Sino-Singapore Jingwei, March 3rd (Wei Wei intern Zhao Wei) "My father is 72 years old and needs long-term hemodialysis due to cerebral infarction and renal failure. I am an only child and have to go to work. My mother also has a serious heart disease. There is no way to take care of my father all the time." Recently, Ms. Xu from Xiangtan City, Hunan Province said in an interview with Sino-Singapore Jingwei.
Statistics show that by the end of 2021, the country's elderly population aged 60 and over will reach 267 million, accounting for 18.9% of the total population.
According to the fourth sample survey on the living conditions of the elderly in urban and rural areas in China, there are more than 40 million disabled and semi-disabled elderly in China.
A demographic study by Peking University shows that by 2030, the number of disabled elderly in China will exceed 77 million, and the disabled elderly will experience an average disability period of 7.44 years.
In order to enable more disabled elderly to receive professional care and prevent families from falling into the dilemma of "one person is disabled and the whole family is out of balance", the long-term care insurance (hereinafter referred to as long-term care insurance) system was launched in 2016 as a pilot.
At present, the long-term care insurance pilot program covers 49 cities, with 145 million insured persons.
Recently, Lu Xiaoming, a member of the National Committee of the Chinese People's Political Consultative Conference, said in an interview with the media that the long-term care insurance pilot program has gone through a long period of practice. It is relatively ripe to summarize and integrate the experience of pilot programs in various places and formulate a unified national long-term care insurance system.
"Gives me confidence in life"
"Long-term care insurance" is also known as the "sixth insurance" of social security. It takes the insured group who have been in a state of disability for a long time as the protection object, and focuses on solving the basic living care and medical care costs of the severely disabled.
Sino-Singapore Jingwei recently visited Xiangtan City and found that, as one of the second batch of pilot cities in the country, Xiangtan City is suffering from an aging population.
According to Ma Jinhui, director of the Xiangtan Municipal Medical Security Bureau, by the end of 2021, the population of Xiangtan City aged 60 and over will reach 590,100, accounting for 21.8% of the permanent resident population.
In this context, Xiangtan City officially launched a pilot program of long-term care insurance on January 1, 2021.
Ms. Xu's father, Xu Longqin, is one of the beneficiaries of long-term care insurance.
As an only child, Ms. Xu cannot take care of her father 24 hours a day due to work reasons, and her mother is over 70 years old. Taking care of her husband is becoming more and more difficult, especially when Mr. Xu has difficulty breathing when he gets sick, he needs to be sent to the hospital immediately.
After various investigations, in November 2021, Ms. Xu decided to send her father to the Elderly Nursing Home of the Sixth People's Hospital of Xiangtan City.
In January 2022, Mr. Xu began to enjoy long-term care insurance benefits. The long-term care fund will pay 70% of the nursing expenses, and he only needs to pay 30%.
"Before enjoying the benefits of long-term care insurance, we had to pay five to six thousand yuan a month. The pension itself of the two elderly people is not high, and my salary is not high, so the burden is still relatively heavy. After having long-term care insurance, we have Only need to pay more than 3,000 yuan, greatly reducing the financial burden." Ms. Xu said.
It is understood that the severely disabled insureds of Xiangtan Mayor's Care Insurance can choose one of the three nursing service methods: medical institutions, pension institutions, and home visits.
In principle, the nursing care of medical institutions admits severely disabled persons who mainly need medical care. The limit is 100 yuan/person/day for second-level medical institutions and above, and 80 yuan/person/day for first-level medical institutions and below. The long-term care insurance fund pays 70%, and the individual pays 30%.
Disabled persons living in designated elderly care institutions are charged 50 yuan/person/day, and the reimbursement rate is the same as that of designated medical institutions.
For those who choose institutional home care, the limit is 75 yuan/person/time, with 80% paid by the long-term care insurance fund and 20% paid by individuals.
"Some elderly people need to be treated in hospitals because of their serious conditions, so they choose medical institutions for care. However, most of the elderly will choose institutional care due to personal wishes and family economic reasons." Taikang Pension, an insurance agency for the mayor of Xiangtan According to the relevant person in charge, 80% of them choose home care.
Zhang Zhengyi, a 62-year-old insured person who lives in Yuhu District, Xiangtan City, chooses home care.
Zhang Zhengyi's wife, Ms. Chen, introduced to Sino-Singapore Jingwei that Zhang Zhengyi was paralyzed in bed due to a sudden brain stem hemorrhage in February 2013. She was completely unable to take care of herself and needed 24-hour personal care every day. Exhausted.
"He is a long-term bedridden patient, and sometimes he needs to be around him all day. Now someone comes to help me and nurses for an hour and a half each time. Not only can he teach me some nursing knowledge and skills, but also someone can talk to me, It can also give me some confidence and courage in life." Ms. Chen said.
It is understood that long-term care insurance has relevant regulations on the length and content of the agency's door-to-door services: life care includes shampooing, bathing, nail clipping, etc., 1.5 hours each time; medical care and rehabilitation training includes speech training, standing training, etc. 8 items, 1 hour each time.
The service frequency is 3-4 visits per week and no more than 16 visits per month.
"Based on the frequency of service items, the frequency of basic life care items such as cleaning and eating will be the most. However, in terms of demand, pressure sore prevention, safety care and guidance, as well as medical care and rehabilitation training items based on specific conditions are the most important. Disabled people need it more.” The above-mentioned person in charge introduced that basic life care can help relieve the pressure of family care and improve the quality of life of the insured; medical care and rehabilitation training can prevent complications, relieve symptoms, and avoid deterioration of the condition.
In terms of expenses, Ms. Chen calculated that she only needs to pay 15 yuan for each individual care, 16 times a month. The long-term care fund reimburses 960 yuan per month, and the individual only needs to pay 240 yuan per month.
The issue of financing needs to be improved
The key to the sustainable development of long-term care insurance lies in financing.
Dong Dengxin, director of the Finance and Securities Research Institute of Wuhan University of Science and Technology, pointed out in an interview with Sino-Singapore Jingwei that there are currently three main financing methods in the pilot areas, and the most popular one is as the "sixth insurance". The second is to merge the long-term care insurance into the medical insurance, and the medical insurance fund will coordinate the expenditure, and the local government will adjust the medical insurance payment standard; the third is to collect it separately according to the income and proportion.
Taking Xiangtan as an example, Ma Jinhui introduced that during the pilot phase, the insured objects are the insured personnel of the basic medical insurance for urban employees in Xiangtan City, including current employees of employers, retirees, some self-employed businesses, full-time employees and other flexible employment personnel.
According to the estimate of the average annual nursing fee for severely disabled persons of about 20,000 yuan and the payment ratio of long-term care insurance funds at 70%, and the number of disabled persons and the level of economic nursing services, the per capita annual financing standard is about 110 yuan.
It is reported that the long-term care insurance fund in Xiangtan City is raised on an annual basis. Unit and individual contributions are shared in the same proportion in principle. Unit contributions are drawn from the employee basic medical insurance premiums paid by them. Pay on behalf.
As for the financing standards, Xiangtan City is divided into active employees, retirees and flexible employment personnel.
The fundraising standard for in-service employees is that the unit payment part is based on the total wages of the employer’s employees in the previous year, that is, the annual payment base of the unit’s basic medical insurance, and is paid at a rate of 0.12%. That is, the annual payment base of the personal basic medical insurance is the base, and the payment is made at a rate of 0.12%, that is, the unit and the individual each bear 0.12%.
Retirees take their total pension income of the previous year as the base, and the individual pays at a rate of 0.24%.
Flexible employment is based on the average salary of employees employed in full-caliber urban units in Hunan Province in the previous year, and is paid by individuals at a rate of 0.24%.
Judging from the two-year pilot experience of Xiangtan long-term care insurance, in 2021, due to the impact of the epidemic, more than 1,100 people will enjoy long-term care insurance, and the fund expenditure will be 4.8773 million yuan, accounting for 15% of the fund income; Nursing insurance fund expenditure reached 15.8773 million yuan, accounting for 35% of the fund's income for the year.
"Through two years of pilot experience and fund income and expenditure, we will adjust some treatment policies in 2023. As the number of people enjoying long-term care insurance benefits increases, it is estimated that the fund expenditure this year will be around 30 million yuan, accounting for 65%. From the current Looking at it, the income can meet the expenditure." Ma Jinhui said.
Lu Xiaoming said that in many places, long-term care insurance is not an independent insurance, but attached to medical insurance and highly dependent on medical insurance funds, and is essentially a part of medical insurance.
However, there are not small differences in the nature and functions of the two. Medical insurance mainly guarantees the treatment and rehabilitation of patients, that is, medical treatment; while long-term care insurance is for the disabled, maintaining their physical function through nursing care, and Does not have significant therapeutic and rehabilitation functions.
Lu Xiaoming further pointed out that medical insurance is facing greater pressure to maintain and increase value, and the medical insurance fund faces the question of whether the blood transfusion for long-term care insurance can be sustained.
Therefore, it is necessary to broaden financial resources and further improve the financing mechanism shared by individuals, units, and the state to ensure its long-term stable development.
Long-term care insurance is expected to improve quality and expand coverage
"At present, although pilot policies for long-term care insurance have been launched successively in various places, due to the lack of a unified institutional framework, each pilot city has problems in terms of coverage, beneficiaries, coverage levels, evaluation standards, financing channels, service items, and management. There are certain differences, and there are challenges to the fairness and sustainability of the system." Sun Jie, a member of the National Committee of the Chinese People's Political Consultative Conference and the School of Insurance of the University of International Business and Economics, pointed out in the proposal.
In terms of long-term care insurance benefits, most of the pilot cities, including Xiangtan City, only cover the elderly with severe disabilities.
However, Nantong, Qingdao, Suzhou and Hohhot cover moderately disabled groups, and some cities include special groups such as dementia in the scope of protection.
Tong Xiaoxuan, president of Xiangtan Sixth People's Hospital, said in an interview with Sino-Singapore Jingwei that the elderly with long-term care insurance in the hospital accounted for only 20% of the admitted patients.
"Such mild and moderate disabilities are not within the scope of long-term care insurance payment, and have not met the payment standard of long-term care insurance."
He Weilong, head of Xiangtan City's Treatment Security and Medical Service Management Section, said that at present, in accordance with the requirements of the National Medical Insurance Bureau to first include severely disabled people in the long-term care insurance coverage, Xiangtan City has not yet included moderately disabled people in the long-term care insurance in the early stage of the pilot program. However, some pilot cities have included moderately disabled persons in the long-term care insurance system.
In the next step of the pilot work, Xiangtan City will learn from the advanced experience of other cities and include moderately disabled persons in long-term care insurance as a direction for future consideration.
With the further exploration and practice of long-term care insurance pilots, the beneficiaries of long-term care insurance are expected to expand.
Sino-Singapore Jingwei noticed that long-term care insurance also appeared in the 2023 government work reports of many places.
According to the 2023 government work report of Beijing, the pilot project of long-term care insurance will be promoted.
The 2023 government work report of Chongqing pointed out that the quality and expansion of long-term care insurance should be promoted.
He Weilong mentioned that the current Xiangtan long-term care insurance pilot only covers employee medical insurance, and urban and rural medical insurance residents have not yet been included in long-term care insurance.
"We will also further optimize the financing standards in the next round of implementation rules, and plan to reduce the payment ratio of retirees. In addition, we will also consider exploring the expansion of long-term care insurance—incorporating urban and rural residents into the coverage of long-term care insurance." He Weilong said.
Dong Dengxin believes that the next stage of long-term care insurance should enter the stage of comprehensive promotion.
"It is imminent and urgent to make the sixth insurance a system covering all the people."
Sun Jie also suggested that, with reference to Japan and Germany's inclusion of long-term care insurance in the framework of the social security system, relevant government departments should study and issue relevant system norms as soon as possible to clarify the positioning and development direction of the long-term care insurance system; at the same time, establish a unified national rating and demand assessment Standards, management norms, gradually improve the multi-channel financing mechanism, expand the scope of protection, and ensure its sustainable development.