Establish A Demand-oriented Long-term Care Insurance System

At present,different countries and regions around the world face the same demographic issue:aging of population.Up to 2016,old people of 60 or over 60 years old account for 31.6%of the total population in Shanghai,symbolizing the intensifying of aging.With the intensification of population aging trend,the problem of eldercare for old disabled people has drawn more attention of people.In 2016,the old disabled population has accounted for 18.3%of the nationwide aged population.With disability deepening of old people,they would raise more demands for life necessities and rehabilitation care in the future.In 2017,pilot projects of long-term care insurance system are carried out in regions such as Shanghai.Pilot results disclose some problems existing in the current system.In view of the high level of aging and the huge number of old disabled people,the long-term care insurance system set up for them is still under exploration in pilot projects.Hence,based on the social background and in comparison with demand theory of long-term care of old people and theories of social welfare development,the paper analyzes how to set up a demand-oriented long-term care insurance system,with Shanghai as the case.First,old people's demands for long-term care services are influenced by many factors.Based on correlation analysis results,the paper deems that income of old people,number of their children,education level,personal self-assessment result and activities of daily living(ADL)index are closely correlated with old people's demands for long-term care.Hence,during establishment of a long-term care insurance system,it is necessary to consider care demands of different types of old people.Secondly,data of Chinese Longitudinal Health Longevity Survey(Shanghai part)indicates that old people's demands for long-term care services mainly focus on care for daily life,spiritual comfort and medicine delivery of community.On-site survey results of No.3 Charity House and Boai Care Station in Xuhui District,Shanghai show that in practical eldercare,services such as cleaning of hands and feet,aided eating,physical measurement and cleaning of head and face are applied most commonly.The paper conducts transverse comparison of construction experience of the long-term care insurance system in America,Japan and Netherlands.In combination with the difference between demands of old people in Shanghai for long-term care services and actual policy provision,as well as interview records of pilot projects in care organizations of Putuo District and Xuhui District in Shanghai,the paper summarizes problems existing during establishment of the long-term care insurance system in Shanghai:low standard awareness in assessment,irrational results inclined to medical science,excessively brief results,content overlaying in services,failure to execute medical care,inconformity between demands and contents,lack of personnel and low prices quoted,insufficient policy propaganda,unsmooth linkage with original home care system,unfairness caused by double subsidies of old people in the organization,long transfer time of personnel,slow handling of long-term care insurance procedures,etc.Aiming at above problems and in combination with foreign experience in establishment of the long-term care insurance system,the paper further points out that it is necessary to develop long-term care insurance as an independent 6th social insurance type,perfect the assessment system,integrate different factors and refine assessment results;classify service contents,separate medical and care services,define rights and responsibilities,and increase selective service contents;separate long-term care workers,carry out autonomous training and upgrade remuneration properly;and finally set up a system suitable for Chinese culture and enhance system propaganda and supervision based on legislation.Through further perfection of the system,more people could gain benefits from the long-term care insurance system in Shanghai.