The Construction Of The Legal System Of Long-term Care Insurance In China

The legal system of long-term care insurance is an insurance legal system to deal with the risk of disability and dementia of the elderly.It has the dual attributes of social insurance law and commercial insurance law,and has the functions of integration,promotion and construction.Based on the difference of understanding the risk attribute and the game of the standard of distinguishing insurance mode,most countries choose the legal system mode which is mainly social insurance mode and supplemented by commercial insurance mode.As far as the legal relationship of long-term care insurance is concerned,the rights in the legal relationship of long-term care insurance mainly embody the insurance beneficial rights of the insured.Insurance agencies and regulators,the families of policy holders and insured individuals,as well as long-term care service institutions or commercial insurance companies have the obligation to implement social insurance and provide insurance treatment services.From the perspective of the operation process of long-term care insurance,the legal system of long-term care insurance that needs to be specially "constructed" includes the applicable scope legal system,the fund-raising legal system and the treatment and payment legal system.The core issues to be solved are the scope of application,financing mechanism and treatment level of the legal system of long-term care insurance.It solves these three problems,that is,it responds to the problem of how to build these three systems.Other issues such as regulatory issues and legal liability issues in the operation process can be directly applied to the relevant provisions of the current social insurance law and commercial insurance.By examining the legal systems of long-term care insurance in various countries,we can see that the scope of application of the legal system of long-term care insurance is related to the universality of social security and the complementarity of commercial insurance;the fund-raising of the legal system of long-term care insurance is relatedto the diversity of the main body and the efficiency of operation;the payment of the legal system of long-term care insurance is related to the sociality and internality of the main body The welfare of tolerance is related.The scope of application of China's long-term basic care insurance follows the coverage of medical insurance.On the basis of unifying and differentiating the standards of coverage,we should achieve universal coverage.As a supplementary insurance,long-term care group insurance can be divided into two types: "supplementary" and "special needs".Urban workers,urban residents,new rural cooperative insurance population,family planning families and the elderly with severe disability and dementia and other special groups may become the insured of group insurance project according to the insured demand and the insured standard.In addition,based on tax preference and savings income,mutual insurance and financial care insurance that citizens can freely insure can also be an effective supplement to long-term care insurance in China.In the process of pilot long-term care system in China,the regulation of insurance fund raising channel is relatively single,which leads to the imbalance of rights and responsibilities.The government's supplementary financing responsibility,the employer's supplementary financing responsibility,the family or community's mutual financing responsibility and the individual's self financing responsibility should be made clear,and the financing channels should be expanded in a socialized and market-oriented way.In addition,the local pilot long-term care insurance relies too much on government finance and medical insurance funds.In the face of institutional obstacles and structural deficiencies of medical insurance funds,and in response to the current needs of enterprises to reduce burden in the international and domestic context,funding standards and dynamic rates should be set proportionally.In the process of raising insurance funds,we should combine the local fund-raising with the central adjustment,the market operation with the government supervision,so as to make clear the division of central and local power in the fund-raising management and the division of market and government power in the fund-raising operation.In terms of the determination of the treatment level,the provisions on the qualifications of beneficiaries of long-term care insurance reflect the treatment standard of insurance and the level of payment.The age of the beneficiary of long-term care insurance should be divided into different sections,and the paymentperiod of the beneficiary's long-term care insurance should be specified.At the same time,the degree of disability and dementia should be evaluated to determine the standard of treatment level of the insurance.At the same time,the qualification requirements of the treatment payer also reflect the level of treatment payment.Specifically speaking,the evaluation agency should have legal qualification and professional ability,and the service agency should have qualified basic conditions.Long term care insurance benefits are mainly divided into two types: service payment and cash payment.Through the three kinds of service care modes of institutional designated care,home-based formal care and home-based informal care,as well as the cash payment modes of quota payment,quota payment and compound payment,the rights of beneficiaries can be guaranteed,and the level of treatment payment can be reflected at the same time.The current social insurance law,labor law,the law on the protection of the rights and interests of the elderly and the future legislation of long-term care have a certain degree of competition.With the development of economy and the increase of national income,the conditions for the separate establishment of long-term care social insurance are gradually met.On the basis of modifying the legal norms of the competing part,the construction scheme of the legal system of long-term care insurance can be applied to the separate legislation.