长期护理保险试点财务赤字风险的评估研究--基于第一批15个试点方案的分析  

An evaluation study on the risk of financial deficit for the long-term care insurance pilots:Based on analysis of the operational scheme in the 15 first-batch pilots

作　　者：陈鹤 赵姗姗 崔斌[2] CHEN He;ZHAO Shan-shan;CUI Bin(School of Public Administration and Policy,Renmin University of China,Beijing 100872,China;School of Public Health,Peking University,Beijing 100191,China)

机构地区：[1]中国人民大学公共管理学院,北京100872 [2]北京大学公共卫生学院,北京100191

出　　处：《中国卫生政策研究》2021年第12期42-50,共9页Chinese Journal of Health Policy

基　　金：国家社会科学基金重大项目(17ZDA124);教育部人文社会科学研究青年项目(18YJC840003);中国人民大学科学研究基金项目(21XNA004)。

摘　　要：目的:评估第一批15个长期护理保险国家试点的财务机制在全国推广后出现财务赤字的风险(2020-2040年)。方法:基于227篇政策相关文件综述各试点的财务机制,选择机制明确、数据可得性高的安庆、承德、重庆、广州、齐齐哈尔、石河子、南通7个试点方案进行预测分析。利用CHARLS2015和2018年数据,以微观仿真方法模拟100万个体在2020-2040年的健康转移轨迹,加权后估计全国推广后的财务收支状况。结果:2020-2040年,我国失能老年人规模、失能时长、长护需求均呈现上升态势,长护险财务压力不断增加。本研究推导了7个试点方案不出现财务赤字的约束条件,即长护险筹资水平和待遇水平的年均增长率需要满足的条件。结论:本研究有利于我国选择财务赤字风险低的试点方案进行推广。未来应注重长护险财务收支的双维联动,并加强对长护险财务可持续性的预测评估。同时,在择优推广时,方案对长护需求的满足程度、养老文化和长护险产业发展情况等也是重要的考虑因素。Objective:To evaluate the rik of financial deficit in the national promotion of long-term care insurance(LTCI)mechanism from 2020 to 2040 following the 15 first-batch pilots.Methods:This study firstly summarized the financial mechanism of each pilot based on 227 policy-related documents,and selects 7 pilot schemes respectively from Anqing,Chengde,Chongqing,Guangzhou,Qiqihar,Shihezi and Nantong which had clear mechanisms and high data availability for predictive analysis.Based on data from CHARLS2015&2018,a microsimulation method was used to simulate the health transition trajectory of 1 million individuals from 2020 to 2040,and the results were weighted to estimate the financial income and expenditure situation following the assumed nationwide promotion of the new policy.Results:During 2020-2040,the scale,time length of disability and demand for LTC of disabled elderly were all predicted to manifest an increasing trend,which would continuously increase the financial pressure of LTC.This study further derived the constraint conditions for preventing financial deficit in the 7 pilot schemes,i.e.,the required annual growth rates of fundraising and benefits in LTCI.Conclusions:This study provided useful information to help China select pilot schemes with lower financial deficit risk for policy promotion.It is suggested that the future implementation of the LTCI policy should pay attention to the bi-dimensional relay between income and expenditure,and that the predictive evaluation on LTCI's financial sustainability should also be better conducted.Meantime,when selecting the optimal schemes for promotion,how the schemes meet the demand for LTC,the elderly care culture and the development status of LTC industry should also be considered as important factors.

关 键 词：长期护理保险 财务赤字风险 微观仿真 评估研究 

分 类 号：R197[医药卫生—卫生事业管理]