摘要
2016年以来,中国先后两次开展长期护理保险制度试点,探索制度框架设计和政策体系建设,试点工作取得卓越成效。随着试点政策的推进和更迭,长期护理保险“碎片化”特征显现,阻碍资源高效配置和制度功能建设,甚至囿于“再碎片化”陷阱,亟待设计“整体化”路径。本文从长期护理保险基金可持续性角度出发,运用齐次性Markov过程和2015—2018年CHARLS数据,计算中国老年人健康状态转移概率矩阵,并通过构建长期护理保险基金精算模型,预测29个试点城市2021—2050年基金可持续性状况;同时采用中国第七次人口普查数据和队列要素模型,预测中国未来城乡人口,并根据国际长期护理保险发展趋势,从“碎片化”政策中提炼“整体化”路径。研究结果显示,第二批试点城市总体可持续性优于第一批试点城市,试点方案与当地发展的适配性进一步提升。针对未来制度可持续性,我们建议中国长期护理保险“整体化”路径如下:全民参保,将中、重度失能人员纳入保障范围,保障水平维持在70%左右,0.7%—1%的城镇职工缴费率,0.6%的城乡居民缴费率,财政为城乡居民补充其可支配收入的0.3%—0.6%。
Since 2016,China has implemented two rounds of long-term care insurance system pilots,focusing on refi ning the institutional framework and policy system construction,which has yielded productive outcomes.However,as pilot policies have evolved,the emergence of a"fragmentation"feature in long-term care insurance has impeded effi cient resource allocation and institutional function development.Consequently,there is an urgent need to design a"holistic"approach to overcome the trap of"re-fragmentation."This paper focuses on the fund sustainability of long-term care insurance,utilizing a homogeneous Markov process and CHARLS data from 2015 to 2018 to calculate the transition probability matrix of the health status of China's elderly population.The study forecasts fund sustainability in 29 pilot cities from 2021 to 2050 by constructing an actuarial model of long-term care insurance fund.Additionally,China's seventh population census data and the cohort element model are used to predict the future urban and rural populations.Aligned with the global trend of long-term care insurance,this paper proposes a"holistic"approach derived from"fragmented"policies.Findings reveal that the overall fund sustainability of the second batch of pilot cities surpasses that of the fi rst batch,showcasing enhanced adaptability of pilot programs to local development.Considering the system's future sustainability,we recommend China's long-term care insurance adopt the following"holistic"approach:universal coverage;a reimbursement rate of approximately 70%;contribution rates ranging from 0.7%-1%for urban employees,0.6%for urban and rural residents;and a government subsidy amounting to 0.3%-0.6%of disposable income for urban and rural residents.
作者
朱铭来
马智苏
Zhu Minglai;Ma Zhisu(School of Finance,Nankai University,Tianjin 300350,China;Zhou Enlai School of Government,Nankai University,Tianjin 300350,China)
出处
《社会保障评论》
CSSCI
2023年第4期114-135,共22页
Chinese Social Security Review
基金
首都医科大学国家医疗保障研究院项目“长期护理保险经济社会效应研究”(YB2022B06)
2022年度中国科协科技智库青年人才计划“供需平衡视角下我国长期护理服务的时空演化研究”(20220615ZZ07110272)
2021年天津市研究生科研创新项目“中高龄劳动者再就业困局如何破解?——医疗保险势能与自雇创业动能”(2021YJSB058)。
