随着我国人口老龄化程度的不断加深,失能人员的长期护理需求日益迫切。长期护理保险制度作为社保“第六险”,其立法层级与归属问题已成为制约制度定型的关键瓶颈。当前,长期护理保险立法主要面临纳入《中华人民共和国社会保险法》（以下简称《社会保险法》）或纳入《中华人民共和国医疗保障法》（以下简称《医疗保障法》）两种路径选择。本文通过理论分析与实证比较,深入探讨了两种路径的法理基础、制度优势、潜在风险及部门利益博弈。研究发现,纳入《社会保险法》有利于确立制度的独立性与筹资可持续性,但修法难度大;纳入《医疗保障法》符合当前行政管理体制与试点经验,但存在“医疗化”倾向与基金挤占风险。本文建议,应采取“法律归属社会保险、行政经办依托医保、资金独立核算”的折中路径,并在《医疗保障法》中设立专章过渡,最终推动长期护理保险成为独立的社会保险险种,以构建公平、可持续的多层次社会保障体系。

With the deepening of population aging in China, the long-term care needs of the disabled have become increasingly urgent. As the "sixth social insurance", the long-term care insurance system faces critical bottlenecks in its legislative hierarchy and legal categorization, which hinder its institutionalization. Currently, the legislation of long-term care insurance primarily confronts two paths: inclusion in the Social Insurance Law or the Healthcare Security Law. Through theoretical analysis and empirical comparison, this paper delves into the legal foundations, institutional advantages, potential risks, and departmental interest conflicts of both approaches. The study finds that incorporating it into the Social Insurance Law helps establish the system's independence and sustainable financing but entails significant legislative amendments. Conversely, integrating it into the Healthcare Security Law aligns with the current administrative framework and pilot experiences but risks "medicalization" and fund misappropriation. The paper proposes a compromise approach—"legally classified under social insurance, administratively managed by healthcare security, with independent funding accounting"—and suggests establishing a transitional chapter in the Healthcare Security Law. Ultimately, it advocates for long-term care insurance to become an independent social insurance category, thereby fostering a fair and sustainable multi-tiered social security system.