目的: 为我国长期护理保险制度的建立和发展提供经验借鉴。方法: 根据美国联邦卫生部门和地方部门的政策文件,结合学者研究和行业分析成果,追溯美国长期护理保障体系发展历程,梳理筹资来源和待遇保障内容。结果: 美国长护制度在保障人群和保障内容上分工明确,引导居家/社区照护逐渐替代机构照护服务,实现控制支出的目的。但也面临筹资压力大、商业保险发展艰难、待遇保障需要平衡机构和非机构护理等问题。结论: 建议我国建立多支柱多层次长期护理服务保障体系,明确制度定位和保障内容,充分平衡机构护理和非机构护理发展以提高制度运行效率。
Abstract
Objective: The paper attempts to provide a experience for the establishment and development of China's long-term care insurance system. Methods: Based on policy documents from the US federal and local health departments, combined with academic research and industry analysis, the paper traced the development process of the long-term care security system in the United States and analyzed the financing sources and benefits covered in the system. Results: In the United States, there was a clear division of labor among the various systems in terms of the people and benefit content. At the same time, in order to control the long-term care expenditure, institutional care services was gradually substituted by HCBS. However, there are also issues such as high funding pressure, difficulties in the development of commercial insurance, and the need to balance institutional and non-institutional care for benefits. Conclusion: It is suggested to establish a multi-pillar and multi-level long-term care service security system in China, clarify the system positioning and benefit content, and balance the provision and usage of institutional nursing services and non-institutional nursing services to improve the efficiency of the system.
关键词
美国 /
长期护理保障 /
筹资 /
待遇
Key words
America /
long-term care /
financing /
benefits
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Long-term care in the United States: atimeline[EB/OL].(2015-08-31)[2023-09-01].https://www.kff.org/medicaid/timeline/long-term-care-in-the-united-states-a-timeline/.
[2] National Care Planning Council.The evolution of long-term care services[EB/OL].(2018-03-20)[2023-09-01].https://www.longtermcarelink.net/articles/The-Evolution-of-Long-Term-Care-Services.html.
[3] JEFF HOYT.Senior living history:1930-1939[EB/OL].(2023-07-27)[2023-09-01].https://www.seniorliving.org/history/1930-1939/.
[4] ICF/IID Program - Background and History[EB/OL].[2023-09-01].https://www.vor.net/legislative-voice/legislator-toolkit/dd-act-reauthorization/item/icfmr-program-background-and-history.
[5] Intermediate care facilities for individuals with intellectual disabilities(ICF/IID)[EB/OL].(2021-12-01)[2021-09-01].https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/Intermediate-Care-Facilities-for-Individuals-with-Intellectual-Disabilities-ICF-IID.
[6] National PACE Association.PACE history[EB/OL].[2023-09-01].https://www.npaonline.org/starting-expanding-a-pace-program/understanding-the-pace-model-of-care/pace-history.
[7] Society of Actuaries.An overview of the U.S.LTC insurance market (past and present): the economic need for LTC insurance, the history of LTC regulation & taxation and the development of LTC product design features[EB/OL].(2014-09-01)[2023-09-01].https://www.soa.org/globalassets/assets/files/resources/essays-monographs/managing-impact-ltc/mono-2014-ltc-manage-narva.pdf.
[8] CRS Reports.Who pays for long-term services and supports[EB/OL].(2022-06-15)[2023-09-01].https://crsreports.congress.gov/product/pdf/IF/IF10343.
[9] CMS' program history[EB/OL].(2022-12-01)[2023-09-01].https://www.cms.gov/About-CMS/Agency-Information/History.
[10] How is Medicare funded?[EB/OL].(2022-09-01)[2023-09-01].https://www.medicare.gov/about-us/how-is-medicare-funded.
[11] The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.2022 annual report of the Boards of Trustees of the Federal Hospital Insurance and federal supplementary medical insurance trust funds[EB/OL].(2022-06-15)[2023-09-01].https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf?ref=mikelarned.com.
[12] Publication 15 (2023), (Circular E),Employer's tax guide[EB/OL].(2022-12-15)[2023-09-1].https://www.irs.gov/publications/p15#en_US_2021_publink1000202402.
[13] What are FICA and SECA taxes?[EB/OL].(2022-12-13)[2023-09-01].https://faq.ssa.gov/en-us/Topic/article/KA-02375.
[14] What is the additional medicare tax?[EB/OL].(2022-03-17)[2023-09-01].https://www.irs.gov/newsroom/what-is-the-additional-medicare-tax.
[15] Who's eligible for Medicare?[EB/OL].(2022-12-08)[2023-09-01].https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicare/index.html.
[16] Medicare costs[EB/OL].[2023-09-01].https://www.medicare.gov/basics/costs/medicare-costs.
[17] Average salary in the US (with demographic data)[EB/OL].(2023-02-17)[2023-09-01].https://www.indeed.com/career-advice/pay-salary/average-salary-in-us#SnippetTab.
[18] Centers for Medicare & Medicaid Services.Medicaid long term services and supports annual expenditures report.federal fiscal year2019[EB/OL].(2021-12-09)[2023-09-01].https://www.medicaid.gov/sites/default/files/2022-01/ltssexpenditures2019.pdf.
[19] Congressional research service.Medicaid's federal medical assistance percentage (FMAP)[EB/OL].(2018-04-25)[2023-09-01].https://crsreports.congress.gov/product/pdf/R/R43847/9.
[20] Federal Medical assistance percentages or federal financial participation in state assistance expenditures (FMAP)[EB/OL].[2023-09-01].https://aspe.hhs.gov/federal-medical-assistance-percentages-or-federal-financial-participation-state-assistance.
[21] Congressional research service.Medicaid: an overview[EB/OL].(2023-02-08)[2023-09-01].https://crsreports.congress.gov/product/pdf/R/R43357.
[22] American association for long-term care insurance, long-term care insurance facts - Data - Statistics - 2022 Reports[EB/OL].long-term care insurance facts - Data - Statistics - 2022 Reports[EB/OL].[2023-09-01].https://www.aaltci.org/long-term-care-insurance/learning-center/ltcfacts-2022.php#total-claims-2022.
[23] American Association for long-term care insurance, long-term care insurance facts - Prices - Data - Statistics -2023 Reports[EB/OL].[2023-09-01].https://www.aaltci.org/long-term-care-insurance/learning-center/ltcfacts-2023.php#insurers.
[24] What's Medicare?[EB/OL].[2023-09-01].https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare.
[25] What Part A covers[EB/OL].[2023-09-01].https://www.medicare.gov/what-medicare-covers/what-part-a-covers.
[26] What Part B covers[EB/OL].[2023-09-01].https://www.medicare.gov/what-medicare-covers/what-part-b-covers.
[27] What's not covered by Part A & Part B?[EB/OL].[2023-09-01].https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b.
[28] Institutional Long Term Care[EB/OL].[2023-09-01].https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/index.html.
[29] Who's eligible for Medicaid?[EB/OL].(2022-12-08)[2023-09-01].https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicaid/index.html.
[30] Medicaid Coverage of Nursing Home Care When, Where and How Much They Pay[EB/OL].(2022-12-26)[2023-09-01].https://www.medicaidplanningassistance.org/medicaid-and-nursing-homes/.
[31] Mandatory & Optional Medicaid Benefits[EB/OL].[2023-09-01].https://www.medicaid.gov/medicaid/benefits/mandatory-optional-medicaid-benefits/index.html.
[32] American Council On Aging.Arizona Long Term Care System (ALTCS) from Arizona Health Care Cost Containment System/Medicaid[EB/OL].(2023-03-13)[2023-09-01].https://www.medicaidplanningassistance.org/arizona-long-term-care-system/.
[33] Genworth.Genworth's2021 Cost of Care Survey: Long-Term Care Costs Increase Due to Labor Market Shifts and Costs Associated with Continued COVID-19 Response[EB/OL].(2022-02-16)[2023-09-01].https://investor.genworth.com/news-events/press-releases/detail/64/genworths-2021-cost-of-care-survey-long-term-care-costs.
[34] American Council On Aging.Paying for Nursing Home Care: Bridging the Benefits of Medicare, Medigap & Medicaid[EB/OL].(2023-05-16)[2023-09-01].https://www.medicaidplanningassistance.org/who-pays-for-nursing-homes/.
[35] Financing Long-Term Services and Supports: Continuity and Change[EB/OL].(2023-05-16)[2023-09-01].https://dpjh8al9zd3a4.cloudfront.net/sites/default/files/publications/31d48e1e-11ee-4843-9a6e-ef5cad92f773/versions/Financing_Long_Term_Services_Supports_cr.pdf.
[36] Favreault MM, Gleckman H, Johnson RW.Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending[J].Health Aff (Millwood).2015 Dec,34(12):2181-91.
[37] Feder J, Komisar HL, Niefeld M.Long-term care in the United States: an overview[J].Health Aff (Millwood).2000 May-Jun;19(3):40-56.
[38] Murtaugh CM, Kemper P, Spillman BC, Carlson BL.The amount, distribution,timing of lifetime nursing home use[J].Med Care.1997 Mar;35(3):204-18.
[39] Basu R, Steiner AC, Stevens AB.Long-Term Care Market Trend and Patterns of Caregiving in the U.S[J].J Aging Soc Policy.2022 Jan-Feb;34(1):20-37.
[40] Wysocki A, Butler M, Kane RL, Kane RA, Shippee T, Sainfort F.Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care[J].J Aging Soc Policy.2015;27(3):255-79.
