中国长期护理保险财政负担能力研究

本文通过测算城乡居民和城镇职工长期护理保险需求,构建医疗保险精算模型,对中国长期护理保险财政负担能力展开研究。结果发现:依托城乡居民医疗保险建立的长期护理保险会增加财政支出,但是支出规模在可控范围内;依托城镇职工医疗保险建立的长期护理保险会威胁职工医疗保险统筹基金的安全,因而不可持续,但是该问题可以通过改革职工医疗保险个人账户来解决;中国长期护理保险应该采用“个人缴费+医疗保险基金补助+财政补助”的模式,且个人缴费最高不超过15%;中国长期护理保险财政负担水平总体较低,财政有能力维持长期护理保险的运行。对此,我国应尽快正式建立全国性的长期护理保险制度和财政对长期护理保险的投入机制。     

夫妻联合长期护理保险的定价模型与应用

在人口老龄化和人口长寿背景下,社会对老年长期护理保障的需求不断增长,基于家庭保障的理念,本文将多元寿险模型推广到夫妻联合长期护理保险,构建了健康、轻度失能、重度失能和死亡的马尔科夫四状态转移模型,并在联合个体状态转移相互独立的假设下给出了夫妻联合长期护理保险定价模型.最后基于中国老年健康影响因素跟踪调查微观数据,实现了...     

互助保险机制在长期护理保障中的应用:典型案例的政策设计及绩效

自长期护理保险政策试点启动以来,部分地区以互助保险为基础架构的长期护理保险制度,在制度框架、筹资机制、支付范围、服务提供方式等方面均具有一定的创新性。基于北京市海淀区试点政策的评估表明,以自愿参保、同质群体风险分摊和收益分享为前提的互助保险机制不能兼顾保障公平性、可持续性和可负担性等多重目标。应坚持以社会保险为基础构建多层次长期护理保障体系,支持商业健康保险公司提供多层次、补充性的保险产品。同时,要做好医疗、养老服务体系的改革和衔接,充分发挥护理保险基金的保障功能和保障潜力。     

长期护理保险制度建设的国际经验及启示

长期护理保险制度在我国是一个新名词,还没有真正进入商业保险和社会保险的实践。但随着我国步入老龄化社会,老年人的长期护理问题将越来越突出地表现为一个需要迫切解决的社会问题。本文通过总结介绍美国、德国、日本、韩国等国家的长期护理保险制度建设的历史经验,分析了该制度实施的路径,提出了在我国建设长期护理保险制度的可行措施和建议。     

Marktversagen auf dem geförderten Pflegezusatzversicherungsmarkt?

This study analyzes the supply side of the private German long term care insurance market. It compares loads and comprehensiveness of subsidized and unsubsidized insurance policies for three age groups. The results show that subsidized insurance policies are less comprehensive than unsubsidized insurance policies. In addition the premiums of subsidized policies are marked up substantially above expected benefits compared to unsubsidized policies. All in all these results indicate market failure due to adverse selection within the subsidized private long term care insurance market. Furthermore, the results show that due to unisex pricing, private long term care policies are in general more attractive to women than to men. As this is not reflected in demand, other factors than supply side failure seem to contribute to an overall low demand for private long term care insurance policies.     

社保模式下实物给付型长期护理保险发展瓶颈及对策

伴随着相关政策的出台,社保模式下的长期护理保险制度逐渐浮出水面,并在各试点地区开始尝试实物给付型长期护理保险,以满足消费者多层次、多样化的需求。随着老年人护理需求和意愿不断增长,长期护理保险的市场需求正在逐步扩大。但是,和巨大的潜在市场需求相比,长期护理保险市场的供给相对缺失,试点实践中存在给付方式单一、法律法规缺失、筹资机制不完善、护理设施及资源不足等诸多问题。借鉴国外经验,本文针对以上问题提出了完善建议,以期为我国社保模式下实物给付型长期护理保险的发展提供可鉴思路。     

Product pricing and solvency capital requirements for long-term care insurance

This paper presents a comprehensive assessment of premiums, reserves and solvency capital requirements (SCRs) for long-term care (LTC) insurance policies using Activities of Daily Living and US data. We compare stand-alone policies, whole life insurance policies with LTC benefit riders (LTC insurance combined with whole life insurance), life care annuities (LTC insurance combined with annuities) and shared LTC insurance in terms of net premium cost and SCRs. Net premiums and best-estimate reserves for base LTC insurance policies are determined using Thiele’s differential equation. Product features such as the elimination period and the maximum benefit period are compared using a simulation-based model. We show how a maximum benefit period can reduce costs and risks for LTC insurance products. SCRs for longevity risk and disability risk are based on the Solvency II standard formula. We quantify the extent to which whole life insurance policies with LTC benefit riders and life care annuities provide lower SCRs than stand-alone LTC insurance policies.     

碎片化医保制度设计弊端与农民工医保模式路径选择

我国二元社会保障模式的构建思维一直影响我国保障制度的建设,导致我国医保制度建设呈现碎片化趋势,农民工医保制度也受这一传导机制影响。鉴于碎片化医保制度存在的诸多弊端和单独构建农民工医保模式存在的制度缺陷,农民工医保模式的路径选择应该是纳入现有保障制度框架。当前最关键和最紧迫的问题是提高现有医保制度统筹层级、解决三大医保制度接续以及加强农民工医保制度的配套建设。     

中国城镇居民医疗保险和新型农村合作医疗衔接路径探讨——基于湖北省武汉市的实证分析

中国城镇职工医疗保险、新型农村合作医疗和城镇居民医疗保险的建立标志着全民医保体系的确立,但是基本医疗卫生服务仍然表现出明显的城乡二元化特征。湖北省武汉市作为中部经济发展水平较高的大城市,在城市化和人口流动加快的背景下,迫切需要实现城乡医疗卫生资源的整合和基本医疗保险制度的衔接。首先实现城镇居民医疗保险和新农合衔接,进而探索城乡居民医疗保险和城镇职工医疗保险衔接,分两步走实现城乡三大医疗保险制度衔接。     

城镇职工退休人员缴纳医疗保险费的可行性及其相关问题探讨——社会保障学者专题讨论综述

2016年初有政府官员提出要建立合理分担、可持续的医保筹资机制,合理强化医保个人缴费责任,研究实行职工医保退休人员缴费政策。部分社会保障学者在微信平台上进行了"退休人员缴纳医疗保险费是否缓解医疗基金支付压力的良方"专题讨论。讨论从退休人员缴纳医保费问题的可行性开始,逐渐深入到医疗控费、公立医院改革、政府角色定位和长期护理保险等医疗领域重难点问题。     

长期医疗护理保险居民参保意愿研究——来自青岛市的调查

青岛市于2012年7月推出长期医疗护理保险制度,到目前为止,制度运行虽然已经初见成效,但广大居民的认同和支持也是影响制度可持续发展的重要因素。通过对青岛居民参加长期医疗护理保险制度意愿的调查,并对回收的数据运用Logit模型进行分析后发现,在其他变量保持不变的情况下,年龄、教育程度、月收入、子女数量、对自我健康状况评估、对长期医疗护理保险的了解程度的差异等因素都对居民的参保意愿有显著影响,而性别、婚姻状况以及对政府的信任程度的差异对居民的参保意愿的影响并不显著。鉴于此,政府应该加强宣传,提高人们对于失能的风险意识和对护理保险的认同感;同时,努力提高居民收入水平,增强居民缴费能力。     

医保制度改革：从城镇保障到城乡统筹——医疗保障“马鞍山模式”研究

安徽省马鞍山市医疗保险制度改革,一直以其创新性和样本性被各级政府、媒体及公众广为关注,被称为“医疗保险马鞍山模式”。本文通过对马鞍山医保制度改革从城镇保障发展到城乡统筹过程的调查,介绍该市医疗保险制度的发展历程,总结、分析统筹城乡医保制度的主要内容、特点及成效,探究存在问题及对策,以期为研究中国当前的医疗保险制度改革提供参考,为广大中西部地区中小型城市的医疗保险工作提供借鉴。     

公私合作构建我国的长期护理保险制度:国外的借鉴

鉴于我国日益严重的老龄化趋势以及沉重的老年护理费用,在我国推行长期护理保险制度势在必行。本文分析了国外护理保险制度中公私合作的模式、经验和教训,指出我国唯有以政府推动、政策支持、强制投保、商业化经营、社会化运作为原则,充分发挥政府的法律、财税支持与监管职能,引入保险公司的商业化经营,建立覆盖城乡的社会化护理机构,继续巩固家庭在老年护理中的作用,才能实现我国长期护理保险制度的可持续发展。     

十二五期间中国军人保险制度发展研究

探讨十二五期间中国军人保险制度的发展,首先要明确军人保险制度发展的出发点,在此基础上明确军人保险制度发展的目标和任务,并紧紧围绕完善军人保险制度的目标任务,立足于军人保险现实情况,统筹兼顾,循序渐进,从不同层面、不同角度完善军人保险制度。具体包括：建立大病医疗保险与基本医疗保障相结合的新型军人医疗保险制度,建立军人分类养老保险制度,完善军人伤亡保险制度,建立军人互助保险等。     

Understanding the motivations of long-term care insurance owners: the importance of retirement planning

This article is based on two recent reports by the American Council of Life Insurers (ACLI) that illuminate the reasons why individuals purchase private long-term care insurance in both the group and individual markets. This information suggests that a younger and more diverse group of individuals are becoming increasingly interested in private long-term care insurance and that workplace education linkage the purchase of long-term care insurance to retirement planning may promote coverage.     

Commitment problems justify subsidies for medical insurance

Consumers who believe that government will provide them with some public medical care, even if they did not purchase medical insurance, may choose to purchase no such insurance. The amount of medical care consumed will then be less than the first-best optimum. Under specified conditions government can then increase the welfare of consumers by subsidizing insurance, or by providing public health care at a more generous level than the minimum it would otherwise give.     

The Private Market for Long-Term Care Insurance in the United States: A Review of the Evidence

This article reviews the growing literature on the market for private long-term care insurance, a market notable for its small size despite the fact that long-term care expenses are potentially large and highly uncertain. After summarizing long-term care utilization and insurance coverage in the United States, the article reviews research on the supply of and the demand for private long-term care insurance. It concludes that demand-side factors impose important limits on the size of the private market and that we currently have a limited understanding of how public policies could be designed to encourage the growth of this market.     

Asymmetric information in health insurance: evidence from the National Medical Expenditure Survey.

Adverse selection is perceived to be a major source of market failure in insurance markets. There is little empirical evidence on the extent of the problem. We estimate a structural model of health insurance and health care choices using data on single individuals from the NMES. A robust prediction of adverse-selection models is that riskier types buy more coverage and, on average, end up using more care. We test for unobservables linking health insurance status and health care consumption. We find no evidence of informational asymmetries.     

Long-Term Care Insurance and Life Insurance Demand

This article investigates the interaction between life insurance and long-term care insurance markets on the demand side. In the model utility depends on both consumption and bequest, and utility from consumption is contingent on the state of health. While the demand for life insurance increases both with decreasing income and with a rising degree of altruism, the influences of these two parameters on the demand for long-term care insurance are ambiguous. If the utility shock arising from disability declines, both insurance demands will rise.     

Asymmetric Information, Long-Term Care Insurance, and Annuities: The Case for Bundled Contracts

This article examines the markets for long-term care insurance and annuities when there is asymmetric information and there are costs of administering contracts. Individuals differ in terms of their risk aversion. Risk-averse individuals take more care of their health and are relatively high risk in the annuities market and relatively low risk in the long-term care insurance market. In the long-term care insurance market, both separating and partial-pooling equilibria are possible. However, in the stand-alone annuity market, only separating equilibria are possible. We show, consistent with the extant empirical research, that in the presence of administration costs the more risk-averse individuals may buy relatively more long-term care insurance and more annuity coverage. Under the same assumptions, we show that equilibria exist with bundled contracts that Pareto dominate the outcomes with stand-alone contracts and are robust to competition from stand-alone contracts. The remaining empirical puzzle is to explain why bundled contracts are such a small share of the voluntary annuity market.