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Every time the reporter Tu Yinghao Every time the editor Yi Qijiang
The 2019 government job report proposed “expanding the long-term care insurance pilot program.” In May of this year, the National Health Security Administration publicly solicited input from the public on “Guiding Opinions on the Expansion of the Long-Term Care Insurance System Pilot Program.” Today, the pilot expansion of long-term care insurance has finally arrived! long-term care!
On September 16, the National Health Insurance Administration and the Ministry of Finance issued the “Guiding Opinions on the Expansion of the Pilot Program of the Long-Term Care Insurance System” (hereinafter, the “Opinions”). The pilot phase began with the population that participates in the basic health insurance for employees and focused on the care of people with severe disabilities. For basic nursing care needs, priority is given to the eligible disabled elderly and the severely disabled.
The relevant person in charge of the Taikang Pension Care Insurance Department said in an interview with the “Daily Economic News” reporter: “Long-term care insurance is a kind of basic life care for people with long-term disability. term and provides services or financial guarantee for health care closely related to it. China’s social insurance system should adhere to independent operation, focus on the establishment of independent types of insurance, independent design and independent promotion.This undoubtedly clarified the positioning of the “sixth insurance” of long-term social insurance from the positioning of the system, that is, a new social security system independent of medical insurance. This is a top-level design change and is very noteworthy.。 “
The person also noted that the document also requires that the operation of long-term care insurance in the future should “start low” and “start from the employees and gradually expand to the whole town.” This also shows that the country still hopes that the development of long-term care insurance should take small steps and gradually discover a system that is adapted to the actual conditions of China.
Focus on establishing “independent insurance”
China has entered an aging society. At the end of 2019, the population aged 60 and over reached 254 million and the disabled exceeded 40 million.The insufficient security of long-term care for people with disabilities has become an urgent social problem that must be solved.
In accordance with the deployment of the Party Central Committee and the State Council, the state has organized some localities to actively carry out pilot projects of the long-term care insurance system since 2016, and the pilot projects are progressing smoothly. The pilot cities originally identified by the Ministry of Human Resources and Social Security and the two key contact provinces of Jilin and Shandong continue to carry out the pilots in accordance with the requirements of this opinion. Other provinces that have not carried out the pilots can add a new city to carry out the pilots, which will be implemented during this year. 2 years. Without the consent of the National Health Insurance Office and the Ministry of Finance, all localities will not expand the scope of the pilot program.
The “Opinions” focus on the establishment of independent types of insurance, clarify the objectives of the system and propose to strive to basically form a normative framework of the long-term care insurance system that is adapted to the level of economic development of China and the aging trend during the period of the “XIV Five-Year Plan” and promote the establishment of a strong and satisfactory public diversity The multi-level long-term care security system you need.
Based on the current reality of economic and social development and the basic needs of the people, and from the perspective of promoting the long-term sustainability of the system, the six basic principles for the expansion of the pilot program have been clarified:
The first is to adhere to the people-oriented approach and focus on the safety issues of long-term care for people with severe disabilities that the masses urgently need to solve. The second is to insist on independent operation and promote independent system design and independent advancement. The third is to adhere to basic protection and strive to meet the basic long-term care protection needs of the masses. The fourth is to insist on sharing responsibilities and rationally dividing financial responsibilities and guaranteeing responsibilities. The fifth is to persist in the innovation of the mechanisms, explore the operational mechanisms of sustainable development and improve the efficiency of the guarantees and the level of management. Sixth, persist in overall planning and coordination and do a good job of linking with relevant social security systems and insurance business functions to form a security force.
The aforementioned Taikang retirees pointed out that long-term care insurance, as a stand-alone type of insurance, will gradually move away from financial allocation support and medical insurance fund transfer support in terms of financing, and will use enterprises and individuals as a financing issue. In this document, fund management also proposes to establish separate accounts for separate accounting.
“Notice”It is clarified that the financing of the insured group of employees is paid mainly by the unit and the individual, and the payment responsibilities are shared by a ratio of 1: 1 in principle. Optimize the financing structure, adopt the rate change method, propose to allocate a part of the employee health insurance premium paid by the unit as a unit payment for long-term care insurance, establish an independent financing channel for the long-term care insurance and does not increase the load on the unit. The individual payment portion may be deducted from the employee’s individual basic health insurance account.
Clearly “bring” social forces to participate in the management
Industry experts noted that compared to Document No. 80 issued in 2016, the expanded pilot document emphasizes building a multi-level nursing security system, from “exploration” to clear “introduction” of social forces to participate in management, while establishing a mechanism to stimulate enthusiasm for participation. Quality of service, efficiency pays, etc. Effectively address the issues of the lack of clear limits of liability for social insurance and commercial insurance, and how the commercial insurance competition mechanism should be brought into play during the preliminary pilot process. It emphasizes the functional connection with commercial insurance and promotes the role of commercial insurance to a new height.
The “Notice” indicated that it supports the introduction of social forces to participate in the management of services, play the role of market mechanisms and stimulate the vitality of market entities. Establish and improve performance evaluation, evaluation incentives, and corresponding risk prevention mechanisms. Accelerate system platform building, realize information exchange and interconnection, and break information islands.
Currently, in the long-term care insurance processing process, the government leads the policy direction, the main forms being the management of commercial insurance commissioned by underwriting and the management of commercial insurance commissioned by the government.
Some commercial insurance companies said that long-term care insurance agencies are actively exploring the establishment of two mechanisms for dynamic management and exit management of designated service agencies, and seriously manage the three entry doors, performance and output to ensure the quality of nursing services and effectively improve the level of nursing service.
The “Notice” clarified and improved the agreement management and the supervision and auditing system, strengthened and standardized the supervision of the service, and played a role in promoting reform on the service supply side. Promote the improvement of unified and standardized long-term care insurance coverage, related standards and management methods.
It is understood that the current pilot cities across the country have different foundations, and there are also certain differences in assessment standards and assessment content. Some prefectures and rated cities rely on universities and scientific research institutions to conduct special research, innovate the assessment standards system, and establish localized disability assessment and rating standards and technical specifications. There are also regions that refer directly to the Papanicolaou scale to perform the identification of nursing needs and grade evaluation.
“The disability assessment, service standards, etc. are the basis for payment of long-term care insurance funds. Assessment standards and assessment content are not uniform in various places, which it can easily cause misunderstandings, such as the participation of people from other places in the evaluation. I hope the country will take the next step in its work. From the perspective of uniformity of system construction and balance of benefits, we can increase research and the improvement of the relevant standard system, “said the aforementioned senior citizen of Taikang.
Source: National Health Insurance Administration
(Edit: Ni Ping)
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