Study On Long-term Care Insurance System In Three Northeastern Provinces

China’s population is ageing rapidly,accompanied by loss of capability and higher life expectancy,especially in the Northeast.Based on data from the 7th National Census,the proportion of population aged 60 and above in the total population in Liaoning Province reached 25.72%,23.06% in Jilin Province and23.22% in Heilongjiang Province,all above the national level.In order to systematically respond to the care needs of the disabled elderly and the high cost of care,the three northeastern provinces have actively launched a pilot long-term care insurance(LTCI)system,which has accumulated valuable local experience after years of exploration.However,the problems of system fragmentation,low level of protection,and poor fund sustainability are still prominent,which need further system optimization and improvement.This paper takes the LTCI system in three northeastern provinces as the research object.Based on a systematic review of relevant domestic and foreign literature,the analysis is carried out based on the theory of institutional change.Specifically,this study adopts the theoretical analysis framework of institutional supply and demand-equilibrium from the view of institutional change,adopts the case study method to investigate the feelings and behavioral choices of LTCI beneficiaries,providers,and operators,and grasps the realities of the pilot schemes in terms of coverage,service supply,treatment payment,and regulatory mechanism,so as to summarize the regional characteristics and common problems of the pilot schemes.In this study,we selected four pilot cities in three northeastern provinces as case cities,which with deeply aging populations,significant needs for disability care,and relatively low levels of economic development,and selected four designated elderly care institutions of different nature through purposive sampling.Semi-structured in-depth interviews were then conducted with institutionalized elderly with disabilities,managers,nursing staff,medical and nursing staff,and health insurance bureau staff.The research results show that there are still a series of problems in the pilot LTCI.First,the scope of coverage is narrow,the criteria for disability assessment vary,and the conditions for treatment payment are harsh;second,the single supply content,the difficulties in delivering services from institutions to the home community,and the supply level of caregivers is insufficient;third,the funding source is single and the payment level is low;fourth,the regulatory mechanism is not sound,the supporting policies are vague,and it is difficult to implement on the ground.On the basis of the theory of institutional change,this study argues that the reason for this unbalanced situation is that the LTCI system is constrained by the limitations of the mandatory institutional change model,the high cost of institutional change and innovation,path dependence and ideology.Therefore,in order to fundamentally solve the unbalanced contradiction of the system and promote the precise connection between supply and demand,this paper puts forward the following suggestions: gradually expand the scope of insurance coverage,unify the criteria of disability assessment;enrich the content of service supply according to needs and actively promote home care services;explore a reasonable funding mechanism and broaden the funding channels;develop scientific care levels and reflect the principle of moderation in treatment payment.It is expected to provide ideas for the pilot LTCI system in the three northeastern provinces and provide intellectual support for the full establishment of the LTCI system.