Based on CHARLS data in 2011, 2013, 2015 and 2018, this article explores the impact of long-term care insurance on medical expenses and sustainability of the basic medical insurance fund with cost-benefit analysis methods. This article finds that long-term care insurance reduces total medical expenses through mechanisms such as reducing the number of individual annual outpatient visits. Since some of the long-term care insurance financing comes from the basic medical insurance fund, this article defines the amount of long-term care insurance financing from the medical insurance fund as cost, and defines the amount of medical insurance fund that long-term care insurance saves by reducing medical expenses as benefit. The paper explored the impact of long-term care insurance on the sustainability of medical insurance funds, which is the difference between the cost and benefit. The study found that based on the population prediction of the medium plan, the "90+10" plan as the care model, all disabled elderly people as the target of guarantee, and 70% as the reimbursement ratio, long-term care insurance can save 65.44 yuan to 105.05 yuan per capita for the basic medical insurance fund. At the same time, this article conducts sensitivity analysis from the perspectives of population forecast plan, nursing model and reimbursement ratio, and finds that with a specific reimbursement ratio of the long-term care insurance system, the higher the proportion of elderly people who mainly chooses home care, the long-term care insurance system can have a more positive impact on the medical insurance fund. Previous studies mainly discussed the negative effects of the long-term care insurance system on the basic medical insurance system, lacking analysis of the positive effects of the long-term care insurance system on the basic medical insurance system. This article conducts research to provide theoretical basis for national and local governments to improve the long-term care insurance system and explore the mutual feedback mechanism between long-term care insurance and basic medical insurance.
Key words
long-term care insurance /
health care utilization /
health insurance fund sustainability /
cost-benefit analysis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 国务院办公厅.《“十四五”国民健康规划》[EB/OL].(2022-06-01)[2023-05-23].https://www.ndrc.gov.cn/fggz/fzzlgh/gjjzxgh/202206/t20220601_1326725.html.
[2] 光明网.养老机构“更专业”才能吸引更多年轻人[EB/OL].(2023-09-10)[2023-09-13].https://baijiahao.baidu.com/s?id=1776616536416499819&wfr=spider&for=pc.
[3] 中国网财经.中国长期护理调研报告:长期护理保险在商业人身险中购买率最低成年人对“以房换护理”的接受度较高[EB/OL].(2020-07-08)[2023-05-23].https://baijiahao.baidu.com/s?id=1671628874892091808&wfr=spider&for=pc.
[4] 雪球.我国失能老人将超7700万人,多地试点长护险最高可报销85%-90%[EB/OL].(2023-04-18)[2023-05-23].https://xueqiu.com/7152303935/246831342.
[5] 荆涛,闫勇,武颢.共同富裕目标下中国长期护理保险制度的现实约束与重塑路径[J].宏观经济研究,2023,295(06):24-33+55.
[6] 赵郁馨,高广颖,杜乐勋.中国卫生总费用发展变化趋势及其影响因素[J].卫生经济研究, 2000,(01):7-9.
[7] ANGULO A M, BARBERAN R, EGEA P, et al.An analysis of health expenditure on a microdata population basis[J].Economic modelling,2011, 28(1-2) : 169-180.
[8] COYTE P C, MCKEEVER P.Home care in Canada: passing the buck[J].The Canadian journal of nursing research-revue canadienne de recherche en sciences infirmières, 2001,33(2) : 11.
[9] 张冲,王学义,孙炜红.农村人口老龄化对居民医疗保健消费的影响——基于中国2002-2012年的省级面板数据[J].财经论丛,2015,(01): 32-38.
[10] 阳义南.照护还是医疗:老年人健康支出的产出效率比较[J].统计研究,2016,33(07):19-27.
[11] MASUDA Y, KUZUYA M, UEMURA K, et al.The effect of public long-term care insurance plan on care management and care planning in Japanese geriatric hospitals[J].Archives of gerontology & geriatrics, 2001, 32(2) : 167-177.
[12] GAUGHAN J, GRAVELLE H, SICILIANI L.Testing the bed‐blocking hypothesis: does nursing and care home supply reduce delayed hospital discharges?[J].Health economics, 2015, 24: 32-44.
[13] FENG J, WANG Z, YU Y.Does long-term care insurance reduce hospital utilization and medical expenditures? evidence from China[J].Social science & medicine, 2020, 258:113—118.
[14] 蒋曼,罗力,戴瑞明,等.长期护理保险对老年健康服务产业发展的影响探索[J].中国卫生资源,2019,22(01):38-42.
[15] 朱铭来,王恩楠.医保支付方式改革如何减轻道德风险?——来自医保基金支出的证据[J].保险研究,2021(04):75-90.
[16] 曹信邦.中国长期护理保险制度构建的理论逻辑和现实路径[J].社会保障评论,2018,4:75-84.
[17] 朱铭来,张晓.长期护理保险筹资机制与个人账户使用探讨[J].中国医疗保险,2018,09:9-12.
[18] 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.
[19] 田勇.中国长期护理保险财政负担能力研究——兼论依托医保的长期护理保险制度的合理性[J].社会保障研究,2020,01:33-47.
[20] 于新亮,刘慧敏,杨文生.长期护理保险对医疗费用的影响——基于青岛模式的合成控制研究[J].保险研究,2019(02):114-127.
[21] 李元.我国失能老人长期照护资金规模的测算分析[J].人口学刊,2018,40(05):78-85.
[22] 封进,陈昕欣,胡博.效率与公平统一的医疗保险水平——来自城乡居民医疗保险制度整合的证据[J].经济研究,2022,57(06):154-172.
