Study On Long-term Care Insurance System In China

In the 1960s, the situation of aging of western countries is very serious. For example, Sweden, France and other western countries' the proportion of elderly population, which means who is more than 65 years old, is more than 10%. Besides, as the degree of aging is deepening, the number of the elderly man of all kinds of disability, dementia (such as alzheimer, hemiplegia caused by cardiovascular and cerebrovascular diseases) is also rising. It is important to know that there is no effective treatment for these chronic diseases at present. The only way is to take long-term medical care for the disability old man, which means the demand for long-term care is growing sharply. Internationally, the United States in the 1970s, Israel in 1986, Germany in 1995 and Japan in 2000, have been established long-term care insurance. While every country has its own mode, system design, way of financing, shared responsibility and so on in long term care insurance, they have passed legislation to establish a long term care insurance system. According to different systems' characteristics, they can be roughly divided into social insurance, commercial insurance and national welfare insurance, which have played an important role in satisfying the demand for long-term care of these countries, and which have helped these countries to accumulate rich experience in such aspects as system design, operational management and so on.However, there is no unified long-term care insurance system so far in China, let alone the research on the level of legislation. Although Beijing, Guangdong, Shaanxi, Anhui and other places are positively researching suitable long-term care insurance system for local development, only a few pilot cities have carried on the practice, in other words, put it to a trial run exploringly of long-term care insurance, such as long-term care insurance of Qingdao, long-term care insurance of employees of Weifang. But according to the sixth census data, by the end of 2010, the population of disabled elderly man, who need to care, in our country has increased to 33 million people (including some disabled elders and completely disabled elders), accounting for 19% of the elderly population, among which the completely disabled elders accounted for 11 million. And this article is based on the above background to study, which try to provide theoretical support and practical experience for nation's next step to establish the long-term care insurance system.First, this paper studies the theoretical system of long-term care insurance and lays a solid theoretical basis for the establishment and development of long-term care insurance system in our country. The theoretical basis that this paper studies on long-term care insurance are Maslow's hierarchy of needs theory, the optimal insurance theory, purchase decision-making process theory, welfare pluralism and "holistic" theory. It is because of considering the most basic physiological and security needs of the disability people (who is unable to complete the daily activities of life) in the maslow's hierarchy of needs theory, this paper put forward that long-term care insurance should not only provide the compensation for the disability's medical and nursing fees, but also provide basic care for them in the definition of long-term care insurance. In addition, the care content of the long-term care insurance not only includes health care and life care, but also includes mental nursing which fully embodies the respect need of Maslow's hierarchy of needs. And the optimal insurance theory and purchase decision-making theory are applicable to commercial long-term care insurance which is free to choose. The multi-level long-term care insurance system (social long-term care insurance as the basis, commercial long-term care insurance as the auxiliary, long term care assistance for the poor as the palm) and the method of long-term care insurance supply (family care, community care, medical care) which the paper puts forward in the process of establishing the long-term care insurance system in China is based on the idea of welfare pluralism which claims the government, family and market should provide social welfare together. An important concept this paper studies establishing the system of long-term care insurance system in China is looking the disability elderly as a whole "person", that is we should attach importance and take the initiative to care about their needs and should not discrimination and ignore them. The disability elderly should be provided dignity and quality long-term care services as much as possible. And the psychological, physical and social needs and care of disabled elders should be attentioned based on the idea of "holistic" theory. The paper researches more comprehensive about various types of the long-term care which is not limited to commercial long-term care insurance, also includes social long-term care insurance and the long-term care assistance for the poor.Secondly, this paper analyzes the present situation of long-term care insurance. On the one hand, there is not unified social long-term care insurance system arrangement and even there is only two pilot cities which explore the real practice; On the other hand, commercial long-term care insurance has slowly developing, less coverage, deficient nursing institutes, staff and beds, too high cost, and so on. On this basis, this paper points out the problems that existing in the current long-term care insurance in our country (relevant policies and regulations are not sound, care institutes and nursing staff are deficient, commercial long-term care insurance effective supply is insufficient and products tend to homogeneity) and thus raises the necessity and feasibility to establish our long-term care insurance system. And the paper further discusses the problems that could be faced in setting up long-term care insurance system. The problems include that it needs time to chang the concept of pension(from family care to social care), commercial long-term care insurance market may appear "market failure", the lack of nursing institute and staff and the lack of statistics and data. The conclusion of the analysis and research provide the gist for the idea of building the long-term care insurance system in our country in this article.Again, the paper also studys the long-term medical care insurance system of Qingdao, and uses logit model to analysis and research the significant factors of the will of attending the long-term medical care insurance of Qingdao residents according to the data of field survey in Qingdao. Results show that gender, marital status and differences in trust for the government will not significantly affect the residents' willingness to join the insuranc, while age, education level, income, number of children, the self health assessment, the difference of degree of understanding of the long-term care insurance have significant effects on residents' willingness to join the insurance under the condition of invariable of other variables. So Qingdao government should fully consider the significant impacts when perfecting the system in order to improve the residents' willingness to join and get their sincerely accept and support, make long-term medical care insurance can truly service for the people in need and reduce the burden of residents. Qingdao long-term care insurance system has achieved certain success since began to run in 2012, such as reduce the burden of the disability and his family; optimize the configuration of the medical resources of Qingdao, promote the development of the nursing institutions; reduce the pressure of medicare payment effectively; improve the disability elderly in later life effectively. But there are still some problems in its institutional arrangements, such as the lack of legal protection and system positioning, limit the safeguard scope and ignore the daily life care, disability personnel evaluation standards are too general, the person in charge is serious lack at the grass-roots level. The study of Qingdao long-term medical care insurance system provides reference for the idea of establishing the long-term care insurance system in our country in this paper.In addition, this article also makes a comparative study for practical experience of long-term care insurance system between developed countrys. The paper makes the comparative analysis by selectting the representative countries and area depending on the system mode, namely the social long-term care insurance (Germany and Japan), commercial long-term care insurance (USA) and the national welfare long-term care insurance (UK and Sweden). And the paper provides the experience and reference to establish our long-term care insurance system after a summary analysis. The conclusions are following:the development of long-term care insurance system can truly help reduce the pressure on the aging of the population; the establishment of the long-term care insurance system needs the protection of national laws and regulations, the development of business needs support of the government's policy; development of long-term care insurance needs establish suitable operation mode according to its own national conditions; Guarantee the stability of the long-term care insurance financing, formulate control measures of the cost of long-term care insurance.Finally, on the base of draw lessons from international experience, according to the advice and requirements of "exploring to establish a long-term care insurance system" put forward by the central and combining our country's institutional environment and Qingdao pilot, this paper puts forward some assumptions to establish our long-term care insurance system. For example, proposed the multi-level concept of long-term care insurance system which is social long-term care insurance as basis, commercial long-term care insurance as supplement and long term care assistance to the poor as palm; intensify propaganda, improve people's awareness of the risk of disability and the identity of care insurance; establish the corresponding financing mechanism and give policy support; strengthening operation management; ensure the supply of long-term care services; use the cost control mechanism of managed care to strengthen the cost control.