摘要
当前,探索稳定、可行的长期护理保险制度是我国亟待完成的任务。社会长期护理保险在我国是新生制度,亟待总结国内外的相关经验。首先综述国际上长期护理保障制度理论和实践中的模式,发现虽然长期护理保障制度按筹资来源可分为财政支持、社会保险、私营保险和依托医疗保障计划筹资四种,但大多国家实行混合制度;继而总结了国际长期护理保险制度的发展趋势。随后,选取德国、荷兰、日本、韩国四个国家作为典型案例,对四国长期护理保险制度的制定背景和政策细节(保险人、被保险人、缴费机制、财务结构、给付对象、护理等级分类、等级评定机构和流程、待遇给付方式和内容)进行比较研究和归纳。在此基础上,按照同样逻辑,比较研究国内先行自发探索长期护理保险制度的青岛、上海、长春和南通四个城市的制度政策细节。最后,认为我国在长期护理保险制度实践中应考虑如下问题:应该建立面向全民的长期护理保障制度;应依附于基本医疗保险,由医疗保险经办机构承担长期护理保险经办业务;大部分地区短期内应建立职工和城乡居民不同的筹资和待遇体系;待遇确定机构应为多方面利益代表联合组成的委员会,适宜采取经办机构派员入户评估、医生审查、委员会复核的三段式方式;待遇供给方面,短期内应以老年人为主要服务对象,进而考虑失能人群、再考虑失智人群,有条件的地方可以全覆盖;待遇内容设计的原则应该是强调保基本、鼓励家庭履行照护义务、鼓励社区护理服务、强调前期预防保健和康复。
Currently, there is an emergent task in China, which is to establish a stable and feasible long- term care insurance system. However, as a newly emerging thing, it needs to summarize the external and internal experience. The research firstly summarizes the international long-term care security system in theory and practice. It is found that the long-term care security system can be classified into four categories： financial support, social insurance, private insurance and financing by means of medical insurance scheme, according to the sources of financing. But most countries implement a mixed system. Then, the development trend of the international long-term care security system is summarized. Secondly, taking Germany, Holland, Japan and South Korea as four typical cases, the research comparatively studies and summarizes the background and policy details （the insurer, the insured, contribution system, object of insurance payment, classification of nursing grades, rating agencies and processes, payment methods and contents） of the long term care security system in the four countries. On this basis, according to the same logic, a comparative study on the institutional and policy details of four cities is made, including Qingdao, Shanghai, Changchun and Nantong, which firstly explores the long-term care insurance system spontaneously in China. Finally, the research suggests that the following issues should be considered in the practice of long-term care insurance system in China. A long- term care security system for all people should be established. The long-term care insurance should be attached to the basic medical insurance, and its business should be undertaken by medical insurance agencies. In most areas, financing and payment systems for employers and residents should be established separately in the near future. Payment determination institute should be a committee composed of representatives of various interests; it＇s appropriate to take the audit way of three stages by the agencies, doctors and co
出处
《四川理工学院学报（社会科学版）》
CSSCI
2017年第5期1-22,共22页
Journal of Sichuan University of Science & Engineering(Social Sciences Edition)
基金
国家软科学研究项目
留学归国人员择优资助科技项目
关键词
长期护理保险
社会保险
私营保险
个人缴费
城乡居民
国际经验
中国模式
long term care insurance
social insurance
private insurance
personal payment
urban and rural residents
international experience
China practices
