| China is in a critical period of population aging.While life expectancy is prolonged,the quality of life has also changed.Both of them have stimulated the growing demand for long-term care of the elderly population.As well as providing a dignified and high-quality life for the elderly,China is accelerating the promotion of the long-term care insurance system,and takes the "sixth insurance of social security" as the development goal,which is clearly stated in the four five-year plans.At present,there are 49 long-term care insurance pilot areas in China,and the inter-regional systems show fragmentation characteristics in both financing standards and compensation standards.The measurement of the disability risk of the elderly is the basis for the calculation of nursing needs.As the insurance is an important risk sharing mechanism,so the choice of its financing model is crucial to the sustainability of social insurance funds.Therefore,the simulation analysis of the long-term care insurance policy based on the disability level of the elderly is of great significance for the establishment of a social long-term care insurance system covering the whole people and integrating urban and rural areas.Population aging has become an inevitable trend of social development in China.Based on the establishment of social long-term care insurance,this study tries to start from the trend of disability changes brought about by population aging,and disassemble the impact of life extension and disability compression or disability expansion on healthy life expectancy.Using the Chinese Longitudinal Healhth Longevity Survey(CLHLS)tracking data and other micro-sampling survey data to establish the trajectory of changes in the health status of the elderly in China;based on macro time series data such as historical mortality and fertility rates,estimate the size of the disabled population in the future nationally and regionally;Further establish the actuarial balance formula at the national level,and then solve the equilibrium premium rate and payment amount of long-term care insurance under different financing models,and compare the results with the actual financing level of each pilot area.Considering that the operation of long-term care insurance is mostly based on the financing of medical insurance funds and the fragmentation of the long-term care insurance system in each pilot regions,therefore,modeling the long-term care insurance fund operation model relying on the medical insurance fund from a regional perspective,and predict and evaluate the sustainability and financial burden of the future medical insurance fund.In addition,the prediction process in this paper will generate a large number of intermediate variables,such as economic variables such as future long-term care insurance demand,institutional care and home care demand,and demographic variables such as the insured population and beneficiary population under different systems.Therefore,the theoretical model and policy simulation results established in this paper will provide a certain theoretical basis and data support for the decision-making of Chinese long-term care insurance system,and provide suggestions for the future development direction of the long-term care insurance system.Based on the above research ideas,the work carried out and completed in this paper is as follows:(1)Has the quality of life been improved in the context of declining mortality?First,using the multi-period survey data of the Chinese Longitudinal Healhth Longevity Survey(CLHLS),according to the latest standards for disability assessment,using descriptive statistical analysis to briefly describe the horizontal and vertical disability rates of the elderly in China,the data quality of the micro-sampling survey data and national representativeness of the sample were assessed.The result showed that the disability rate of men measured by activities of daily living(ADL),instrumental activities of daily living(IADL)and cognitive ability from 2002 to 2011 was 11.55-13.63%,and that of women was 17.65-19.71%.The probability of recovering from a mild disability to a healthy state is about 3 to 4 times that of recovering from a severe disability to a mildly disabled or healthy state.Then,a multi-state life table model was established,and the risk exposure method was used to solve the health state intensity matrix of the elderly individuals,and the healthy life expectancy of different survey periods and the duration of the elderly individuals in the disabled state were further calculated.Empirical results show that men’s health advantage and women’s survival advantage were found to not change over time.Finally,the differential analysis of healthy life expectancy and life expectancy in different periods,it is found that Chinese elderly individuals of different age groups,genders,and initial health states conform to different health models,and the healthy elderly individuals in the initial state fit the "‘disability expansion’ model,young male elderly individuals with mild disability in the initial state fit the ‘disability compression’ mode.The younger elderly have a higher life expectancy improvement effect than the older elderly.(2)How to estimate and predict the future size of the disabled population in China and various regions?According to the macro simulation method,the size of the disabled population can be divided into two parts: the size of the elderly population in different age groups and the age-specific disability rate.The future size of the elderly population in each province(autonomous region,municipality directly under the central government)can be obtained through the national population size and population spatial flow model.The current micro-survey database lacks information on the disability rate of 31 provinces(autonomous regions and municipalities),especially the level of disability rate by age.This paper attempts to realize the prediction of the scale of disabled population in various regions in the future under the background of sparse data.First,based on the population cohort composition model,the factors affecting the future population size are decomposed into fertility rate,life expectancy at birth,and migration rate,etc.,and the Bayesian hierarchical model model of the United Nations is used to predict the probability of my country’s future population size and age structure.Among them,when predicting the total fertility rate,the United Nations refers to the fertility transition process of all countries and adds it as a priori distribution,and then uses China’s historical total fertility rate data,using the Markov Monte Carlo method(MCMC)to carry out The posterior distribution is sampled,and finally the posterior distribution of the total fertility rate is obtained.The same is true for modeling life expectancy at birth.Then,assuming that the population flow between provinces obeys the Markov transfer process,the population spatial flow model is used to estimate the future population spatial distribution of each province and obtain a steady-state distribution.Finally,combined with national-level population data and population spatial flow data,the size and age structure of the elderly population in various provinces in China were obtained,and further combined with the data about the inability of the elderly to take care of themselves in the seventh census data,the scale of elderly disabled population in each province is eventually obtained.(3)Under different financing models,what is the equilibrium premium rate of long-term care insurance that conforms to the actuarial balance model?China will face huge financial expenditures for long-term care insurance in the future,so it is necessary to establish a social long-term care insurance system to disperse risks from the overall level of the society,and choose the financing model that is most conducive to the sustainable operation of the system.Therefore,it is necessary to calculate the actuarial balance rate under different financing modes.First,using the multi-period micro-tracking survey data,through continuous time homogeneous Markov process and generalized linear model,to describe the movement law of the health status transition of the elderly in China,and combined with the Seven Census data and the age shift algorithm,the scale and structure of the disabiled elderly population fare calculated;Further based on the actuarial balance theory of social insurance,construct a dynamic actuarial model under the pay-as-you-go system and the three mixed systems for financing,and then set and select different parameters,especially including demographic and economic parameter settings;Finally,the data is substituted to solve the equilibrium premium rate and payment amount of long-term care insurance for urban employees and urban and rural residents in the next 20 years.The results show that during the measurement period and under the same financing mode,the equilibrium premium rate of long-term care insurance for urban employees is lower than that of urban and rural residents,but the payment amount is higher than that of urban and rural residents.Long-term care insurance for urban employees with a lower equilibrium premium rate is more suitable for a mixed system with a certain accumulation function to deal with the possible expenditure gap during the peak period of population disability;Long-term care insurance for urban and rural residents is more suitable for the pay-as-you-go system.At this time,the payment pressure of various fund-raising entities is relatively low,and the operating cost of the system is low,so it is easier to accept in the early stage of promotion.(4)At present,the main source of financing for long-term care insurance funds is the transfer of medical insurance funds.Will the operation of long-term care insurance in the future affect the balance of income and expenditure of medical insurance funds?What is the financial burden resulting from this?Since the financing of urban and rural residents’ medical insurance basically depends on fiscal transfer payments,and its fund balance is smaller than that of employees’ medical insurance,the operation of the long-term care insurance system will have a far greater impact on residents’ medical insurance than on employee’s medical insurance.Therefore,this paper mainly analyzes the financial burden brought by the operation of long-term care insurance for residents relying on residents’ medical insurance.From the theoretical level,this paper analyzes the channels through which the implementation of the long-term care insurance system affects the sustainability of the medical insurance fund.With the aging and disability in the future,the further promotion of the long-term care insurance system will have a negative impact on the sustainability of the medical insurance fund,but because the long-term care insurance may have a certain substitution effect on medical expenses,it may also alleviate medical insurance fund expenditures.Therefore,it is necessary to establish a social insurance actuarial model to simulate the situation caused by the sustainability of the future medical insurance fund deficit and fund balance during the promotion of the long-term care insurance system from 2020 to 2050,and to measure the corresponding financial burden.The empirical results show that when the substitution factor is between 2.057 and 2.058,the nationwide promotion of long-term care insurance will not have any impact on the sustainability and financial burden of the medical insurance fund;the substitution factor in Shanghai is the highest,reaching 3.62;Tibet is the lowest,only is1.26.Although in the initial stage of the long-term care insurance system pilot,it is reasonable to adopt the method of transferring part of the resident medical insurance fund as long-term care insurance financing,but in the long run,independent financing and independent operation of long-term care insurance is still the main direction.The significance and contribution of this study are mainly reflected in:(1)Analyze the disability rate from cross-sectional and longitudinal tracking dimensions to gain a more comprehensive understanding of the actual level of the disability rate of the elderly in China;Moreover,the multi-period tracking data reduces the fluctuation caused by cross-sectional data or one-time tracking survey data measurement,so that the prediction of the future disabled population size is more accurate.This paper also defines mild disability and severe disability according to the latest disability assessment standards,refines the unhealthy state,and enriches the research on health and lifespan.(2)This paper models the transition trajectory of the health status of the elderly from a micro perspective,and predicts the size of the disabled population in each region from a macro perspective by embedding the inter-provincial population flow model in the cohort factor model.On the one hand,from the perspective of the differences of elderly individuals,it explores the performance of the elderly with different characteristics such as gender,urban and rural areas,and initial health status in terms of health and longevity;On the other hand,from the commonality of the elderly group,it shows the general trend of aging and disability in the future.The combination of individuality and commonality can more comprehensively describe the historical changes and future development trends of my country’s elderly population.(3)In terms of theoretical model construction,the risk exposure method of actuarial science and the multi-state life table method of demography can be combined to make more effective use of the specific information of the sample during multiple investigations and the time of death;Use the population cohort element method and the population spatial flow model to describe the future population spatial distribution and population change trend in more detail;Under different social insurance actuarial balance frameworks,establish the equilibrium payment rate for four modes of annual balance of payments,ladder balance of payments,long-term balance of payments and annual reserve balance.(4)Through the simulation study of long-term care insurance systems in different pilot areas,this study will produce a series of forecast results such as deficit time point,accumulated balance,and financial burden.This provides a data reference for the further promotion of the future long-term care insurance system and the sustainability of the medical insurance fund.And from a regional perspective,it enriches the actuarial research on my country’s social long-term care insurance,and provides a direction for the improvement of the coordinated regional adjustment system in different pilot regions. |
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