本文基于CHARLS2011年、2013年、2015年和2018年共四年数据,运用成本-收益分析法,研究长期护理保险对医疗费用及基本医保基金可持续性的影响。本文发现长期护理保险通过减少个体年门诊次数等机制降低了医疗总费用。由于长期护理保险部分筹资源于基本医保基金,本文将这部分从基本医保基金中提取的金额定义为成本,将长期护理保险通过降低医疗费用而节省的医保基金支出金额定义为收益,探究长期护理保险对基本医保基金可持续性的影响,即成本与收益的差值。研究发现在以中方案人口数量预测为基础数据、“90+10”方案为照护模式、全体失能老人为保障对象、70%为报销比例的模式下,长期护理保险可为基本医保基金人均节省65.44元—105.05元。同时,本文从人口预测方案、护理模式和报销比例等角度进行敏感性分析,发现当长期护理保险报销比例一定时,选择以居家护理为主的老人占比越高,长期护理保险对基本医保基金可持续性的正向影响越强。以往研究大多讨论长期护理保险制度对基本医疗保险制度的负面作用,缺少长期护理保险制度对基本医疗保险制度正面作用分析。本文以此为出发点进行探究,为国家和地方政府完善长期护理保险制度、探究长期护理保险与基本医疗保险互馈机制等内容提供理论依据。
Abstract
Based on CHARLS data in 2011, 2013, 2015 and 2018, this article explores the impact of long-term care insurance on medical expenses and sustainability of the basic medical insurance fund with cost-benefit analysis methods. This article finds that long-term care insurance reduces total medical expenses through mechanisms such as reducing the number of individual annual outpatient visits. Since some of the long-term care insurance financing comes from the basic medical insurance fund, this article defines the amount of long-term care insurance financing from the medical insurance fund as cost, and defines the amount of medical insurance fund that long-term care insurance saves by reducing medical expenses as benefit. The paper explored the impact of long-term care insurance on the sustainability of medical insurance funds, which is the difference between the cost and benefit. The study found that based on the population prediction of the medium plan, the "90+10" plan as the care model, all disabled elderly people as the target of guarantee, and 70% as the reimbursement ratio, long-term care insurance can save 65.44 yuan to 105.05 yuan per capita for the basic medical insurance fund. At the same time, this article conducts sensitivity analysis from the perspectives of population forecast plan, nursing model and reimbursement ratio, and finds that with a specific reimbursement ratio of the long-term care insurance system, the higher the proportion of elderly people who mainly chooses home care, the long-term care insurance system can have a more positive impact on the medical insurance fund. Previous studies mainly discussed the negative effects of the long-term care insurance system on the basic medical insurance system, lacking analysis of the positive effects of the long-term care insurance system on the basic medical insurance system. This article conducts research to provide theoretical basis for national and local governments to improve the long-term care insurance system and explore the mutual feedback mechanism between long-term care insurance and basic medical insurance.
关键词
长期护理保险 /
医疗服务利用 /
医保基金可持续性 /
成本-收益分析
Key words
long-term care insurance /
health care utilization /
health insurance fund sustainability /
cost-benefit analysis
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基金
首都医科大学国家医疗保障研究院开放性课题“多层次长期护理保障体系问题研究”(YB2023B06); 国家自然科学基金面上项目“长期护理保险嵌入农村医养健康服务体系的传导机制、福利效应和路径优化研究”（72274104); 国家自然科学基金青年科学基金项目“灾难性卫生支出的风险识别、致贫路径与精准保障研究”（71804090)
