| Research BackgroundWith the rapid transition of nature and social structure of population in China, the number of the oldest old and the disabled will increase numerously in the next 50 years, which is a big challenge to the social security system. Research shows that, the function of traditional family care weakens; on the other hand, long term care service system covering urban and rural areas has not been established in China. The pilot in some local governments is successful and is also helpful for the top-level design of long term care system across China.Research ObjectiveFirstly, based on the multi-state prediction model, the paper forecasted the population by age, gender, area, health status in the middle and long term in China. Further, the paper measured the demand of long term care for the elderly, which consists of parameters of the number of the disabled and the trend of unhealthy life expectancy. Moreover, the paper analyzed the sustainability of insurance fund under the hypothesis of implementing the long term medical care insurance in Qingdao City to the nationwide. Finally, the suggestion was given based on the results.Data and methodThe data in this paper can be divided into four types. The first type is from statistical yearbooks and census. The second is micro survey data, which is composed of "sample survey of the aged population in urban/rural China" in 2000,2006,2010, respectively. The third is from the database of the local social security administration, including the data of long term medical care insurance of Qingdao City from 2012 to 2014 and the data of the urban medical insurance of Anji County from 2013 to 2014. The fourth is the international data from UN and OECD.There are mainly three methods. The first is the multi-state population prediction method, the second is the longitudinal data analysis, and the third is public policy simulation method.Results1. The amount of disabled elderly will increase sharply and the disabled prevalence will in a dynamic balance.In the next 50 years, the "zigzag" feature of age structure in China will not change. The number of the oldest old and the disabled will increase rapidly. In 2015, the disabled (one or more ADL cannot be finished) population aged above 60 is approximately 17 million in China, among which 7 million are totally disabled. In 2054, the number of the disabled will rise to the peak, about 43 million, among which the number of the total disabled is nearly 16 million. In the meanwhile, the longevity and health status maintains dynamic equilibrium. Specifically, the healthy life expectancy accounts for about 91.5% of the life expectancy.2. The total cost of national long term care will go up to 12 times in the next 45 years.The paper established the forecasting model of long term care insurance based on the current Qingdao mode. It is assumed that, the insurance will be 100% covered to urban residence from 2016, and will be 50% covered to rural residence in 2016 and 100% covered to rural residence till 2060; also, the nursing cost will rise consistent with the elderly dependency ratio during the period. The results illustrate that the proportion of total cost to GDP will rise from 0.047% in 2016 to 0.6% in 2060. However, the proportion is still below 1%, which is under the average level of developed countries.3. The pooling funds will keep sustainable if individual contributions can be taken into account.The paper proposed to establish a scientific fund-raising pattern that is composed of pooling funds transferring from basic medical insurance combined with individual contribution. The pooling funds can meet the demand of long term care till 2060, and there is a huge surplus before 2050.Suggestion1. China’s "reform dividend" window period will disappear in 2030, before that, a robust social security system should be established.After the traditional "demographic dividend" disappeared, "reform dividend" can be seen as a continuation of the "demographic dividend". However, with the development of population, the "reform dividend" window period will eventually disappear in 2030. Therefore, the government should accelerate the pace of the top-level design of the security system, to shorten the period of pilot to full implementation.2. The social insurance system should be designed under the principle of the human "Four Classification" life cycle.Facing the new normal characteristics of population development, the design of social insurance contributions and payments should take "the four life stage"-children, adulthood, retirement (healthy), retirement (disabled) into consideration.3. China should establish a long term care insurance systemUnder the principle of "limited government fiscal responsibility", the government should set up long-term care insurance system which covers both urban and rural population at a moderate level of security with multi financing resources and higher integration.4. Individual payment should be added into the Long Term Care Insurance system... |
PDF Full Text Request