“十五五”时期，我国长期护理保险制度将从局部试点迈向全面建制。构建覆盖广泛且财务可持续的长期护理保险适度保障体系成为关键议题。本研究以社会保障适度水平理论为基础，构建内嵌逆向选择与道德风险等风险因子的长期护理保险适度保障水平测度模型。通过理论分析与国际比较，剖析德国和日本在参保约束、风险池均衡等方面的制度工具，呈现了其通过强制性参保、第三方质量检查、服务标准化等机制平抑风险因子，从而有效治理信息不对称，降低制度运行损耗，使保障水平更贴近经济社会可承受的适度区间的路径。结合中国试点实践，提出优化筹资责任共担机制、健全服务供给标准化体系、促进制度协同与培育银发经济等政策建议，为中国特色长期护理保险制度的全面建制提供理论支撑与路径参考。
Abstract
During the 15th Five-Year Plan period, China's long-term care insurance system will transit from localised pilot schemes to comprehensive institutionalisation. Establishing a broadly accessible and financially sustainable moderate guarantee framework for long-term care insurance has become a critical issue. This study constructs a measurement model for the appropriate level of long-term care insurance, embedding risk factors such as adverse selection and moral hazard, based on the theory of adequate social security levels. Through theoretical analysis and international comparison, it examines institutional tools employed by Germany and Japan in areas such as participation constraints and risk pool balancing. It demonstrates how these countries mitigate risk factors through mechanisms including compulsory participation, third-party quality inspections, and service standardisation, which can effectively addresse information asymmetry, reduce operational losses within the system, and align benefit levels with the economically and socially sustainable optimal range. Drawing on China's pilot initiatives, the study proposes policy recommendations including optimising co-financing mechanisms, enhancing standardised service provision systems, promoting institutional coordination, and cultivating the silver economy, so as to offer theoretical underpinnings and practical pathways for establishing a comprehensive long-term care insurance system with Chinese characteristics.
关键词
长期护理保险 /
适度保障水平 /
逆向选择 /
道德风险 /
风险治理
Key words
long-term care insurance /
moderate benefit level /
adverse selection /
moral hazard /
risk governance
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 经济参考报.长护险从试点迈向全面建制[EB/OL].(2025-12-26)[2026-01-02].https://www.jjckb.cn/20251226/6fd4b4907d154c3b998f3113927085ba/c.html.
[2] 中国政府网. 2026年全国民政工作会议在京召开[EB/OL].(2026-01-01)[2026-01-06].https://www.gov.cn/lianbo/202601/content_7053628.htm.
[3] Brown J R, Finkelstein A.Why is the market for long-term care insurance so small?[J]. Journal of Public Economics, 2007, 91(10): 1967-1991.
[4] 纪斌,姜日进,张志勤.我国农村地区建立长期照护体系的紧迫性?可行性及其对策建议[J].中国医疗保险,2024(1):75-81.
[5] 岳福岚. 我国长期护理保险试点运行的实践?问题及建议——以德国长期护理保险法改革为镜鉴[J].保险研究,2024(8):113-127.
[6] 房连泉. 完善长期护理保险筹资机制的政策选择[J].中国医疗保险,2025(4):48-53.
[7] 穆怀中. 社会保障适度水平研究[J].经济研究,1997(2):56-63.
[8] AKERLOF G A.The market for "lemons": quality uncertainty and the market mechanism[J]. Quarterly journal of economics, 1970, 84(3): 488-500.
[9] SPENCE M.Job market signaling[J]. Quarterly journal of economics, 1973: 355-374.
[10] STIGLITZ J E, WEISS A.Credit rationing in markets with imperfect information[J]. The American economic review, 1981, 71(3): 393-410.
[11] ARROW K J.Uncertainty and the welfare economics of medical care[J]. The American economic review, 1963, 53(5): 941-973.
[12] 《社会保障概论》编写组.《社会保障概论》[M].北京:高等教育出版社,2019:187-191.
[13] 肖颖,王雪辉,朱勤.长期护理保险对老年人照料模式的影响研究[J].人口与发展,2025,31(4):68-78.
[14] FINKELSTEIN A, MCGARRY K.Multiple dimensions of private information: evidence from the long-term care insurance market[J]. American economic review, 2006, 96(4): 938-958.
[15] UGARTE MONTERO A, WAGNER J.On potential information asymmetries in long-term care insurance: a simulation study using data from switzerland[J]. Insurance: mathematics and economics, 2023, 111: 230-241.
[16] KO A.An equilibrium analysis of the long-term care insurance market[J]. The Review of economic studies, 2022, 89(4): 1993-2025.
[17] BRAUN R A, KOPECKY K A, KORESHKOVA T.Old, frail, and uninsured: accounting for features of the U.S. long-term care insurance market[J]. Econometrica, 2019, 87(3): 981-1019.
[18] BOYER M M, DE DONDER P, FLUET C, et al.Long-term care insurance: information frictions and selection[J]. American economic journal: economic policy, 2020, 12(3): 134-169.
[19] HANDEL B R, KOLSTAD J T, SPINNEWIJN J.Information frictions and adverse selection: policy interventions in health insurance markets[J]. The review of economics and statistics, 2019, 101(2): 326-340.
[20] KONETZKA R T, HE D, DONG J, et al.Moral hazard and long-term care insurance[J]. The Geneva papers on risk and insurance - issues and practice, 2019, 44(2): 231-251.
[21] POWELL D, GOLDMAN D.Disentangling moral hazard and adverse selection in private health insurance[J]. Journal of econometrics, 2021, 222(1): 141-160.
[22] ELY J C, GEORGIADIS G, RAYO L.Feedback design in dynamic moral hazard[J]. Econometrica, 2025, 93(2): 597-621.
[23] AIS. Global insurance market report2023[R/OL]. (2023-12)[2026-01-01]. https://www.iais.org/uploads/2023/12/Global-Insurance-Market-Report-2023.pdf.
[24] Cornell P Y, Grabowski D C, Cohen M, et al.Medical underwriting in long-term care insurance: Market conditions limit options for higher-risk consumers[J]. Health affairs, 2016, 35(8): 1494-1503.
[25] Bundesministerium für Gesundheit. Was ist die Pflegeversicherung?[EB/OL].(2025-02-25)[2026-02-21].https://www.bundesgesundheitsministerium.de/themen/pflege/online-ratgeber-pflege/die-pflegeversicherung.
[26] SATO J, MITSUTAKE N, KITSUREGAWA M, et al.Predicting demand for long-term care using Japanese healthcare insurance claims data[J]. Environmental health and preventive medicine, 2022, 27(1): 42-42.
[27] BUSSE R, BLÜMEL M, KNIEPS F, et al. Statutory health insurance in germany: a health system shaped by 135 years of solidarity, self-governance, and competition[J]. The lancet, 2017, 390(10097): 882-897.
[28] MIKOSHIBA M.Universal insurance with in-kind transfers: the welfare effects of long-term care insurance in japan[J]. 2025(1):38-39.
[29] TAMIYA N, NOGUCHI H, NISHI A, et al.Population ageing and wellbeing: Lessons from japan's long-term care insurance policy[J]. The Lancet, 2011, 378(9797): 1183-1192.
[30] Health and Welfare Bureau for the Elderly Ministry of Health, Labour and Welfare. Long-Term Care Insurance System of Japan[R/OL].(2016-12)[2026-02-21].https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_e.pdf.
[31] DEBIE A, NIGUSIE A, GEDLE D, et al.Building a resilient health system for universal health coverage and health security: A systematic review[J]. Global health research and policy, 2024, 9(1): 2.
[32] VAN DIJK C E, LANGEREIS T, DIK J W H, et al. The health and long-term care costs in the last year of life in the netherlands[J]. The European journal of health economics, 2025,26:1149-1162.
[33] SHEPARD M, WAGNER M.Do ordeals work for selection markets? Evidence from health insurance auto-enrollment[J]. American economic review, 2025, 115(3): 772-822.
[34] WAN C, BATEMAN H, HANEWALD K.Demand for life annuities, critical illness insurance, and long‐term care insurance[J]. Journal of risk and insurance, 2025,10(1111) :1-25
[35] WANG Z, HUANG Y, CHEN M, et al.Elderly care burden and household investment behavior: the roles of family income, social security, and long-term care insurance[J]. International review of economics & finance, 2025, 97: 103816.
[36] COURBAGE C, OROS C.On the effects of public subsidies for severe and mild dependency on long-term care insurance[J].Insurance: mathematics and economics, 2024, 119: 106-118.
[37] 张元颖,陈云云.长护险定点服务机构管理国际经验比较和启示——基于德日美典型案例[J].中国医疗保险,2025(3):116-124.
[38] Bundesministerium für Gesundheit. Bund-Länder-AG zur Pflegereform gestartet[EB/OL].(2025-07-07)[2026-02-21].https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/bund-laender-ag-zur-pflegereform-gestartet-pm-07-07-25.
[39] 民政部.提高民政工作服务民生水平[EB/OL].(2026-02-16)[2026-02-21].https://www.mca.gov.cn/n152/n164/c1662004999980009279/content.html.
[40] 张盈华. 中国特色长期护理保险制度:理论逻辑与政策选择[J].社会保障评论,2025,9(4):20-31.
[41] 国家医疗保障局.积极进取担当作为全力推进医保高质量发展——全国医疗保障工作会议在京召开[EB/OL].(2025-12-13)[2026-02-21].http://www.nhsa.gov.cn/art/2025/12/13/art_14_19020.html.
[42] 王宗凡. 长期护理保障的中国道路:从长期护理保险试点探索到全面建制[J].社会保障评论,2025,9(4):1-19.
[43] 刘晓婷,石连忠,刘嘉欣.长护险智能监管困境及优化路径研究——以浙江省杭州市为例[J].中国医疗保险. 2025(12): 78-85 .
[44] 马智苏,何敏,朱铭来.失能评估口径?失能照护需求与长期护理保障[J].人口与经济,2025(5):31-49.
[45] 国家医疗保障局.国家医疗保障局关于印发《国家长期护理保险服务项目目录(试行)》的通知政策解读[EB/OL].(2025-09-25)[2026-01-08].https://www.nhsa.gov.cn/art/2025/9/25/art_105_18022.html.
[46] 央视网.从“异地服务”到“特殊病照护”AI赋能参保人员“智”享长护险[EB/OL].(2025-11-23)[2026-01-08].https://news.cctv.cn/2025/11/23/ARTIES2VyLLVj4HsJ5yzlRLJ251123.shtml.
[47] 徐良平.长期护理保险如何实现“老有所护”[N].学习时报,2026-01-07(8).
基金
湖北省高等学校哲学社会科学一般项目“失能老人长期照护需求差异及政策优化研究”（25Y349）；2025年度黄冈市社科研究课题“四维耦合视域下黄冈市失能老人长期照护需求研究”（ZX2025049）；2025年黄冈师范学院大学生创新创业训练计划项目“家—医—社三位一体失能老人长期照护服务体系建构研究”（2025DC006）。
