Research On China’s Long-term Care Insurance Policy From The Perspective Of Active Aging

With the advent of the age of longevity and the rapid expansion of the disabled elderly population,the traditional long-term care model for the elderly in China is facing difficulties.The disability risk of the elderly population has become a serious challenge for the government and society.In order to actively deal with the disability risk of the elderly population,the Chinese government has launched the pilot work of long-term care insurance system,and encouraged the pilot cities to explore the longterm care insurance system with localization significance.Although the government and academic circles have stressed the need to sum up the experience of the pilot cities,there is still a lack of research on the overall situation,common characteristics and common problems of the long-term care insurance policy in the pilot cities at this stage.Especially in the context of the national strategy of actively coping with the aging population,the relevant research on the extent to which the long-term care insurance policy has practiced the theory of active aging is still insuficiency.Based on this,from the perspective of positive aging theory,combined with policy output model,this paper analyzes the overall status,common characteristics and common problems of long-term care insurance policies issued by 30 pilot cities,and explores how to promote the development of China’s long-term care insurance policies.Specifically,the main contents are as follows:Firstly,based on the theory of active aging and the policy output model,this paper constructs the policy analysis framework of long-term care insurance,which is composed of three dimensions:participation,health and security.(1)The dimension of participation refers to safeguard the opportunities and rights of the disabled elderly to receive welfare and participate in the long-term care services provided for them according to their personal needs,that is,the social distribution basis of long-term care insurance policy,which specifically includes three parts:the scope of insurance,the object of protection,the standard and subject of disability identification.(2)Health dimension refers to the long-term care service supply system that provides health and social services for the disabled elderly,which is composed of social supply types and delivery system.The type of social supply is further divided into three parts:service items,service forms and payment standards;the delivery system can be divided into government departments,long-term care insurance agencies.designated nursing institutions and informal care subjects.(3)Security dimension refers to the financing mode to solve the problem of long-term care service cost for the disabled elderly,which mainly includes three parts:financing channels,financing forms and standards,and start-up funds.Secondly,using the policy analysis framework of long-term care insurance,the development status and common characteristics of long-term care insurance policies in30 pilot cities were compared and analyzed.(1)The development status of long-term care insurance policy in 30 pilot cities can be summarized as follows.Firstly,in the dimension of participation,the coverage of basic medical insurance is mainly determined;the objects of insurance are limited by four factors:the length of disability,the degree of disability and dementia,the place of receiving long-term care services and the length of time to pay medical insurance fees;there are three kinds of disability assessment tools:ADL.ability assessment for older adults as well as the local self established comprehensive disability assessment standards;the assessment subjects mainly include insurance agencies,labor appraisal committees,third-party assessment institutions,designated nursing institutions,commercial insurance institutions and experts.Secondly,in the health dimension,the first is that the service items mainly include life care,medical care,preventive care,rehabilitation care and psychological counseling;the second is that the service forms can be divided into fixed-point institutional care(medical institution care and elderly care institution care),home care(home-based care,home-based self-care)and dementia zone;the third is that the payment standard can be divided into three categories:proportional payment,fixed payment or differential compensation.Thirdly,in the dimension of security,the most common financing channels include the transfer of basic medical insurance fund and personal account,government subsidies and personal payment,the financing forms mainly include proportional financing,quota financing and mixed financing;most regions have the start-up funds of long-term care insurance.(2)The common characteristics of the long-term care insurance policy in the pilot cities are as follows:firstly,in the dimension of participation,the long-term care insurance policy is a kind of social policy based on the diagnosis difference;secondly,in the dimension of health,the pilot cities adopt the post remedial risk response strategy with service welfare as the main and cash welfare as the supplement;the welfare delivery system is a decisive factor.Third,in the security dimension,the financing mode is a pay as you go social insurance type,mainly relying on medical insurance.Thirdly,based on the theory of active aging,we examine the long-term care insurance policies of 30 regions and find some common problems.(1)The main problems in the social distribution basis of participation dimension include:urban and rural residents are not included in the coverage,the elderly with severe mental retardation are excluded from the welfare applicants,the structure of disability identification and evaluation tool is simple,the setting of disability evaluation level is rough and inconsistent,and the lack of independent and professional disability evaluation organization.(2)The main problems of social supply type of health dimension are:lack of preventive strategies,low accuracy of service supply content;the main problems of welfare delivery system are:ignoring the important role of community,and the service delivery layout with institutional care as the core is difficult to solve the problem of imbalance between supply and demand of long-term care.(3)The main difficulties of the financing mode of security dimension are as follows:the limited payment ability of the financing subject,the inconsistency between treatment payment and individual payment,and the controversy of the financing mode with longterm care insurance as the core.Next,this paper summarizes the practical experience of the Netherlands,Germany and Japan,which are more advanced countries in long-term care insurance system,and gets the following enlightenment.(1)In the dimension of participation,the coverage of the three countries is adjusted according to the operation status.In general,the Netherlands and Germany cover all citizens,while Japan mainly focuses on the elderly;they have established a unified evaluation system;in addition,they have also established a unified evaluation system.The elderly with ability have the right to choose the form of welfare payment.(2)In the dimension of health,the three countries pay attention to the development of informal care;in the long-term care service supply,community,as the center of service system,connects and integrates home care,institutional care and informal care,which solves the fragmentation of service supply;in the service supply,we strengthen the supervision of service quality;pay attention to preventive strategies;three countries before the legislation of long-term care insurance system all allow a "preparation stage" to reserve service providers for the formal operation of the system.(3)In the security dimension,the first is the special use of special funds,which increases the feasibility of introducing the plan;the second is the separation of funds from the larger government budget,so that the financing of longterm care insurance will not directly conflict with military,education,infrastructure investment and other priority projects.Third,the three countries take the long-term care insurance as the basic system,and adopt a variety of ways to supplement it.Finally,it puts forward the promotion strategy of China’s long-term care insurance system.(1)It follows the basic value orientation of distributive justice,pursues the four principles of equal opportunity:equal distribution of interests and responsibilities,reasonable distributive standards and procedures,and correction of injustice.(2)In the dimension of participation,we need to improve the disability assessment system,expand the right of disabled elderly to choose welfare content independently,and provide policy support for the elderly to palrticipate in long-term care service provision.(3)In the health dimension,we should jointly promote the construction of community care service system,the construction of cross sectoral service supply mechanism based on the life course,and promote the combination of formal care and informal care to develop the localized integrated care service system.(4)In the security dimension,we should build a multi-level long-term care security system,the long-term care subsidy system is the foundation,the long-term care social insurance system is the core,and the long-term care commercial insurance is an important supplement.