日本看护护理保险制度评析及展望

人口老龄化是当今世界各国面临的重大社会问题，已经引起国际社会的广泛关注。建立社会互助为主要内容、完善的养老保险体系是当前的重要任务。日本国的看护护理保险制度是继日本健康保险和养老保险制度之后最新出台的社会福利保险项目，是一项社会保障式家庭护理保险制度，相关的服务机构采取派遗家庭援助者或受保人利用专业化护理服务设施的保险形式。资金运作形式反映了个人自主负责和适当的政府负担的最初原则。该项保险事业由地方政府负责实施，充分体现了政府部门人性化服务的机能。看护护理保险系统的设立，标志着日本福利事业水平的进一步提高，带动、促进了银发市场的开发和建设，并为其他国家提供了有效模式。     

试析老龄化社会与日本的“看护保险制度”——兼论中国的养老社会化应强化生理和心理的保障功能

日本的“看护保险制度”对中国有参考借鉴作用。中国已进入老龄化社会，“核家庭”已不能承担起夫妻二人要照看四位老人的重担，中国虽然还是一个发展中的国家，但是与经济发展和经济承受力不协调的是，中国过快地进入了老龄化社会，要解决中国的养老问题，必须走养老社会化之路，在养老问题上必须从传统社会的“家庭中心论”转变为现代的“社会中心论”。中国仅有过去的注重经济资助的养老保险还是不够的，中国的养老社会化应大力强化生理和心理的保障功能。     

日本家庭经济制度变迁与养老方式选择的思考

日本养老方式选择的直接原因是家庭经济制度变迁。在家庭经济制度变迁中日本选择了独具特色的“养老护理保险”方式，并取得了良好的效果。我国可借鉴日本经验，把家庭经济制度变迁作为重要参数，选择和开发适合我国国情的养老保险方式。     

日本的老人看护保险制度

而对少子高龄化的挑战,日本政府采取了一系列的对策，社会保障制度改革便是其中之一。而看护保险制度的建立则走出了日本社会保障制度改革的第一步。在分析看护保险制度建立背景的基础上，详细了解日本看护保险制度的内容，对中国解决人口老龄化问题将能提供一些值得参考的经验。     

探析融合型养老服务模式

居家养老、社区养老和机构养老是目前我国三种主要的养老服务模式,融合型养老服务则融合了三者优势。本文对融合型养老服务方式、特点、运营体系和发展中存在的问题进行分析,为完善融合型养老服务,提出健全养老服务体系建设、资金流通机制、人才考核激励机制、互联网智能发展体制和医养融合发展机制等建议。     

青岛市养老服务市场化的探析

2012年,青岛市为有效应对社会老龄化,制定出台了《关于建立长期医疗护理保险制度的意见(试行)》,在全国范围内率先采用社保筹资,建立了长期医疗护理保险制度。2015年12月,青岛市长期医疗护理保险制度获得年度中国政府创新最高奖——"最佳实践奖"。青岛市长期医疗护理保险制度的建立不是空穴来风、一蹴而就的,而是青岛市在自身财力的支持下,未雨绸缪,长期坚持发展"医养结合"的养老服务模式的结果。     

社区居家养老服务的障碍与完善路径——以天津五社区为例

人口老龄化加快是当今社会面临的严峻挑战,社区居家养老具有其他养老方式不可比拟的优势。文章以对天津市部分社区的调查为基础,反映出在这一模式的发展过程中呈现的资金紧张、宣传力度不够、缺乏统一标准等一系列障碍,继而从建立护理保险制度、多渠道筹资、政府角色定位、整合社会资源等角度提出解决路径,从而推动居家养老服务体系的建设发展。     

健全养老社会服务体系与机制——基于中外比较视角

伴随着我国人口老龄化、高龄化和家庭小型化的发展,养老服务的需求不断增加.文章比较了德国、日本和新加坡三国养老社会服务的制度化、参与主体和服务内容等.德国突出了社区养老的特征,日本表现为社区为依托的多元化发展,新加坡由政府主导养老社会服务.同时,分析了我国现代养老社会服务的演进过程和社区居家养老、机构养老、居家养老、自立养老四种养老社会服务模式.在借鉴国外经验基础上,探索我国养老社会服务未来可行的发展路径,养老社会服务在政府指引下形成政府与社区、机构、家庭、公民个人等多元合作共建局面,实现养老社会服务本土化改进,积极朝向制度化、体系化、机制化和专业化方向发展.     

国外居家养老方式的经验与启示——以美国、芬兰、瑞典、日本为例

居家养老，顺应了人口老龄化的客观要求，同时也满足了老年人养老的需要，己成为国际社会普遍推崇的养老方式、从不同的方面解析了美国、芬兰、瑞典和日本的居家养老模式，并以诧为鉴提出了我国居家养老服务改革发展的一些对策。     

从介护保险到介护预防:日本改革及其影响

2000年日本开始实施介护保险制度,经过十几年的发展与完善,介护保险发挥着越来越重要的作用。由于日本是跑步进入老龄社会且老龄化率持续增加,严峻的形势给国家和地方财政造成了巨大负担。2005年介护保险改革引入"介护预防"理念,并加强地区服务支援体系建设,不仅减轻了财政负担和家庭介护人员的压力,对支援老年人自立,提高老年人生活质量产生了重要影响。     

On the consumption insurance effects of long-term care insurance in Japan: Evidence from micro-level household data

Using micro-level household data in the 2001 Comprehensive Survey of the Living Conditions of the People on Health and Welfare compiled by the Japanese Ministry of Health, Labor and Welfare, this paper examines how having a household member in need of long-term nursing care can result in welfare losses measured in terms of consumption. In so doing, this study evaluates the role of the public long-term care insurance scheme implemented in Japan in April 2000. The results indicate that when households include a disabled family member, household consumption net of long-term care costs do not decrease as much as before the introduction of long-term care insurance. Further, when compared with the surveys conducted in 1998, the adverse effects on consumption net of long-term care costs have become much weaker. These findings suggest that the introduction of social insurance in 2000 helped Japanese households to reduce the welfare losses associated with a disabled family member.     

Who bears the burden of social insurance? Evidence from Japanese health and long-term care insurance data

Using the society-managed health insurance data, which is cross-sectional time-series and covers 1670 health insurance societies for seven years (FY1995–2001), we found for the first time in Japan that the majority of the employers' contribution to health insurance is shifting back onto the employees in the form of wage reduction. On the other hand, we cannot find such evidence for the contribution to long-term care insurance using a two-year (FY2000–2001) panel data set. The difference can be theoretically explained by how employees value the contribution relative to social security benefits they enjoy. J. Japanese Int. Economies 18 (4) (2004) 565–581.     

Gatekeeper incentives and demand inducement: An empirical analysis of care managers in the Japanese long-term care insurance program

This study analyzes the incentives and supplier-induced demand of care managers, who are intermediaries between consumers and service providers in the Japanese social insurance program for long-term care. Care managers can be considered as pure gatekeepers, in that their function is limited to referral people to specialists and they themselves do not provide care. Care managers are rewarded by capitation, which is considered as a cost-effective payment mechanism for insurers. However, many care managers actually work for firms that also operate as service providers. Service providers are rewarded by a fee-for-service payment and can have a motivation to induce excess consumer demand. The violation of the neutrality of care managers might result in a financial burden on social insurance. In this study, we empirically test whether there is a positive correlation between care manager density and care costs, which might imply the existence of supplier-induced demand. Our results show a positive correlation, particularly in the case of care managers who work for firms that jointly operate in service provision sectors. Based on these results, we conduct a quantitative analysis, and show that the demand induced by care managers might produce a considerable financial burden on social insurance.     

上海市长期护理保险制度需求影响系统结构分析

上海市作为我国第一个进入老龄化的地区,其老龄化程度及发展速度都处于较高水平,社会护理压力越来越大,长期护理保险制度受到了许多学者以及上海市政策制定者的关注。文章选取影响长期护理保险制度需求的9个主要因素运用ISM方法进行分析,从而得出长期护理保险制度需求的发展趋势并寻求提高长期护理保险制度有效需求的可行之径,即建设人口均衡社会、加大宣传力度、构建可持续发展的社会保障体系、提高医疗水平。     

Nonprofit/for-profit status and earning differentials in the Japanese at-home elderly care industry: Evidence from micro-level data on home helpers and staff nurses

In April 2000, Japan embarked on a reform of its health care market. Along with the introduction of a long-term care insurance scheme, the government for the first time allowed for-profit operators to compete head-on with non-profit operators in the provision of at-home care services. Taking advantage of a unique and rich micro-level survey, this study is the first to examine wage differentials between the nonprofit and the for-profit sectors in Japan's nursing care industry, concentrating on home helpers and staff nurses. Controlling for nonrandom unobserved selection biases, our results show that a nonprofit wage premium exists. This finding supports the hypothesis that nonprofit providers operate under non-distributional constraints. J. Japanese Int. Economies 21 (1) (2007) 106–120.     

政府补助、保险支付与老年临终照料成本——基于2002-2014年CLHLS死亡人口追踪数据的分析

为应对日益增大的老年人照料压力,我国各地试点通过政府补助或社会保险支付的方式满足老人的照料需求。基于2002-2014年CLHLS死亡人口追踪数据,文章用两部分模型、Heckman选择模型和结构方程模型,分析了政府补助、保险支付对老年临终照料直接成本和总成本的影响及其中介机制。研究发现,老年临终照料服务由保险支付的直接成本和总成本都比家庭支付明显更高,政府补助的直接成本比家庭支付更高,保险支付的直接成本比政府补助更高。保险支付和政府补助对照料成本影响的机制存在差异,保险支付主要通过收入效应对照料成本产生显著影响,但替代效应也发挥了中介作用,政府补助则主要通过替代效应对照料成本产生显著影响。文章的研究结论具有重要的政策含义。我国发展长期护理保险,应合理界定政府、市场、社会和家庭对老年人的照料责任,并明确长期护理保险的有限责任,尽量降低可能的收入效应和替代效应对照料成本的影响。     

Quality and efficiency of home help elderly care in Japan: Evidence from micro-level data

With the introduction of public long-term care insurance in the spring of 2000, for-profit enterprises were allowed to enter the home help elderly care market in Japan for the first time. We take advantage of data from a unique, self-conducted survey to compare the efficiency and quality of service offered by providers with different types of ownership and different lengths of operation. We present two major findings. First, contrary to the prevailing perception, we find no significant difference in the quality of service between for-profit and nonprofit providers. Although the nonprofits are able to offer more qualified and experienced staff, the quality of services provided by nonprofits is worse in some aspects than that of their for-profit counterparts. Second, our estimates of a quality-adjusted cost function demonstrate that the management of newer providers is more efficient than that of older providers. Our results show that the competition mechanism works effectively in the home help care market, and that there is no reason to believe that the for-profit providers are behaving opportunistically. Thus, this study justifies the belief that free-market policy contributes significantly toward improving the quality and the efficiency of home help long-term care in Japan. J. Japanese Int. Economies 21 (2) (2007) 287–301.     

人口老龄化背景下保险公司投资养老实体产业研究

我国人口老龄化趋势日益严峻，积极发展养老实体产业成为解决未来老龄人口养老问题的重要举措。我国养老实体产业发展还存在着土地性质不明确、行业标准不统一、经营模式不规范、税收优惠不普及等问题。保险资本作为重要的社会投资力量，参与投资建设养老实体产业，既能缓解我国养老困境，又有利于保险公司缓解投资压力、匹配长期性负债资产、提高整体偿付能力等等。     

借鉴日本护理保险制度 构建我国护理保险体系

护理保险是应对人口老龄化带来的社会问题的一种有效途径。日本的护理保险制度具有护理保险法律法规健全、内容细致多样化及具有专业的护理人员等特点,这种制度为日本老年人提供了很好的护理保障。我国在未来要面临更加严重的人口老龄化问题,我国可以借鉴日本的发展经验,构建我国护理保险体系。在发展我国护理保险体系时,我国应确定社会保险和商业保险相结合的模式;注重法律法规的建设;创新护理保险产品种类;加强人才的培养。     

从资产负债管理看日本寿险业的利差损问题及对我国的启示

日本寿险公司倒闭事件给世界寿险业带来冲击，也引发了我们的深层思考。日本寿险公司倒闭的主要原因在于利差损，利差损产生的根源归根结底是由寿险公司的资产负债不匹配引起的。我国寿险公司应在经营过程中强化资产负债管理，以防范风险。