基于失能存活时间差异的长期护理保险收入再分配效应  

Income Redistribution Effects of Public Long-Term Care Insurance Based on Differences in Disabled Survival Time

作　　者：何文炯[1] 侯雨薇[1] He Wenjiong;Hou Yuwei

机构地区：[1]浙江大学公共管理学院

出　　处：《中国人口科学》2024年第4期67-82,共16页Chinese Journal of Population Science

基　　金：国家社会科学基金重大项目“人口老龄化与长寿风险管理的理论与政策研究”(编号:13&ZD163)的阶段性成果。

摘　　要：长期护理保险(简称“长护险”)已试点多年并将在全国普遍实施,其收入再分配效应值得关注。文章基于CLHLS数据,估计了不同收入群体的预期失能存活时间,通过构建长护险终身缴费和待遇总额的精算分析模型,测算公平保费并计算不同群体的内部收益率,以探究在不同做法下长护险制度可能产生的收入再分配效应。研究发现:(1)低收入群体在获取医疗和照护资源等方面处于劣势,可能导致其发生失能后的死亡风险更高,预期失能存活时间较短;(2)若全体参保者按公平保费定额筹资,且待遇水平相同,长护险可能产生逆向再分配,即预期失能存活期较短的低收入群体帮助预期失能存活期较长的高收入群体;(3)若按公平保费定额筹资,在设有最高支付限额的条件下,即使提高低收入参保者的报销比率,对促进正向收入再分配的效果也不明显;(4)若按工资或收入的固定比率筹资,则有利于实现正向的收入再分配。在设计全国统一的长护险制度时,需要注重制度的公平性和可持续性,在统一且适度的待遇水平下,科学测算公平费率并实行按固定比率筹资的方式,促使长护险发挥正向收入再分配功能。Long-term care insurance(LTCI)has been piloted for years and is set for nationwide implementation,raising concerns about its income redistribution effects.Using CLHLS data,this study estimates the disabled survival time across income groups and constructs an actuarial model to calculate fair premiums and internal rates of return.The findings suggest that the low-income group is at a disadvantage in accessing medical care and caregiving resources,leading to a higher risk of death after becoming disabled and a shorter expected duration of survival with disabilities.Additionally,uniform premiums and benefits could lead to reverse redistribution,where low-income groups subsidize high-income groups.Increasing reimbursement rates for low-income participants under a fixed premium model shows limited effect on positive redistribution.Funding based on a fixed percentage of wages or income fosters positive income redistribution.When designing a unified national LTCI system,it is recommended to focus on fairness and sustainability,calculate fair rates under a uniform and moderate benefit level,and adopt a funding method based on a fixed percentage of wages or income to promote the positive income redistribution function of LTCI.

关 键 词：长期护理保险 失能存活时间 终身收入再分配 内部收益率 

分 类 号：F842.6[经济管理—保险] F124.7