Some thoughts on long term care insurance system

With the deepening of the aging degree of society, the country and society are facing a huge burden of old-age care. As of 2019, there are more than 40 million disabled elderly people over the age of 60 in China. How to solve the problem of caring for disabled elderly people is a dilemma that tens of millions of families are facing, and it is also a problem that the country needs to solve urgently. With the "Guidance on Expanding the Pilot long-term Care Insurance System" issued by the National Healthcare Security Administration on September 10, 2020, long-term care insurance, known as the "sixth social insurance", has become a social hot spot and attracted the attention of the public.

The so-called "long-term care insurance" is mainly when the insured loses the ability to take care of themselves in life, gets sick in old age or dies, can get life care and medical care services or financial compensation. At present, long-term care insurance in China is mainly divided into two categories: one is the social security managed by relevant government departments such as local medical insurance bureburets, such as the long-term care insurance project in Beijing Shijingshan District. The funds mainly come from government finance or social mutual assistance, and commercial insurance companies or pension service institutions are entrusted by the government to carry out nursing services for disabled people. The other type is commercial long-term care insurance, which is insured and paid by individuals to commercial insurance companies. When the insurance claims are met, the insurance company's claim costs are used to purchase services or the insurance company's cooperative pension institutions provide nursing services directly.

While the in-depth implementation of the long-term care insurance system has aroused heated discussion in the society, as a new thing, there will be various questions and different doubts. In this regard, I would like to share with you a few thoughts.

First, the long-term care insurance system has many positive effects. On the one hand, the long-term care insurance system can provide service guarantee for the disabled elderly, so that the disabled elderly can enjoy better nursing services and spend their old age in peace. At the same time, it also allows tens of millions of family members to return to social work, liberating the labor force and easing economic pressure. On the other hand, the establishment of long-term care insurance system can relieve the pressure of the government and society on the care of disabled elderly people, and solve the dilemma of disabled care through the established insurance system and the mode of "social mutual assistance and risk sharing". At the same time, with the long-term care insurance system to create sufficient employment opportunities and industrial prospects, is a great economic value of the "sunrise industry".

Second, the long-term care insurance system needs to broaden financing channels and seek more social support, so that the nursing industry can complete "self-hematopoietic". At present, the difficulty of constraining the development of long-term care insurance system lies in fund raising. The main source of social insurance financing in our country is the way that enterprises and individuals pay fees and financial subsidies. Under the background of the high social security contribution and the government's commitment to gradually reduce the social security rate, it has been difficult to complete the collection of long-term care insurance fund by increasing the new insurance types of social security contribution. Some regions that have carried out long-term care insurance pilot business in the first place mainly rely on the balance of medical insurance funds and financial allocations to establish long-term care insurance funds, which cannot achieve long-term sustainable development. Therefore, how to make the long-term care insurance system complete "self-hematopoietic" is an urgent problem to be solved. In my opinion, on the one hand, long-term care insurance can be financed by making full use of the employee's personal medical insurance account, and the employee's long-term care insurance fund pool can be established by the employee's personal voluntary and personal medical insurance account payment. On the other hand, open long-term care insurance enterprises and individuals to purchase channels. Long-term care insurance can be purchased by enterprises and individual employees, and the long-term care insurance fund can be increased by increasing the welfare of enterprise employees. For freelance workers and urban and rural residents, they can contribute to long-term care insurance through government subsidies and personal contributions. Through the participation and support of more social forces, the long-term care insurance system can be "self-hematopoietic".

Third, long-term care insurance system needs more perfect nursing grade evaluation. Nursing grade evaluation is the basis of long-term care insurance system, which is not only the basis of fund expenditure but also the standard of nursing service provision. The Activity of Daily Living (ADL) Scale was developed by the United States in 1969, which was mainly used to assess the daily living ability of the subjects, and was also the basis standard used in the establishment of the long-term care insurance system in early China. However, the assessment criteria of the Activity of Daily Living Scale (ADL) are relatively simple and cannot meet the requirements of the current long-term care assessment. In 2013, the Ministry of Civil Affairs issued the "Elderly ability assessment" industry standards in pilot cities have not been applied to the evaluation standards, making the current long-term care insurance system lack of unified and reasonable standards, to a certain extent, hindering the development of long-term care insurance system. Therefore, in order to better develop the long-term care insurance system and adapt to the current nursing service requirements, we urgently need a set of unified rationalization evaluation standards. This requires our national and social institutions to join forces, while learning from foreign advanced experience, combined with the current status of disability care in China, summarize the pilot experience, as soon as possible to develop a unified evaluation standard, in order to lay a solid foundation for the long-term care insurance system in the later period.