通讯作者: 方亚, fangya@xmu.edu.cn

DOI：10.12201/bmr.202211.00018

Optimization Scheme Design of Long-term Care Insurance Financing in China : A System Dynamics Simulation

• 摘要：目的：分析我国长期护理保险(长护险)基金的收支状况及其影响因素,预测长护险基金结余变化趋势,为我国构建基金可持续的长护险筹资机制提供优化方案与政策建议。方法：运用文献分析、现场调研等方法明确我国长护险基金收支现况及其主要影响因素,基于系统动力学(System Dynamics, SD)方法,建立长护险基金收支SD模型。结果：基于基金可持续原则,本研究共产生45种筹资组合方案,按照基金结余呈现出一条较为平缓的、不低于横坐标轴的曲线,且在预测年限后期应出现最高值(拐点)的判定标准,结合长护险给付水平大于80%的政策建议,最终筛选得出5种优化筹资方案。结论：为保障长护险制度的稳步推进和基金可持续运行,应尽快建立“独立型”长护险的筹资动态调整机制,适度提高个人缴费水平,加强老年人的失能干预,制定科学客观的失能评定标准,以维持基金规模的稳定和可持续性,进而为我国各试点城市探索适宜的长护险筹资政策提供循证依据。

  关键词： 长期护理保险; 筹资机制; 系统动力学模型; 政策优化

   

  Abstract: Objective: This study aimed to explore the relationship between revenue and expenditure of long-term care insurance(LTCI) and its influencing factors, and to predict the changing trend of LTCI funds, so as to provide evidence for the establishment of an unified and sustainable financing mechanism of LTCI in China. Methods: The current situation and its main influencing factors of supply and demand of LTCI funds were determined by literature analysis, system analysis, questionnaire survey, and expert consultation. We constructed the model of Chinas LTCI financing according to the system dynamics (SD) method and used it for simulation. Results: Based on the principle of fund sustainability, this study produces 45 financing combination schemes. According to the judgment standard that the funds balance presents a relatively gentle curve, no less than the horizontal axis, and the maximum value (inflection point) should appear in the later period of forecast, combined with the policy suggestions that the payment level of LTCI is greater than 80%, five better financing schemes are finally screened. These five financing schemes have no deficit and excessive balance in the forecast period, which is in line with the principle of sustainability. It can provide reference for the selection of financing schemes in pilot areas. Conclusions: By appropriately increasing the individual payment rate, strengthening the disability intervention of the elderly, formulating scientific and objective disability evaluation standards, and finally establishing a dynamic financing adjustment mechanism of LTCI. This study can provide a basis for the scientific formulation of LTCI financing mechanism in China, and provide a reference for developing countries to establish a sustainable LTCI.

  Key words: long-term care insurance; financing mechanism; system dynamics model; simulation and optimization

  提交时间：2022-11-23

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• 序号	提交日期	编号	操作
  1	2022-08-16	bmr.202211.00018V1	下载

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