上海市长期护理保险与社会医疗保险制度对接路径研究  

Study on the Docking Path between Long-term Care Insurance and Social Medical Insurance System in Shanghai

作　　者：魏梦娟 孙烨 高程程 马俊 WEI Meng-juan;SUN Ye;GAO Cheng-cheng;MA Jun(Shanghai University of Engineering Science,Shanghai 201620,China)

机构地区：[1]上海工程技术大学

出　　处：《现代医院管理》2019年第6期93-96,共4页Modern Hospital Management

摘　　要：通过对上海市长期护理保险参保对象与待遇给付对象的分析,追根溯源,辨析长期护理保险基本概念,明确就长期护理保险本身而言,其不应只是应对老龄化带来的社会问题,也应是基于整个生命周期面向具有失能、失智风险的人群的护理服务。从分析长护险与医保制度设计出发,对比分析两种制度的参保对象、筹资渠道、待遇给付对象以及服务提供方式,并结合实地调研的经验,从制度衔接的角度分析政府职能协调、筹资渠道对接、医疗服务与护理服务对接的现状及存在的问题,从长护险与医保资金筹集,医保与长护险费用报销,医保与长护险服务对接,医疗信息共享四个方面进行长护险与医保制度对接路径设计。Through the analysis of the long-term care insurance participants and the beneficiaries in Shanghai,the basic concept of the long-term care insurance should be distinguished and analyzed after tracing to the source,so as to make it clear that the long-term care insurance itself should not only deal with social problems brought by aging,but also be nursing services for people with the risk of disability and dementia based on the whole life cycle.Starting from the analysis of the long-term care insurance and medical insurance system,insurance participants,financing channels,beneficiaries and service delivery in the two systems were analyzed and compared.The path design of the long-term care insurance docking with the health care system was made from the the four aspects of the long-term care insurance,medical insurance fundraising,medical insurance and the long-term care insurance reimbursement,health care and insurance services docking,medical information sharing.Combined with the experience of field research,this paper also analyzes the status quo and the existing problems of government function coordination,financing channel connection,medical service and nursing service connection from the perspective of system connection.

关 键 词：长期护理保险医疗保险制度衔接 

分 类 号：R197[医药卫生—卫生事业管理]