目的: 评估不同筹资模式下我国长期护理保险基金的中长期可持续性,为制度全面建制提供实证参考。方法: 以青岛、上海、南通、成都四座代表性试点城市为研究对象,将筹资模式归纳为医保主导型与多元共担型两类;基于2020—2024年全国基金运行数据,构建收支动态平衡模型,在保守、中性、积极三种情景下对2024—2035年基金收支进行模拟测算,并开展单因素敏感性分析。结果: 保守情景下,基金收支比由1.86缓慢降至1.17,全程维持平衡;中性情景下,收支比于2029年跌破1,2035年降至0.59;积极情景下,2028年即出现赤字,2035年收支比仅为0.39。敏感性分析显示,目标待遇享受率是影响基金可持续性的首要因素,其影响幅度约为筹资增长率和待遇增长率的两倍。结论: 在保障范围扩展所驱动的支出增长持续快于筹资增长的背景下,长护险基金的可持续运行需要在保障范围控制、筹资能力提升与费用增长管理三个维度协同推进。
Abstract
Objective: The paper attempts to evaluate the mid-to-long-term sustainability of China's long-term care insurance (LTCI) fund under different financing models and provide empirical evidence for the nationwide establishment of the LTCI system. Methods: Four representative pilot cities — Qingdao, Shanghai, Nantong, and Chengdu — were selected as research subjects. Their financing models were classified into two categories: the medical-insurance-dominated model and the multi-source co-financing model. Based on national LTCI fund operation data from 2020 to 2024, a dynamic revenue-expenditure balance model was constructed. Fund sustainability was simulated under three scenarios (conservative, moderate, and aggressive) for the period 2024-2035, followed by univariate sensitivity analyses on three core parameters. Results: Under the conservative scenario, the revenue-expenditure ratio will decline gradually from 1.86 to 1.17, maintaining balance throughout the projection period. Under the moderate scenario, the ratio will fall below 1 around 2029 and further decline to 0.59 by 2035. Under the aggressive scenario, the fund deficit will emerge in 2028, with the ratio dropping to 0.39 by 2035. Sensitivity analysis revealed that the target benefit coverage rate had the greatest impact on fund sustainability, with the magnitude of impact approximately twice that of the financing growth rate and benefit growth rate. Conclusion: Given that expenditure growth driven by the expansion of coverage consistently outpaces financing growth, the sustainable operation of the LTCI fund requires coordinated efforts across three dimensions: controlling the scope of coverage, enhancing financing capacity, and managing cost growth.
关键词
长期护理保险 /
筹资模式 /
基金可持续性 /
情景分析 /
人口老龄化
Key words
long-term care insurance /
financing model /
fund sustainability /
scenario analysis /
population aging
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] COLOMBO F, LLENA-NOZAL A, MERCIER J, et al.Help wanted?: providing and paying for long-term care[M]. OECD health policy studies, 2011.
[2] 人力资源和社会保障部办公厅.关于开展长期护理保险制度试点的指导意见:人社厅发〔2016〕 80号[Z].2016.
[3] 刘冰冰,刘晓梅,刘子琼,等.基于政策评估的长期护理保险差异化研究[J].健康发展与政策研究,2024,27(06):457-464.
[4] 中共中央办公厅,国务院办公厅.关于加快建立长期护理保险制度的意见[Z/OL].(2026-03-25)[2026-04-27].https://www.gov.cn/yaowen/liebiao/202603/content_7063789.htm.
[5] 荆涛,邢慧霞,万里虹,等.扩大长期护理保险试点对我国城镇职工医保基金可持续性的影响[J].保险研究,2020(11):47-62.
[6] CAMPBELL J C, IKEGAMI N, GIBSON M J.Lessons from public long-term care insurance in Germany and Japan[J]. Health affairs, 2010, 29(1): 87-95.
[7] OECD. Ready for the next crisis? investing in health system resilience[M]. Paris: OECD Publishing, 2023.
[8] IKEGAMI N.Public long-term care insurance in Japan[J]. Jama, 1997, 278(16): 1310-1314.
[9] 郭佩. 日本长期护理保险制度改革借鉴[J].中国金融,2023,(12):83-84.
[10] 许敏敏,段娜.德国长期护理保险及其筹资机制经验对我国的启示[J].价格理论与实践,2019(07):99-103.
[11] KONISHI T, INOKUCHI H, YASUNAGA H.Services in public long-term care insurance in Japan[J]. Annals of clinical epidemiology, 2024, 6(1): 1-4.
[12] 戴卫东,余洋.中国长期护理保险试点政策“碎片化”与整合路径[J].江西财经大学学报,2021(02):55-65.
[13] 林宝. 中国长期护理保险筹资水平的初步估计![J].财经问题研究,2016(10):66-70.
[14] 张盈华. 中国长期护理保险制度的可持续评价与趋势分析[J].人口学刊,2020,42(02):80-89.
[15] 汤薇,粟芳.中国长期护理保险不同筹资模式研究[J].财经研究,2021,47(11):34-48.
[16] 孙洁,蒋悦竹.社会长期护理保险筹资机制理论分析框架[J].江西财经大学学报,2018(01):59-68.
[17] 刘文,王若颖.我国试点城市长期护理保险筹资效率研究——基于14个试点城市的实证分析[J].西北人口,2020,41(05):29-45.
[18] 国家医疗保障局. 2024年全国医疗保障事业发展统计公报[EB/OL].(2025-07-14)[2026-04-27].https://www.gov.cn/lianbo/bumen/202507/content_7031956.htm.
[19] 国家医疗保障局. 2025年医疗保障事业发展统计快报[EB/OL].(2026-03-16)[2026-04-27].https://www.nhsa.gov.cn/art/2026/3/16/art_7_19918.html.
[20] 青岛市人民政府.青岛市长期护理保险办法[EB/OL].(2021-03-25)[2026-04-27]. http://ybj.qingdao.gov.cn/zfxxgk_117/fdzdgknr_117/gwfg_117/gfxwj_117/202203/t20220309_4575448.shtml.
[21] 上海市人民政府办公厅.上海市长期护理保险试点办法[EB/OL].(2025-12-29)[2026-04-27].https://www.shanghai.gov.cn/gwk/search/content/51cafb297f0a4397ad30afe0d91ad104.
[22] 成都市医疗保障局.成都市长期护理保险相关管理办法[EB/OL].(2025-11-04)[2026-04-27].https://cdyb.chengdu.gov.cn/gkml/xzgfxwj/1435315257756090368.shtml.
[23] 南通市医疗保障局.关于明确2026年度城乡居民基本医疗保险和长期护理保险筹资标准等事项的通知[EB/OL].(2025-11-25)[2026-04-27].https://ylbzj.nantong.gov.cn/ntsylbzj/bmwj/content/b31296d0-3878-49dc-8071-d7f664b941b8.html.
[24] BARR N A.The economics of the welfare state[M]. Oxford University Press, 2020.
[25] 曾毅,陈华帅,王正联.21世纪上半叶老年家庭照料需求成本变动趋势分析[J].经济研究,2012,47(10):134-149.
[26] 王金营,李天然.中国老年失能年龄模式及未来失能人口预测[J].人口学刊,2020,42(05):57-72.
基金
国家自然科学基金项目（42565002）;云南省基础研究计划面上项目（202501AT070467）
