制度碎片化、老年福祉与长期护理保险制度整合——基于四期CHARLS数据和试点城市的实证分析  

Fragmentation of the System,Elderly Welfare,and Integration of Long-Term Care Insurance System:An Empirical Analysis Based on the Fourth Wave of CHARLS Data and Pilot Cities

作　　者：周明[1,2] 王若莹 叶宇婷 ZHOU Ming;WANG Ruo-ying;YE Yu-ting(School of Public Administration,Northwest University,Xi’an 710127,China;Institute of Health and Aging,Northwest University,Xi’an 710127,China)

机构地区：[1]西北大学公共管理学院,陕西西安710127 [2]西北大学健康养老研究院,陕西西安710127

出　　处：《西北大学学报(哲学社会科学版)》2025年第3期108-121,共14页Journal of Northwest University:Philosophy and Social Sciences Edition

基　　金：国家社会科学基金一般项目“全生命周期视域下健康老龄化体系路径研究”(21BSH021)。

摘　　要：长期护理保险是应对人口老龄化的重要政策工具,旨在提高失能老年人的生活质量。基于四期CHARLS数据,运用三重差分法分析长期护理保险试点地区政策差异对失能老年人福祉的影响效应。研究发现,长期护理保险改善了失能老年人的健康状况,减少了家庭照护时间,降低了失能老人的抑郁程度,改善了其福祉水平。异质性分析表明,多元化的筹资渠道和服务给付模式对重度失能老人的福祉提升尤为显著。长期护理保险的区域差异根植于政策试点阶段对基本医保体系的制度性依附与路径依赖,叠加地方分权导向下异质化政策试验的碎片化效应以及央地政府间福利公平目标与财政风险管控逻辑的持续性博弈。为破解制度整合困境,应强化顶层设计,构建独立资金池体系,重构政策执行机制,弱化对基本医保体系的依赖,增进区域共济和央地协同。Long-term care insurance is an important policy tool to address population aging,aiming to improve the quality of life for disabled elderly individuals.Based on the fourth wave of CHARLS data,this study uses the difference-in-differences method to analyze the impact of policy differences in pilot areas for long-term care insurance on the welfare of disabled elderly individuals.The study finds that long-term care insurance improves the self-reported health status of disabled elderly individuals,reduces family caregiving time,lowers depression levels,and enhances their overall welfare.Heterogeneity analysis shows that diversified financing channels and mixed payment models have a particularly significant impact on improving the welfare of severely disabled elderly individuals.Regional differences in long-term care insurance are rooted in the institutional attachment and path dependence of the basic health insurance system during the policy pilot stage,compounded by the fragmented effects of heterogeneous policy experiments under the local decentralization approach,as well as the ongoing game between central and local governments in balancing welfare equity goals and fiscal risk control.To overcome the challenges of institutional integration,the study suggests strengthening top-level design,building an independent fund pool system,promoting digital governance and multi-level collaborative protection,reducing dependence on the basic health insurance system,and enhancing regional solidarity and central-local coordination.

关 键 词：老年福祉 长期护理保险政策 地区差异 三重差分法 制度整合 

分 类 号：C979[经济管理—劳动经济]