荆门市长期护理保险制度构建及试点运行状况分析

陈晓晨; 杜天天; 王思彤; 戴伟; 刘跃华

引用本文：陈晓晨, 杜天天, 王思彤, 戴伟, 刘跃华.荆门市长期护理保险制度构建及试点运行状况分析[J].中国卫生政策研究,2020,13(12):30-34

荆门市长期护理保险制度构建及试点运行状况分析

投稿时间：2020-08-12 修订日期：2020-11-19 PDF全文浏览 HTML全文浏览

陈晓晨^1,2, 杜天天³, 王思彤², 戴伟⁴, 刘跃华^1,5

1. 国家卫生健康委卫生发展研究中心北京 100191;
2. 清华大学医院管理研究院广东深圳 518057;
3. 中国劳动和社会保障科学研究院北京 100029;
4. 湖北省医疗保险管理局医疗保障服务中心湖北武汉 430070;
5. 国家卫生健康委国家药物和卫生技术综合评估中心北京 100191

摘要:目的：分析湖北省荆门市长期护理保险（以下简称长护险）试点制度构建及近年运行状况，以期为长护险制度优化提供建议。方法：使用回顾性研究，基于荆门市长护险基本运行情况的半结构式访谈和2017年7月-2019年6月8 712名长护险受益人赔付数据，整理政策内容和运行状况，运用描述性统计方法进行分析。结果：荆门市长护险采用制度全民覆盖，等级评定重度失能（<40分）为准入标准，差异化待遇支付和以全日居家护理为主的照护模式；受益人群中，73.2%选择全日居家护理服务，17.0%选择非全日居家护理服务，2017年7月-2019年5月人均护理费用支出为13 756.0元，其中人均保险统筹支出为11 086.0元（80.6%），人均自付费用为2670.0元（19.4%）。结论：荆门市长护险试点工作运行平稳，建议该试点在细化资金筹集标准，建立多样化服务给付体系和分级护理体系规范化等方面持续探索，以实现长护险制度的可持续发展。

关键词:长期护理保险全民覆盖实施现状失能人群

基金项目:国家自然科学基金（71804032）；北京社科基金（16SRB010）；泰康溢彩公卫专项基金“中国失能老年人医养结合整合照料模式与支付标准研究”

Analysis of the construction and pilot operation of long-term care insurance system in Jingmen City

CHEN Xiao-chen^1,2, DU Tian-tian³, WANG Si-tong², DAI-Wei⁴, LIU Yue-hua^1,5

1. China National Health Development Research Center, Beijing 100191, China;
2. Institute for hospital management, Tsinghua University, Shenzhen Guangdong 518057, China;
3. China Academy of Labor and Social Security, Beijing 100029, China;
4. Medical Security Service Center, Hubei Medical Insurance Administration Bureau, Wuhan Hubei 430070, China;
5. National Center for Drug and Technology Assessment, Beijing 100191, China

Abstract:Objective:To analyze the operation mode and the current status of long-term care insurance that has been recently developed in Jingmen City, and to provide suggestions for the optimization of long-term care insurance system. Methods:Based on the data of 8712 long-term care insurance beneficiaries in Jingmen City from July 2017 to June 2019, a retrospective research was conducted and offline semi-structured interviews on the basic operation mode of long-term care insurance were conducted, the related policy and operation status were summarized, and the descriptive statistics was used for analysis. Results:The results have shown that Jingmen long-term care insurance adopted the universal coverage system, including people assessed of graded severe disability (<40 points), differentiated payment methods and full-time home-based care was taken as the main care mode. As of June 2019, among 8712 people who enjoy the treatment, 73.2% chose full-time home-based care, 17.0% chose part-time home-based care, 9.1% chose elderly healthcare institution service, and 0.7% chose hospital service, respectively. The average cost of nursing was 13756.0RMB, 11086.0RMB (80.6%) was paid by the insurance and 2670.0RMB (19.4%) was out-of-pocket (OO-P) in the effective accumulative time from July 2017 to May 2019. Conclusions:The pilot work of the long-term care insurance adopted in Jingmen is running smoothly. It is suggested that the pilot should continue to explore in the refinement of fund-raising standards, diversified service payment system should be established and hierarchical nursing system standardized so as to realize the sustainable development of long-term care insurance system in China.

Key words:Long-term care insurance Universal coverage Implementation status Disabled people

摘要点击次数: 2144 全文下载次数: 814