摘要
人口老龄化加速背景下,失能群体照护需求激增,长期护理保险（以下简称“长护险”）成为破解家庭照护困境、完善社会保障体系的关键举措,而定点长护服务机构的规范管理是保障长护险制度可持续运行的核心环节。本研究基于我国长护险试点实践,系统梳理定点服务机构（以下简称“定点机构”）管理的现状、特征与难点,通过构建政府管理框架,分析其制度设计、治理结构与运行机制,并选取德国、日本两个长护险制度成熟国家开展国际比较,剖析其在资源配置、准入管理、质控评价、退出机制等方面的经验做法。研究发现,我国长护险定点机构管理已形成“国家—省级—市级”三级政策体系与全周期闭环管理机制,但仍面临管理标准难统一、多头监管合力不足、质量评价体系不统一、社区居家机构监管难、激励约束刚性不足、退出服务衔接不畅等问题。结合我国国情并批判性借鉴德日经验,本研究提出优化建议：构建分级分类的差异化政策体系;强化多部门协同,形成目标一致的治理合力;优化全周期管理,完善准入、评价、退出闭环;强化技术赋能和激励支撑,提升治理效能。
Abstract
In the context of rapid population aging, the surge in care demands from disabled groups has made long-term care insurance (LTCI) a key measure to address family caregiving challenges and improve the social security system. The standardized management of designated LTCI service institutions is a core link to ensure the sustainable operation of the LTCI system. Based on China’s LTCI pilot practices, this study systematically reviews the current status, characteristics, and difficulties in the management of designated institutions. By constructing a government management framework, it analyzes institutional design, governance structures, and operational mechanisms. It also selects two mature LTCI systems—Germany and Japan—for international comparison, examining their experience in resource allocation, access management, quality control and evaluation, and exit mechanisms. The study finds that China’s management of designated LTCI institutions has formed a “national-provincial-municipal” three-tier policy system and a full-cycle closed-loop management mechanism. However, challenges remain, including difficulties in standardizing management norms, insufficient coordination among multiple regulators, inconsistency in quality evaluation systems, difficulties in supervising community-based and home-care institutions, weak incentive and restraint mechanisms, and poor transition in service exit procedures. Based on China’s national conditions and a critical appraisal of German and Japanese experiences, this study proposes optimization recommendations: establishing a tiered and categorized differentiated policy system; strengthening cross-departmental coordination to create a consistent governance synergy; optimizing the full-cycle management to improve the closed loop of access, evaluation, and exit; and enhancing technology empowerment and incentive support to improve governance efficiency.
关键词
长期护理保险 /
定点服务机构 /
管理实践 /
政策优化 /
国际比较
Key words
long-term care insurance /
designated service institutions /
policy optimization /
management practices /
international comparison
刘昭, 刘跃华, 段承阿鑫, 张帆, 赵琨.
我国长期护理保险定点服务机构管理实践与政策优化路径[J]. 中国医疗保险. 2026, 0(6): 5-15 https://doi.org/10.19546/j.issn.1674-3830.2026.6.001
Management Practices and Policy Optimization Pathways for Designated Long-Term Care Insurance Service Institutions in China[J]. China Health Insurance. 2026, 0(6): 5-15 https://doi.org/10.19546/j.issn.1674-3830.2026.6.001
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基金
2025年国家医疗保障局委托课题“长护险服务项目目录动态调整机制”（20255660031）;2025年国家医疗保障局委托课题“定点长护服务机构运行监测分析”（202506046）
