2016年以来,长期护理保险试点城市（地区）已扩大到49个并取得了长足发展,各试点地区因地制宜出现了诸多制度创新,但也存在明显的政策碎片化现象。本文着重讨论了长期护理保险制度碎片化现象较为明显的四个问题,包括享受待遇的目标人群、服务方式的供给结构、服务项目的侧重比例、两大制度板块的覆盖边界等;着重分析了模式选择的四个不同做法,包括运行模式、保障模式、筹资模式、经办模式等,并逐一提出相应的政策建议。根据“摸着石头过河与顶层设计相结合”的方法论,本文认为,应尽快结束试点,进入顶层设计阶段,以减少沉没成本;根据不同国家建立长期护理保险的时间节点,我国建立长期护理保险制度充分体现了“尽力而为、量力而行”的基本原则,是推进中国式现代化和实现共同富裕的重要举措;根据人口老龄化发展趋势,建议以2035年为界进行“两阶段推进”,以期平稳过渡到全国一盘棋的统一制度。

Since 2016, the number of pilot cities (regions) for long-term care insurance have expanded to 49 and long-term care insurance made significant progress. Each pilot city (region) has introduced many institutional innovations tailored to local conditions, but there is also obvious policy fragmentation. This article focuses on four issues related to the fragmentation of the long-term care insurance system, including the target population benefiting from the policy, the supply structure of service modes, the focus of service projects, and the coverage boundaries of the two major institutional sectors. Emphasis was placed on analyzing four different approaches of mode selection, including operation mode, guarantee mode, financing mode, and administration mode, and corresponding policy recommendations were proposed one by one. According to the methodology of "crossing the river by feeling the stones and combining it with top-level design", this article proposes that the pilot should be completed as soon as possible and enter the top-level design stage to reduce sunk costs. According to the time nodes of establishing long-term care insurance in different countries, the establishment of long-term care insurance system in China fully reflects the basic principle of "do everything within our capacity", which is an important measure to promote Chinese path to modernization and achieve common prosperity. With the trend of population aging, it is recommended to carry out a "two-stage promotion" with the year of 2035 as the boundary to smoothly transit to a unified system for the whole country.