目的:梳理国际长期护理保险（以下简称“长护险”）服务项目目录的动态机制，为我国构建全国统一、科学且具备适应性的目录调整体系提供理论支持和政策建议。方法:选取日本、德国、荷兰及韩国四个具有代表性的国家作为研究对象，系统比较其长护险服务项目目录在调整触发机制、实现路径、制度化运行方式以及质量反馈机制等方面的实践。结果:研究发现，国际成熟的长护险制度普遍将服务项目目录调整嵌入常态化制度运行，通过人口结构变化、照护需求演变等引出触发调整，并结合项目准入、退出与存量优化实现结构更新。制度化评估程序、稳定的调整周期以及循证评估工具和信息系统，是保障目录动态优化的重要支撑。结论:我国可在统一服务项目目录框架下，建立以评估为核心的动态调整机制，通过明确调整时序、优化服务结构和强化数据支撑，推动服务项目目录由静态设置向动态治理转型，提升长护险制度的科学性与可持续性。
Abstract
Objective:The paper examines international approaches to the dynamic adjustment of service catalogues in long-term care insurance (LTCI), and to provide theoretical insights and policy implications for building a nationally unified, scientific, and adaptive catalogue adjustment mechanism in China. Methods:Japan, Germany, the Netherlands, and South Korea were selected as representative cases. A comparative analysis was conducted to examine their practices in terms of adjustment trigger mechanisms, implementation pathways, institutionalized operation mode, and quality feedback mechanisms related to LTCI service catalogues. Results:The analysis shows that mature LTCI systems commonly embed service catalogue adjustment into routine institutional operations. Adjustments are typically triggered by demographic changes and evolving care needs, and are implemented through a combination of service entry, exit, and optimization of existing items. Institutionalized evaluation procedures, stable adjustment cycles, and the use of evidence-based assessment tools and information systems play a critical role in supporting dynamic catalogue optimization. Conclusions:Within a nationally unified service catalogue framework, China could establish an evaluation-centered dynamic adjustment mechanism by clarifying adjustment timing, optimizing service structure, and strengthening data support. Such a transition from static catalogue setting to dynamic governance would enhance the scientific robustness and long-term sustainability of the LTCI system.
关键词
长期护理保险 /
服务项目目录调整 /
动态治理 /
循证评估 /
国际比较
Key words
long-term care insurance /
service catalogue adjustment /
dynamic governance /
evidence-based evaluation /
international comparison
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参考文献
[1] Health at a Glance 2023: OECD Indicators[R/OL] Glance 2023: OECD Indicators[R/OL]. Paris: OECD Publishing. (2023-11-07) [2025-05-26]. https://doi.org/10.1787/7a7afb35-en.
[2] Global status report on the public health response to dementia[EB/OL]. Geneva: World Health Organization. (2021-09-02)[2025-05-26]. https://www.who.int/publications/i/item/9789240033245.
[3] Mortality associated with COVID-19 outbreaks in care homes: international evidence[R/OL]. London: International Long-Term Care Policy Network. (2020-04-12) [2025-05-26]. https://ltccovid.org/wp-content/uploads/2020/04/Mortality-associated-with-COVID-12-April-3.pdf.
[4] 国家统计局.第七次全国人口普查公报[EB/OL].(2021-05-11)[2025-05-26].https://www.gov.cn/guoqing/2021-05/13/content_5606149.htm.
[5] 中国老龄科学研究中心.第五次中国城乡老年人生活状况抽样调查基本数据公报[EB/OL].(2024-10-17)[2025-05-26].http://www.crca.cn/index.php/19-data-resource/life/1117-2024-10-17-08-01-05.html.
[6] 中国残疾人联合会. 2024年残疾人事业发展统计公报[EB/OL].(2025-05-06)[2025-05-26].https://www.cdpf.org.cn/zwgk/zccx/tjgb/1706f34657364af9a52b67f77d8c9f2b.htm.
[7] Long-term care insurance system of Japan[R]. Health and Welfare Bureau for the Elderly Ministry of Health,ong-term care insurance system of Japan[R]. Health and Welfare Bureau for the Elderly Ministry of Health, Labour and Welfare, 2016.
[8] NADASH P, DOTY P, VON SCHWANENFLÜGEL M. The German long-term care insurance program: evolution and recent developments[J]. The gerontologist, 2018, 58(3): 588-597.
[9] MADELON K. Netherlands: health system review2016: Vol.18 No.2[R/OL]. European observatory on health systems and policies.(2014-06-25)[2025-06-04]. https://eurohealthobservatory.who.int/monitors/health-systems-monitor/updates.
[10] JUNG KI S.National health insurance & long-term care insurance system republic of korea[R]. National Health Insurance Service, 2023.
[11] Japan Health Policy-3.2 Japan’s long-term care insurance system[R]. Policy-3.2 Japan’s long-term care insurance system[R]. Japan health policy now, 2019.
[12] GA H.Long-term care system in Korea[J]. Annals of geriatric medicine and research, 2020, 24(3): 181-186.
[13] VAN DER AA M J, EVERS S M A A, KLOSSE S, et al. Reform of long-term care in the Netherlands: solidarity maintained?[J]. Nederlands Tijdschrift Voor Geneeskunde, 2014, 158: A8253.
[14] Human rights of older persons in long-term care: German national report[R/OL]. Berlin: German Institute for Human Rights. (2025-02-26)[2025-05-29]. https://www.americanbar.org/groups/law_aging/publications/bifocal/vol46/vol46issue3/germaneldercare/.
[15] MILSTEIN R, MILSTEIN R.Germany's difficult balancing act: universality, consumer choice and quality long-term care for older persons: No.3: Germany[R].Geneva: World Health Organization.
[16] KIM H, KWON S.A decade of public lng-term care insurance in South Korea: Policy lessons for aging countries[J]. Health policy, 2021, 125(1): 22-26.
[17] IKEGAMI N.Expanding services, controlling costs and developing new forms of institutional care in Japan[R]. Geneva: World Health Organization, 2025.
[18] TSUTSUI T, MURAMATSU N.Japan’s universal long‐term care system reform of 2005: containing costs and realizing a vision[J]. Journal of the American Geriatrics Society, 2007, 55(9): 1458-1463.
[19] WACHS D.Long-term care assessment toolkit: application to the Republic of Korea (English) [R]. Washington D.C. : World Bank Group.
[20] The 3rd national dementia plan: living well with dementia in the community[R]. Sejong: Ministry of Health and Welfare (Republic of Korea), 2016.
[21] Federal Ministry of Health. Peer review on "Germany's latest reforms of the long-term care system"[R]. Germany: DG Employment, Social Affairs and Inclusion, 2018.
基金
国家医疗保障局课题“长护险服务项目目录动态调整机制”（20255660031）。
