中国多层次长期护理保险制度:筹资机制与缴费负担  

China’s Multi level Long term Care Insurance System:Fundraising Mechanism and Payment Burden

作　　者：高凯 GAO Kai

机构地区：[1]南京信息工程大学法学与公共管理学院 [2]南京信息工程大学共同富裕研究院

出　　处：《消费经济》2025年第1期48-66,共19页Consumer Economics

基　　金：国家社会科学基金重大项目“我国医养结合优化模式筛选及推进医养结合全覆盖对策研究”(20&ZD114);南京信息工程大学人才启动经费课题“风险沟通对个人养老金参保率提升的影响效应:理论机制、实证检验与政策优化”(1511152401009)。

摘　　要：目前中国各试点地区长期护理保险制度总体呈现出较大差异。通过分析各地区长期护理保险筹资机制差异背后的制度逻辑,文章认为长期护理保险制度既具有类似于医疗保险“一年管一年”的社会风险分担属性,又具有类似于养老保险的老年失能风险不断累积的基金积累属性,长期护理保险介于医疗保险和养老保险之间独特的制度属性决定了长期护理风险分担应该采用现收现付社会风险共担和基金积累个人风险自负相结合的方式。文章提出中国多层次长期护理保险制度框架,其中第一层次由政府财政兜底,保障低收入困难人群、残疾人等其他非老年失能对象的护理救助制度;第二层次为社会风险共担、现收现付制的长期护理保险制度;第三层次为个人自担风险、采用延期年金形式给付的商业长期护理保险制度。文章通过精算建模、参数赋值和数值模拟,测算出2024—2063年多层次制度框架体系中各层次的缴费率、真实缴费负担以及参照延期年金给付的商业长期护理保险现金价值对照表。研究总体通过多层次长期护理保险制度的建立,为廓清既往试点中各地区长期护理保险制度模式选择争论,促进中国长期护理保险制度走向成熟、统一和定型奠定了重要基础。Currently,the long-term care insurance system in various pilot regions of China show significant differences.By analyzing the institutional logic behind the differences in the selection of long-term care insurance participation mechanisms in various regions,it is believed that the long-term care insurance system has a social risk sharing attribute similar to the “one year management one year” of medical insurance,as well as a fund accumulation attribute similar to pension insurance,where the risk of elderly disability continues to accumulate.The unique institutional attribute of long-term care insurance between medical insurance and pension insurance determines that long-term care risk sharing should adopt a combination of pay as you go social risk sharing and individual risk assumption through fund accumulation.Based on this,a multi-level long-term care insurance system framework in China is proposed,in which the first level is supported by government finance and provides care and assistance for low-income disadvantaged groups,disabled persons,and other non elderly disabled individuals;The second level is the long-term care insurance system of social risk sharing and pay as you go system;The third level is the commercial long-term care insurance system where individuals bear the risks themselves and pay in the form of deferred annuities.Through actuarial modeling,parameter assignment,and numerical simulation,calculate the payment rates,real payment burdens of each level in multi-level institutional framework from 2024 to 2063,and given a comparison table of commercial long-term care insurance cash values based on deferred annuity payments.The establishment of a multi-level long-term care insurance system has laid an important foundation for clarifying the debate on the selection of long-term care insurance system models in various regions in previous pilot projects,and promoting the maturity,unity,and standardization of China's long-term care insurance system.

关 键 词：长期护理保险 筹资机制 现收现付 基金积累 多层次 

分 类 号：F842.6[经济管理—保险]