摘要
宁波作为全国首批长期护理保险试点城市之一,其运行模式已逐步成型,建立起了资金筹集、失能评估、服务供给、待遇支付和经办管理“五大体系”。本文结合实地调研和数据统计,详细梳理宁波长护险的实施方案与实施效果,并对其筹资机制、失能评估、护理服务和第三方机构经办等方面的问题进行归纳。通过层次分析法(AHP)进一步评估发现,长护险需要重点关注长期护理需求风险、运营风险、服务供给风险和道德风险。本文提出未来长护险可持续发展的具体路径为:完善政策设计,建立独立的动态筹资体系;加强失能评估的统一性和透明性;扩大保障范围,提升护理待遇;提高护理服务质量与监管水平;明确第三方机构经办流程制度,激发经办机构参与积极性。
As one of the first long-term care insurance(LTCI)pilot cities in China,Ningbo City has gradually shaped its operation mode and established“five systems”of fund-raising,disability assessment,service supply,benefit payment and claim management.Through field investigation and data statistics,this paper analyzes the implementation plan and effects of LTCI of Ningbo City in detail,and summarizes the problems of financing mechanism,disability assessment,nursing service and operation by third-party agencies.After evaluating the risks by analytic hierarchy process(AHP),it is found that the LTCI needs to pay attention to the long-term care demand risk,operational risk,service supply risk and moral hazard.This article proposes a specific path for the sustainable development of long-term care insurance in the future,which is to improve policy design and establish an independent dynamic financing system,strengthen the uniformity and transparency of disability assessment,expand the scope of guarantee and improve nursing benefits,improve the quality and regulatory level of nursing services,clarify the procedures and systems for third-party agencies,and incentivize active participation by the third-party agencies.
出处
《中国医疗保险》
2025年第11期92-98,共7页
China Health Insurance
基金
国家社会科学基金一般项目“我国商业保险公司参与医保经办服务的动力机制、效果评估和路径优化研究”(21BGL291)
国家社会科学基金重大项目“建设金融强国的内涵、目标和路径研究”(24&ZD092)。
关键词
长期护理保险
失能评估
道德风险
long-term care insurance
disability assessment
moral hazard
