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.
Key words
long-term care insurance /
designated service institutions /
policy optimization /
management practices /
international comparison
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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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References
[1] 民政部,全国老龄办.2024年度国家老龄事业发展公报[R/OL].(2025-07-25)[2025-09-26].http://www.mca.gov.cn/n152/n166/c1662004999980006135/content.html.
[2] 陆治原.国务院关于推进养老服务体系建设、加强和改进失能老年人照护工作情况的报告——2024年9月10日在第十四届全国人民代表大会常务委员会第十一次会议上[R/OL].(2024-09-11)[2025-09-26].http://www.npc.gov.cn/npc/c2/c30834/202409/t20240911_439362.html.
[3] 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)[2025-09-26].https://www.nhsa.gov.cn/art/2025/9/25/art_196_18377.html.
[4] 国家医疗保障局.国家医疗保障局办公室关于印发《长期护理保险护理服务机构定点管理办法(试行)》的通知[EB/OL].(2024-10-14)[2025-09-26].https://www.gov.cn/zhengce/zhengceku/202410/content_6980290.htm.
[5] 南通市医疗保障局.关于印发《南通市照护保险居家服务机构定点管理暂行办法》的通知[EB/OL].(2020-12-29)[2026-03-26].https://ylbzj.nantong.gov.cn/ntsylbzj/gfxwj2/content/b45f6f90-80ec-4b47-814c-ce4707505e15.html.
[6] 青岛市医疗保障局.青岛市长期护理保险定点长护服务机构资源配置规划(2026-2028年)[EB/OL].(2025-12-25)[2026-03-26].http://www.qingdao.gov.cn/zwgk/xxgk/ybj/gkml/gwfg/202512/t20251231_10428687.shtml.
[7] 沈阳市医疗保障局.关于印发《沈阳市长期护理保险护理服务机构定点管理实施细则(试行)》的通知[EB/OL].(2025-12-01)[2026-03-26].https://ybj.shenyang.gov.cn/zwgk/zc/xzgfxwj/202512/t20251204_4948620.html.
[8] 苏州市医疗保障局,苏州市民政局,苏州市卫生健康委员会.关于印发苏州市长期护理保险定点护理服务机构管理办法的通知(试行)[EB/OL].(2023-02-03)[2026-03-26].http://ybj.suzhou.gov.cn/szybj/chxi/202303/54c6fd9d90054616802b719d1c810833.shtml.
[9] 湖南省医疗保障局.湖南省长期护理保险护理服务机构定点管理实施细则(试行)[A/OL].(2025-07-03)[2026-04-07].http://www.hunan.gov.cn/hnszf/xxgk/wjk/szbm/szfzsjg_19847/sylbzj/gfxwj_19835//202509/t20250915_33804831.html.
[10] 孙晨晗,胡敏,陈文.德国长期护理服务质量监管的经验与启示[J].中国卫生政策研究,2023,16(09):72-79.
[11] 齐天骄. 欧洲福利国家长期照护服务变迁及对我国的启示[J].社会保障研究,2021(06):55-64.
[12] Sozialgesetzbuch-sgb.§ 113b SGB XI Qualitätsausschuss[EB/OL].(2023-06-19)[2026-04-07].https://www.sozialgesetzbuch-sgb.de/sgbxi/113b.html.
[13] Bundesministerium der Justiz. Fünfter Abschnitt SGB XI Medizinische Dienste,Medizinischer Dienst Bund Sozialgesetzbuch (SGB) Elftes Buch (XI)[EB/OL].(2022-03-23)[2026-04-07].https://www.buzer.de/gesetz/4851/b33798.htm.
[14] Schulz E. Quality Assurance Policies and Indicators for Long-Term Care in the European Union, Country Report: Germany [R]. ENEPRI Research Report No.104,2012. https://aei.pitt.edu/33808/.
[15] European Commission. Long-term care policies in practice: a European perspective (EUR 31258 EN)[Z]. Publications Office of the European Union. https://doi.org/10.2760/611873.
[16] 杨根来,臣川元宽.日本介护福祉法规选编(译文版·第一辑)[M].北京:中国财富出版社,2017.
[17] 东京都福祉局.令和7年度老人福祉设施整备费补助纲要[EB/OL].(2025-04-01)[2025-12-29].https://www.fukushi.metro.tokyo.lg.jp/documents/d/fukushi/2025-04-07-094535-843.
[18] 厚生劳动省.关于外籍护理人才从事上门护理服务[EB/OL].(2025-04-01)[2026-04-23].https://www.mhlw.go.jp/stf/newpage_56271.html.
[19] 厚生劳动省.指定介护老人福祉设施的人员、设施及设备以及运营相关标准:厚生省令第39号[S/OL].(1999-03-31)[2026-04-23].https://www.mhlw.go.jp/web/t_doc?dataId=82999406&dataType=0&pageNo=1.
[20] 厚生劳动省.护理保险制度中保险者功能评估的思考方式与课题[J].日本公共卫生杂志,2023,72(5):395-405.
[21] 李光廷. 日本确保照护品质经验引介——介护保险制度下品质控管制度之设计[C].台湾医学会教育演讲,2011:E19-1.
[22] 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(03):116-124.
[23] 稻城市福祉部高龄者福祉课.社会福祉法人等对生计困难者的利用者负担减轻制度[EB/OL].(2024-12-16)[2025-12-29].https://www.city.inagi.tokyo.jp/cn/kenko/kaigohoken/1003335/1003342.html.
[24] 苏炜杰. 日本居家养老服务政府责任:立法保障、运行逻辑与经验启示[J].现代日本经济,2023,42(04):80-94.
