基于PMC指数模型的我国长期护理保险政策量化评价——以11个不同失能评估标准的试点城市为例  

Quantitative evaluation of China′s long-term care insurance policy based on the PMC index model:cases of 11 pilot cities with different disability assessment criteria

作　　者：罗红叶 罗萍[2] 洪全丽 李宏亨 王红媚 谢爱红 刘哲敏 LUO Hongye;LUO Ping;HONG Quanli;LI Hongheng;WANG Hongmei;XIE Aihong;LIU Zhemin(School of Information and Management,Guangxi Medical University,Nanning 530021,Guangxi,China;the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi,China;Finance Office,Guangxi Medical University,Nanning 530021,Guangxi,China;Section of Research Cooperation,the People′s Hospital of Guangxi Zhuang Autonomous Region·Guangxi Academy of Medical Science)

机构地区：[1]广西医科大学信息与管理学院,广西南宁市530021 [2]广西医科大学第二附属医院,广西南宁市530007 [3]广西医科大学财务处,广西南宁市530021 [4]广西壮族自治区人民医院·广西医学科学院科研合作部,广西南宁市530021

出　　处：《广西医学》2023年第1期71-76,81,共7页Guangxi Medical Journal

基　　金：“广西高等学校千名中青年骨干教师培育计划”人文社会科学类立项课题(2022QGRW017)。

摘　　要：目的对我国不同失能评估标准的试点城市的长期护理保险政策进行量化评价,为长期护理保险制度设计提供参考。方法选取我国11个不同失能评估标准的试点城市,搜集政府层面公布的有关长期护理保险制度的政策文件。基于政策文本核心词挖掘和社会网络分析结果,进行政策建模一致性(PMC)指数模型变量设置和参数识别;计算PMC指数后对政策文本结果进行量化评价。结果PMC指数分析结果显示,仅有1个城市的长期护理保险政策评为优秀,4个城市的长期护理保险政策评为良好,两者共占45.45%;其余6个城市的长期护理保险政策处于可以接受的范围内。相较于评估结果为“良好”和“优秀”的试点城市,评分结果为“可接受”的城市的一级变量(参保范围、纳入群体、评估标准、商险参与、筹资方式、基金运行)的得分偏低。结论不同试点城市间的长期护理保险制度设计存在较大差异。建议我国在逐步扩大保险的保障范围时,注重失能评估与待遇标准衔接,并落实照护服务规范,加强专业化队伍建设,改变单一支付机制,提高筹资和待遇给付的多样性,激励商业保险公司参与经办,加强基金的监督与管理。Objective To quantitatively evaluate long-term care insurance policy on pilot cities with different disability assessment criteria in China,and to provide reference for the design of long-term care insurance system.Methods A total of 11 pilot cities with different disability assessment criteria in China were selected.The policy documents concerning long-term care insurance system published by the governmental level were retrieved.The variables set and parameter recognition of policy modeling consistency(PMC)index model was perform based on the results of core words mining and social network analysis of policy documents.The PMC index was calculated,then quantitative evaluation on the results of policy documents was performed.Results The results of PMC index analysis revealed that only one city′s long-term care insurance policy was rated as excellent,and 4 cities′long-term care insurance policies were rated as good,accounting for 45.45%,and the remaining 6 cities′long-term care insurance policies were within the acceptable range.Compared with the pilot cities rated as"good"and"excellent",the scores of the primary variables,including insurance coverage,inclusion groups,evaluation criteria,commercial insurance participation,financing methods and fund operation of the cities rated as"acceptable"were lower.Conclusion There are significant differences in the design of long-term care insurance systems between the different pilot cities.It is recommended that China should pay attention to the convergence of disability assessment and benefit standards,implement care service standards,strengthen the construction of professional teams,change the single payment mechanism,improve the diversity of financing and benefit payment,encourage commercial insurance companies to participate in the operation,and strengthen the supervision and management of the fund when gradually expanding the insurance coverage.

关 键 词：长期护理保险 政策建模一致性指数模型 失能评估 政策量化评价 

分 类 号：R197.1[医药卫生—卫生事业管理]