Study On Evaluation And Optimization Of Pilot Effect Of Long-term Care Insurance For Urban And Rural Residents

Since the beginning of the 21 st century,China is faced with the double pressure of“rapid aging” and “rapid old aging”.Also,the rapid increase in the number of disabled elderly is another urgent issue.In the trend of miniaturization of family structure and increase of female employment rate,the function of caring the elderly undertaken by the family has gradually weakened.In this context,the Ministry of Human Resources and Social Security proposed to carry out the pilot project of long-term care insurance in 2016.It started an ice-breaking journey for the national long-term care insurance system.Long-term care insurance,as an important part of China's institutional framework to actively respond to the aging population,is a crucial measure to meet the needs of long-term care of society.Over the past four years,long-term care insurance has played an important role in reducing the economic burden of disabled elderly families,optimizing the allocation of medical resources,and improving the quality of life of the elderly.However,the development of the system is still in its infancy.There are some problems,for instance,the development of long-term care services is not developed,the range of beneficiaries of the system is narrow,and top-level design is short in supply.In particular,the established facts of differentiated pilots caused by the “blooming of a hundred flowers” policies in various regions hinder the unification of the long-term care insurance system.At present,the voice of pilot expansion is getting increasingly louder.It is an inevitable trend to establish and improve the long-term care insurance system nationwide as soon as possible,especially the long-term care insurance for urban and rural residents that covers more people.Hence,it is not only necessary but also urgent to study the evaluation of the pilot effect of the long-term care insurance for urban and rural residents,and provide theoretical reference and practical guidance for the optimization and pilot promotion of the long-term care insurance for urban and rural residents.In this paper,the long-term care insurance for urban and rural residents is taken as the research object,according to Welfare Pluralism,Service Quality Evaluation Theory,Savas Theory of Privatization and other related theories,on the basis of domestic and foreign literature review and existing research,using actuarial,AHP+entropy weight,fuzzy comprehensive evaluation method,Three-stage DEA+Tobit,PLS-SEM and other model methods,from the aspects of concept definition,framework combing,current situation analysis,financing effect evaluation,service effect evaluation,handle effect evaluation,policy optimization and so on,makes a more in-depth and systematic study on the pilot effect and optimization of long-term care insurance for urban and rural residents.The main research conclusions are as follows:(1)The of pilot city areas include eastern,central and western regions.The aging degree and the average life expectancy of the population are relatively high,far exceeding the average of China.The economic situation is generally relatively wealthy,and the living standards of residents are relatively high.Since the pilot of long-term care insurance for urban and rural residents,it has effectively reduced the family economic pressure of disabled people,liberated the labor force,reduced the expenditure of medical insurance fund on the whole,improved the quality of life of the elderly,greatly promoted the development of care industry and expanded employment channels,and played a positive role in resolving the risk of disabled care and meeting the diversified care needs of the elderly.(2)The accumulated balance of the fund of basic medical insurance for urban and rural residents in the forecast period increased first and then declined.On the one hand,the accumulated balance of the fund of basic medical insurance for urban and rural residents can be used reasonably and effectively.In other words,it can partially pay for the expenses of long-term care insurance for urban and rural residents.On the other hand,it is also necessary to be vigilant against the trend of declining accumulated balances to avoid affecting the sustainability of medical insurance funds due to excessive allocation costs of long-term care insurance for urban and rural residents.Regardless of coverage,the multi-financing mode has higher fund sustainability than the medical insurance allocation mode.The proportion of the fund of basic medical insurance for urban and rural residents in the financing amount of long-term care insurance for urban and rural residents should not exceed20% no matter in the coverage of severe,moderate or severe disabled elderly.At this level,it can be basically ensure the balance of medical insurance fund revenue and expenditure.In addition,the accumulated balance of medical insurance fund can be made full use in the forecast period.The multi-financing mode of “individual payment+medical insurance allocation+financial subsidy” should be adopted for the long-term care insurance for urban and rural residents.In the context that the proportion of the fund of basic medical insurance for urban and rural residents to pay for the fund of long-term care insurance for urban and rural residents is 20%.The proportion of individual payment should be controlled at15% of the total amount of financing;the proportion of individual payment to the per capita disposable income of rural residents is between 0.18% and 0.23%.The financial subsidy is supposed to account for 65% of the total amount of financing,that is,the proportion of the financial subsidy on the long-term care insurance for urban and rural residents to the national fiscal expenditure is between 0.54% and 0.92%,thus ensuring the sustainability of the system as well as the affordability of the system.(3)The services supply efficiency of long-term care for urban and rural residents and its influencing factors have been analyzed based on the three-stage DEA-Tobit model.The study found that: as a whole,designated care service institutions are still in the initial stage,and there is much room for improvement of comprehensive technical efficiency.Compared with before and after the adjustment of SFA regression,the efficiency of designated care service institutions changed significantly.Specifically,the scale redundancy caused by environmental factors is mainly manifested in the more developed or aging areas,the more likely the caregivers and auxiliary personnel are to be surplus;the more financial investment,the more likely the beds are to be idle.There are obvious differences in the comprehensive efficiency of designated care service institutions of different supply mode.The efficiency value of designated care service institutions of PPP supply mode is higher than that of designated care service institutions of government arranged supply mode.Tobit regression analysis shows that supply mode,geographical location,timely fee settlement,and medical care integration,collectively,have a significant positive impact on the supply efficiency of designated care service institutions,while the impact of service types and frequency of supervision is not significant.(4)Under the evaluation standard of 1 to 5 points,the comprehensive evaluation score of the long-term care institutions service quality of urban and rural residents is 3.384,which is more inclined to the“average”level,indicating that the long-term care institutions service quality of urban and rural residents is recognized to a certain extent;the scores of the first level indicators from high to low are as follows: empathy is the best(3.718),assurance(3.627),responsiveness(3.495),shape(3.383),followed by effectiveness(3.176).This shows that there is still a lot of room for improvement in various indicators,especially in the dimensions of shape and effectiveness.The comprehensive evaluation score of the long-term care home service quality of urban and rural residents is 3.779,which is higher than the quality of institutional care service and inclined to the “relatively good”level.This shows that the long-term care home service quality of urban and rural residents is relatively ideal;the scores of the first level indicators from high to low are as follows:effectiveness(3.978),assurance(3.919),empathy(3.900),shape(3.419),responsiveness(3.128),except for the responsiveness dimension,the scores of all indicators are higher than the quality of institutional care services.(5)The evaluation of the handling ability of long-term care insurance for urban and rural residents can be carried out from the aspects of qualification application,disability assessment,institution access,treatment payment and policy publicity.The comprehensive evaluation values of the handling ability of long-term care insurance for urban and rural residents under the social-business cooperative mode and government arranged mode are3.477 and 3.348 respectively.Compared with the government arranged mode,the social-business cooperative mode shows stronger handling ability and higher public satisfaction.Further analysis of influencing factors verified the significant impact of the mode of handling on the handling ability of long-term care insurance for urban and rural residents.In addition,it also showed that human resources,information system construction,administrative culture,and policy support would have an significant positive influence on the handling ability of long-term care insurance for urban and rural residents,and the expectation of participation will show a significant negative impact on the handling ability of long-term care insurance for urban and rural residents.The improvement of the handling ability of long-term care insurance for urban and rural residents would reduce the frequency of complaints and improve the degree of trust in the long-term care insurance for urban and rural residents,thus enhancing the sense of obtaining the policy.(6)Policy suggestions for the optimization of the long-term care insurance for urban and rural residents include three aspects: financing,service and handling.From the perspective of financing,surplus funds should be used rationally to expand the scope of system protection,establish a multi-channel fund-raising mechanism with shared responsibilities,coordinate the relationship with commercial long-term care insurance,and clarify the purpose of social long-term care insurance funds;from the perspective of service,adhere to the reform direction of the PPP supply mode of long-term care services,continuously improve the efficiency of service supply,focus on dimensions of shape and effectiveness,improve the long-term care institutions service quality of urban and rural residents,focus on dimensions of responsiveness,and improve the long-term care home service quality of urban and rural residents;from the perspective of handling,commercial insurance companies should be encouraged to participate in the handling of long-term care insurance for urban and rural residents,implement a social-business cooperative handling mode,cultivate professional talents,cultivate proper administrative culture,improve related supporting policies,and strengthen the construction of information systems.