| [Purpose] Analyze the operation mechanism and efficiency of different commercial insurance participation in long-term care insurance management model in China,explore the construction of a polycentric governance model for long-term care insurance,analyze the factors affecting the role of commercial insurance in the long-term care insurance management model in J city,propose an optimization strategy for commercial insurance participation in the construction of long-term care insurance,and provide a perfect long-term care insurance system in China The study will provide a reference for the improvement of long-term care insurance system in China.[Methods] Through literature research method,we sorted out the contents of long-term care insurance policies and the management models of commercial insurance participation in long-term care insurance in China,compared and analyzed the operational efficiency of different management models through data envelopment analysis,and constructed a polycentric governance model of long-term care insurance based on the management model with better operational efficiency and combined with the connotation of polycentric governance theory.Qualitative interviews were conducted with the medical insurance bureau of J city,insurance companies,care service providers and other governance subjects,and descriptive analysis of data on the operation of long-term care insurance in J city was conducted.[Results](1)This study analyzes the content of China’s long-term care insurance policy based on social welfare policy theory.In terms of participation dimension,the target participants are set to rely on the scope of basic medical insurance,and their benefits are influenced by the length of disability,the degree of disability(only severely disabled people are covered in 20 pilot cities)and the mode of care services.In the supply dimension,firstly,the service content includes daily living,medical service,disease prevention,rehabilitation service and psychological comfort;secondly,the service form can be divided into designated institutional care and home care(23 out of 29 pilot cities provide both forms of service);thirdly,the treatment payment is divided into proportional reimbursement and fixed reimbursement.The subjects in the delivery dimension are government departments,commercial insurance companies,care service organizations,and NGOs.In the protection dimension,there are two main channels for raising insurance funds: single-center and multi-funding.There are three forms of financing: proportional financing,flat-rate financing,and mixed financing.Government departments are mainly responsible for system development and supervision in the participation dimension,supply dimension and protection dimension,while commercial insurance companies and other organizations mainly provide welfare services in the delivery dimension.(2)This study compares the management models of domestic commercial insurance companies’ participation in long-term care insurance and analyzes the operational efficiency of 14 pilot cities of long-term care insurance in 2020.The management models are divided into three categories according to the differences in the degree of involvement of commercial insurance companies in the provision of services,review of disability levels,information construction,fund raising and management,and system design: government purchased services model,government commissioned management model,and government subsidized operation model.The main difference between the three models is whether insurance companies can participate in the management of long-term care insurance funds and the design of the long-term care insurance system in the pilot cities.In terms of efficiency: the input indicators of the evaluation index system selected the number of health personnel,the number of beds,the number of medical institutions,and the amount of fund financing,while the output indicators selected the number of people receiving treatment and the amount of fund expenditure.The results showed that the technical efficiency of 14 pilot cities of long-term care insurance reached 0.536,and only three cities,Shanghai,Jingmen,and Chengdu,achieved DEA effectiveness.The average efficiency values of the government-commissioned management model exceeded those of the government-purchased service model in terms of technical efficiency,pure technical efficiency,and scale efficiency.(3)This study constructs a polycentric governance model for long-term care insurance and conducts an empirical study of city J.The model is based on the following conditions The model is implemented under conditions to achieve plurality of participating subjects,multi-directionality of power,and efficiency of operation.The management model of city J is close to the long-term care insurance polycentric governance model and has achieved good results.After the introduction of T insurance company in city J,the utilization rate of long-term care insurance fund increased from17.90% in 2018 to 56.61% in 2021;the per capita handling to enjoy long-term care insurance service cost decreased from 752.18 yuan in 2018 to 399.23 yuan in 2021;the actual compensation ratio of the fund increased from 69.79% in 2018 to 77.56% in 2021.(4)A variety of factors affect the role of commercial insurance.The overstepping of government departments,the lack of management model power multi-directionality,the lack of independent and closed operation of insurance funds,the lack of performance assessment system of insurance companies and the weak business capacity of commercial insurance may affect the effectiveness of governance of commercial insurance participation in long-term care insurance.[Conclusion](1)China’s commercial insurance participation in long-term care insurance management model has opened up channels for social organizations to participate in long-term care insurance governance,but there are shortcomings in fair public authority to implement public management and transparency in the decision-making process,and the results of the efficiency analysis indicate that there is more room for improvement.(2)The results of practice in city J show that the plurality of participants in the polycentric governance model of long-term care insurance helps to achieve a win-win situation for all parties,and commercial insurance not only reduces the burden of government work,but also helps itself to enter the retirement market and improve the convenience of residents’ participation in insurance.The efficient operation of commercial insurance contributes to the sustainable development of the long-term care insurance system.(3)The management model of long-term care insurance in J city has achieved the plurality of participating parties and efficient operation but lacks the multi-directional nature of power.The lack of decision-making power,two-way supervision power and weak revenue of commercial insurance companies weakened the motivation of insurance companies and affected the effective participation of commercial insurance.To improve the management mode of commercial insurance participation in long-term care insurance,it is necessary to realize the multi-directional power based on the plurality and efficiency of the participating parties,and the governmental departments need to do a good job of service-oriented government and continuously improve the supporting system of long-term care insurance,while commercial insurance companies need to further improve their business capacity and narrow the difference between their services and the needs of the public. |
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