The long-term care insurance system has been piloted for 5 years, with 134 million people participating
Long-term care insurance to promote the development of the elderly care industry (Health Focus)
Our reporter Li Hongmei, Wang Mingfeng and Shen Shaotie
"People's Daily" (19th edition on August 13, 2021)
my country has entered an aging society. As of the end of 2019, there were 254 million people aged 60 and over, and more than 40 million disabled people.
Insufficient long-term care protection for disabled persons has become an urgent problem to be solved.
With the aging and aging of the population intensifying, it is imperative to establish a long-term care insurance system.
In 2016, my country started pilot projects in 15 cities and 2 key contact provinces.
In September 2020, the National Medical Insurance Administration and the Ministry of Finance issued the "Guiding Opinions on Expanding the Pilot Program of the Long-Term Care Insurance System", adding 14 pilot cities to the original pilot cities.
A few days ago, the reporter walked into some pilot cities for long-term care insurance systems to conduct interviews.
Long-term care insurance solves the life care and nursing problems of disabled persons and improves the quality of life of disabled persons
In 2016, Liu's mother-in-law in Chengdu, Sichuan Province, suffered from ischemic hypoxic encephalitis and lost her ability to take care of herself. She relied on her wife, Uncle Zhao, to take care of her.
Once, when Uncle Zhao was taking care of Liu's mother-in-law, both of them fell to the ground.
There was no one at home at that time, and Uncle Zhao struggled to dial 120, but he didn't even have the strength to open the door for the medical staff.
Chengdu is one of the first batch of 15 pilot cities for long-term care insurance systems in the country, and the pilot work was officially launched in July 2017.
After the policy was promulgated, Mother-in-law Liu was assessed and determined to be severely disabled and could enjoy basic care treatment of about 1,000 yuan per month.
At the same time, there are also professional organizations that regularly come to provide care services every month.
Since then, Uncle Zhao no longer has to worry about not being able to take care of his wife.
Currently, 14.239500 people in Chengdu have long-term care insurance.
As of June 2021, a total of 58,700 applications for identification of disability have been accepted, and 45,800 have passed the assessment; 752,800 people have been paid for treatment, totaling 844 million yuan.
A sample survey shows that long-term care insurance reduces the financial burden of family care for disabled persons by at least 44.31%, and significantly improves the people's sense of medical security, happiness, and security.
Nantong City in Jiangsu Province is also the first batch of cities to pilot a long-term care insurance system.
After five years of exploration and practice, Nantong has gradually formed a long-term care insurance model that integrates "institutional care, home services, allowances and subsidies, assistive device support, and prevention and control".
At present, the Nantong Mayor's Protection Insurance has covered the city's urban and rural residents, and the coverage has expanded to the moderately and severely disabled (dementia) people.
80% of disabled people choose home services, and 20% receive nursing services in institutions.
When receiving nursing services in designated medical institutions or designated elderly service institutions, each person can enjoy a monthly payment of 2,100 yuan.
The home care service has introduced 4 series, 12 packages, and more than 30 service items, and the number of home care services has reached more than 1 million.
Among the disabled population, the elderly with disability and multiple diseases coexist at an overwhelming majority.
Disabled people need long-term professional care, and the family structure is miniaturized and empty, which brings a heavy burden to individuals.
Long-term care insurance effectively compensates for the social security "shortcomings" of disabled persons, solves the problems of life care and nursing for disabled persons, and improves the quality of life of disabled persons.
Up to now, the number of insured persons in the 49 pilot cities for the long-term care insurance system has reached 134 million, and the cumulative number of people enjoying benefits is 1.52 million.
Fund protection expenses, social forces management, assessment of disability status, and on-site service are the operating characteristics of long-term care insurance
Uncle Zhao, who lives in Guchengjiayuan Community, Pingguoyuan Street, Shijingshan District, Beijing, is 78 years old this year.
In 2017, he accidentally fell at home, causing damage to the lumbar spine, loss of consciousness in the lower body, and lying in bed for a long time.
"Please close your eyes and I will wash your hair." A few days ago, Han Zaijie, an elderly care worker from Beijing Yihujia Technology Service Co., Ltd. came to wash his hair for the bedridden Uncle Zhao.
Han Zaijie placed an inflatable shampoo beside Uncle Zhao's bed, hung a bag of water on the wall beside the bed, turned on the small sprinkler, and scrubbed Uncle Zhao's hair with warm water.
"It costs a lot to take care of my father every month," said my daughter, Sister Zhao. Her father's medical and nursing expenses exceed 7,000 yuan a month, far exceeding the retirement salary of the elderly.
"My mother is not in good health and needs long-term treatment and care. I quit my job at home to take care of the elderly, and the financial pressure is not small."
In January this year, Sister Zhao applied for a long-term care insurance for her father.
Uncle Zhao is a retired worker of the Beijing Boiler Factory. He only needs to pay 90 yuan a year, and the government subsidizes 90 yuan. He can get a monthly reimbursement of 1044 yuan. The elderly caregivers provide 12 hours of home service, which is equivalent to saving another 1080 yuan. Obviously reduced the economic pressure.
Fund protection expenses, social forces management, assessment of disability status, and provision of on-site services are the operating characteristics of the long-term care insurance system.
In 2018, Shijingshan District, Beijing began to pilot long-term protection insurance.
In September 2020, Shijingshan District was included in the scope of the pilot expansion of national long-term care insurance, covering more than 470,000 insured persons.
The service methods are divided into institutional care, institutional home care and home care. The service content includes 32 daily basic life care and medical care, including cleaning care, diet care, excretion care, lying and safety care, disease observation, and rehabilitation care.
After conversion, the insured person can enjoy a monthly reimbursement of about 2,000 yuan.
At present, there are nearly 2,500 residents in Shijingshan District enjoying long-term care insurance.
Recently, the Office of the National Medical Insurance Administration and the General Office of the Ministry of Civil Affairs issued the "Long-term Care Disability Level Evaluation Standard (for Trial Implementation)", proposing that pilot areas start to test the long-term care disability level evaluation standard to determine whether the insured can enjoy long-term care insurance treatment.
This evaluation standard is a comprehensive evaluation index system, which is composed of 3 first-level indicators and 17 second-level indicators, such as the ability of daily living activities, cognitive ability, perception and communication ability, and makes the assessment subject, object, process, etc. It is stipulated that the combination method will be used to determine the level of disability in the end.
How to raise funds for long-term care insurance?
Relevant policies stipulate that the pilot phase should start from the people participating in the basic employee medical insurance, and the initial stage can be deducted from the basic employee medical insurance premiums paid by them. Where conditions permit, multi-channel funding mechanisms can be explored and fund payment levels are generally controlled. Around 70%.
For example, Nantong has established multi-channel financing methods such as personal payment, financial subsidies, fund transfers, social donations, etc. The average fund is 100 yuan per year, of which 30 yuan is paid by individuals, and the unit payment is allocated by the basic medical insurance coordinating fund 30 yuan, and financial subsidies 40 yuan.
The needy groups and minors are fully subsidized by the government.
From 2016 to 2020, the municipal government directly invested 280 million yuan, accounting for 45% of the total fund.
The handling services of long-term care insurance are handed over to commercial insurance companies for professional operation, and professional care services are purchased from service organizations, and the quality of services is guaranteed through supervision and assessment.
Aixin Life is one of the two long-term care insurance agencies in Shijingshan District. Dong Zhangyong, senior manager of the company's health insurance business department, said that if the service quality of the care institution fails, it will suspend payment, refuse to pay, terminate the agreement, and terminate the agreement. handle.
Fan Yijie, head of nursing staff at Beijing Yihujia Technology Service Co., Ltd., said that the company strictly controls quality, regularly conducts skills training and service training, organizes skill competitions and assessments, and continuously improves service levels.
Establish and improve a multi-level long-term care security system that meets the diverse needs of the people, so that the elderly in need can enjoy treatment
"I can't afford to go to work, so I can take a vacation. But taking care of my old mother, even if I feel unwell, I have to persist." Mother Xie, who lives in Chengdu, Sichuan Province, needs her son to take care of her. At her age, she feels exhausted and overwhelmed by caring for her 100-year-old mother all the time.
The 101-year-old mother-in-law Xie broke the bones of her feet and her feet were severely deformed and unable to stand.
In addition, the body's functions are gradually deteriorating, suffering from a variety of senile diseases, and completely losing the ability to take care of themselves.
On January 8, 2021, after passing the disability assessment, Mother Xie will enjoy the secondary treatment for severe disability in the long-term care insurance for urban and rural residents, and can be reimbursed for nursing expenses of 722 yuan per month.
"We brothers and sisters pooled some money, plus the monthly long-term care insurance benefits, we can ask a professional home care worker to take care of the mother. Long-term care insurance has helped a lot!" Mother Xie said excitedly.
Wang Zongfan, a researcher at the Chinese Academy of Labor and Social Security Sciences, believes that the long-term care insurance pilot program has gradually covered urban and rural residents from urban employees and achieved full coverage; there is an independent financing and treatment guarantee system, and the unit and individual payment obligations are combined; there is a third party Entrust the management system to form a management model of diversified governance and professional operation.
Each pilot area draws on international experience, adapts measures to local conditions, actively explores, and establishes different local evaluation standards.
The national evaluation standards promulgated this time are formed on the basis of fully summing up local experience and can adapt to the actual needs of evaluation in different regions. This means that the country will have a unified long-term care disability level evaluation standard.
In the future, how to tailor refined service content for each disabled person, determine the corresponding payment standards, and improve the efficiency of fund use, has become a problem that needs to be further explored and resolved.
Experts believe that long-term protection insurance is a brand-new system. It has not been operating for a long time abroad, and there is no mature experience in China. The construction of the standard system is still relatively lagging, and more exploration is needed.
For example, the care service industry needs to be regulated, including service project standards, professional competence standards for care service personnel, and institutional access standards; insufficient care services, shortage of professionals, and insufficient institutions and facilities are still important factors restricting the development of long-term care insurance , It is necessary to promote the development and growth of the service industry through the purchase mechanism and standardized management of long-term protection insurance.
In the future, my country will promote the establishment and improvement of a multi-level long-term care security system that meets the diverse needs of the people, so that the elderly in need can enjoy treatment and relieve their worries.
■Extended reading
Long-term care insurance is a social insurance system that raises funds through mutual assistance and provides services or financial guarantees for the basic living care of long-term disabled persons and medical care closely related to them. Long-term care insurance provides protection for disabled persons through the purchase of care services, and the protection benefits are embodied in the form of providing care services rather than directly issuing cash. Long-term care insurance gives priority to protecting the basic care needs of severely disabled people, such as disabled elderly and severely disabled people. Since 2016, long-term care insurance has been piloted in my country for 5 years, which has reduced the financial burden and business burden of disabled families and promoted the development of elderly care and other industries.