The operation concept of long-term care insurance system and its enlightenment to China

(2) The root cause of the establishment: Germany's social state principle and strong nationalist tradition

On the one hand, the introduction of long-term care security system in the form of social insurance reflects the particularity of long-term care risk: although long-term care can be used as an insurable risk, its risk is more uncertain than that of medical insurance, and the premium is difficult to calculate accurately. On the other hand, it reflects the "path dependence" of the German welfare system: due to the coalition of German political parties, the exercise of veto by either party will make it difficult to pass the legislative draft in the end. In addition, the social insurance system has been proved to be effective in long-term practice, so all parties tend to adopt relatively conservative social insurance schemes.

From the perspective of the development history of German social security, the introduction of the German long-term care insurance system reflects the integration of the "Sozialstaat" principle and the nationalistic tradition, which is deeply embedded in the German cultural tradition and historical context. The principle of social state originated from the idea of risk sharing among different guilds in the early 19th century and emphasized social solidarity among different classes. A strong nationalist tradition requires that the superrational state exercise its legitimate authority for the common good.

Long-term care first came into view out of a common concern for the fate of older people in need of long-term care, reflecting a deep tradition of social solidarity. At a time when local governments are unable to bear the financial burden of long-term care, the introduction of the new system transfers the responsibility of long-term care for disabled and semi-disabled people to the federal government, which means the retreat of local governments in the field of welfare state and the strengthening of the responsibility of the federal government, reflecting a very strong nationalistic color: When families are unable to provide services and the state government's social policies are difficult to maintain, the federal government naturally assumes the responsibility of replacing the old system with a new system. Through discussion and debate in all sectors of the society, the mandatory change of the system "top-down" and the rapid development of the long-term care insurance system in various federal states are finally realized through legislation.

Thus, the idea of deep social solidarity gives rise to a common concern for the fate of the elderly in need of long-term care, while a strong tradition of nationalism makes the state unhesitantly take on the responsibility of caring for society and its people in times of need, even in times of austerity in the welfare state. There are deep reasons why the long-term care insurance system can still pass legislation.

Second, the operation concept of social long-term care insurance system

Germany's long-term care insurance system has three components. The first is the social long term care insurance (SLTCI), which covered 86.7% of the population in 2017. The second is private long term care insurance (PLTCI), which covered 11.3% of the population in 2017. Both the social long term care insurance system and the private long term care insurance system were established when the long term care Insurance legislation was enacted in 1994. The third is the supplementary care insurance system, established in 2013, about 2% to 3% of the population participated in the supplementary long-term care insurance system. As the social long-term care insurance system covers the widest population and is the main system of long-term care insurance in Germany, this paper focuses on the German social long-term care insurance system.

Since its establishment, Germany's Social long-term care Insurance system (SLTCI) has been responsible for three functions: for local governments, it means to reduce the financial burden of social assistance; For people in need of long-term care, the burden on individuals and families can be reduced through the mutual assistance of the whole society; For the system itself, it is necessary to control the increase of expenses to stabilize the payment rate of the system. Therefore, the system design and operation of SLTCI in Germany follows the following concepts: first, the governance concept of combining state centralization and decentralization; Second, the principle of universality based on nursing needs assessment; The third is to adopt the principle of budget and cost control in the system payment; The fourth is to emphasize the concept of welfare pluralism in the system financing. This part will analyze the concept and operation of the German long-term care insurance system from these four aspects.

(1) Governance concept: the combination of state centralization and decentralization of governance

After the formal establishment of SLTCI, the responsibility of long-term care rose from the local government to the federal government, and SLTCI became a governance arrangement at the national level, which meant the strengthening of national centralization and the withdrawal of local governments in the field of welfare state, and the social assistance system returned to its institutional origin.