generally thinks that the development mode of long-term care insurance needs institutional innovation, but there are differences on how to innovate. This paper focuses on the independent system of long-term nursing insurance, including old-age insurance, medical insurance and the integration of three insurance. This paper focuses on the shortage of long-term nursing services due to the increasing proportion of disabled and semi-disabled elderly people in China. Taking the choice of the optimal mode of long-term care insurance as the research goal, the paper reviews the relevant literature at home and abroad, and applies the theory of institutional innovation. Three theories of social division of labor and life cycle hypothesis have analyzed the necessity and urgency of carrying out the long-term nursing insurance system in China, including the needs of the elderly and the security of the residents. On the basis of expounding in detail the origin and characteristics of the four construction modes of long-term nursing insurance, the advantages and disadvantages of the four innovative modes are compared and analyzed. The conclusion is that it is the best choice to embed the long-term nursing insurance system into medical insurance in line with the current stage of social and economic development. This paper summarizes the general law of the development of long-term nursing insurance system, explores the combination of long-term nursing insurance and medical insurance, and discusses the legislative norms, the participation of multiple subjects, the scope of security, and the mode of financing. The specific model of long-term nursing insurance embedded in medical insurance is designed in the aspects of benefits and quality control, and the possible problems in the process of model construction are forecasted and countermeasures are put forward.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684;R47

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