长期护理保险受益资格评估机制探析  

Research of Evaluation on Beneficiary Qualification of Social Long-term Care Insurance

作　　者：孙洁[1] Sun Jie(School of Insurance,University of International Business and Economics,Beijing 100029)

机构地区：[1]对外经济贸易大学保险学院,北京100029

出　　处：《中国医疗保险》2018年第9期13-17,共5页China Health Insurance

摘　　要：在实行社会护理保险制度的国家,政府都颁布相关法律规定受益资格标准。受益资格是评估一项长期护理制度综合性的重要维度之一。作为受益资格的重要组成部分,失能老人的护理需求评估体系是长期护理保险制度的重要组成部分,是护理服务提供、保险待遇享受、服务费用补偿的重要依据,关系到长期护理保险基金的平稳可持续。同时,护理需求评估涉及到长期护理保险待遇支付方式和支付标准,关系到制度实际有效的覆盖面,影响商业保险承办后理赔的标准。因而,受益资格评估是长期护理保险制度的灵魂所在,是一个制度功能的承载。借鉴发达国家经验,我国应实行统一的护理需求评估标准和受益资格认定标准,通过实行标准化、模块化的综合分数评估,为失能失智群体提供护理服务支持。Beneficiary qualification is an important dimension of evaluation on long-term care system. It decides allocation of service resources, refer to coverage, benefit and cost. As a part of important component, care needs assessment for disabled elderly is an important basis of service supply, beneficiary available and reimbursement. So Beneficiary qualification is the bearing of the system function.Use for reference of developed countries, we should enact unified standard of evaluation on beneficiary qualification, and modular evaluation.

关 键 词：社会长期护理保险 受益资格 护理需求评估 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]