长护险定点服务机构管理国际经验比较和启示——基于德日美典型案例  

Comparison and Inspiration of International Experience in the Management of Designated Service Institutions for Long-Term Care Insurance——Based on Typical Cases from Germany,Japan,and the United States

作　　者：张元颖 陈云云 

机构地区：[1]上海申健长期护理研究促进中心,上海200063 [2]上海师范大学哲学与法政学院,上海200234

出　　处：《中国医疗保险》2025年第3期116-124,共9页China Health Insurance

基　　金：国家医疗保障局立项课题“长期护理保险定点机构管理机制研究”(2023020)。

摘　　要：随着人口老龄化加剧,构建社会性长期护理保险制度(以下简称“长护险”)成为应对老龄社会风险的必然选择。自2016年启动试点以来,我国长护险制度建设成效显著,定点服务机构数量与日俱增,但由于起步较晚,现行管理机制尚不完善,有必要学习和借鉴发达国家的先进经验。目前,全球长护险定点服务机构的管理模式分为基于专业的管理系统、基于检查的管理系统、基于数据测量和公开报告的管理系统、发展中的管理系统等四类。不同模式下,中央和地方的管理分工不同,各主体对机构的管理职能也存在差异。本文以德国、日本、美国为典型案例进行分析,并结合我国国情,提出构建全流程服务质量监管体系、加快数字化监管平台建设等建议,以期提高长护险定点服务机构运行效率,促进长护险高质量、可持续发展。With the intensification of population aging,establishing a social long-term care insurance(hereinafter referred to as LTCI)system has become an inevitable choice to address the risks of an aging society.Since the pilot program was launched in 2016,the construction of LTCI system has achieved remarkable results in China,with the increasing number of designated service institutions for LTCI.However,since we start late,the current management mechanism is still not perfect,and it is necessary to learn from and draw on the advanced experience of developed countries.Currently,the management models of designated service institutions for LTCI worldwide are divided into four categories,i.e.professionalism-based regulatory system,inspection-based regulatory system,data measurement and public reporting-based approaches,and developing regulatory systems.Under different models,the management division of labor between the central and local governments varies,and the management functions of each authority for institutions also differ.This article analyzes typical cases of Germany,Japan,and the United States,proposes suggestions according to the special conditions of China,such as building a full-process service quality supervision system and accelerating the construction of a digital supervision platform,with the aim of improving the operation efficiency of designated service institutions for LTCI and promoting the high-quality and sustainable development of LTCI.

关 键 词：长护险 长护险定点服务机构 管理机制 管理模式 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]