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不同国家公共长期护理保险(LTCI)制度演变的回顾:影响与挑战。

Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge.

机构信息

School of Mathematics and Statistics, Chongqing Technology and Business University, Chongqing, 400067, China.

School of Public Administration, Sichuan University, Chengdu, 610065, China.

出版信息

BMC Health Serv Res. 2020 Nov 20;20(1):1057. doi: 10.1186/s12913-020-05878-z.

Abstract

BACKGROUND

The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China.

METHODS

This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist.

RESULTS

The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited.

CONCLUSION

Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

摘要

背景

长期护理服务(LTC)的需求不断增长,这对全球各国来说都是一项艰巨的任务,尤其是中国,中国人口老龄化问题尤为严重。根据《中国统计年鉴(2019)》,2018 年中国 65 岁及以上老年人口达到 1.67 亿,失能老年人口高达 5400 万。德国等国家自 20 世纪 90 年代以来通过推行公众长期护理保险(LTCI)制度缓解了这一危机,而中国的公众 LTCI 制度直到 2016 年才开始正式试点。因此,公众 LTCI 制度的发展逐渐成为包括中国在内的各国学者关注的热点。

方法

本综述系统地对现有相关文献进行了分类,从四个方面讨论了公众 LTCI 系统的发展,即不同国家的公众 LTCI 制度比较、公众 LTCI 的影响、公众 LTCI 的挑战以及公众 LTCI 与私人 LTCI 的关系。我们从 2008 年 1 月至 2020 年 9 月,在 Web of Science 核心合集、Medline、SCOPUS、EBSCO、EMBASE、ProQuest 和 PubMed 等数据库中进行了检索。使用 CASP(批判性评价技巧方案)批判性评价清单对 38 篇定量文章和 21 篇定性文章的质量进行了评估。

结果

本综述系统地从四个方面检查了公众 LTCI 系统的发展,即不同国家的公众 LTCI 制度比较、公众 LTCI 的影响、公众 LTCI 的挑战以及公众 LTCI 与私人 LTCI 的关系。例如,LTCI 对失能老年人的健康和生活质量有积极影响。然而,LTCI 在减轻失能老年人家庭的经济负担方面的作用可能有限。

结论

可以从中国 LTCI 制度的未来发展中获得一些政策启示。例如,政府应充分考虑价格上涨、老年残疾率和巨大的经济负担等限制因素。还可以加强公众 LTCI 与私人 LTCI 的有效结合。这不仅有助于扩大其理论研究的空间,还可以借鉴世界各地各国 LTCI 制度实践中的经验。这将极大地有助于中国 LTCI 制度的顺利发展,并进一步推动其深入改革。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7797/7678285/26bcd8987a6e/12913_2020_5878_Fig1_HTML.jpg

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