State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China.
Front Public Health. 2021 Aug 16;9:714044. doi: 10.3389/fpubh.2021.714044. eCollection 2021.
This study aimed to predict the changing trend of long-term care insurance (LTCI) funds by clarifying the linkage between revenue and expenditure and its influencing factors and to provide evidence for the establishment of a sustainable LTCI financing mechanism in China. We have taken Xiamen as an example, based on the data from Xiamen Special Economic Zone Yearbook and field survey. The changing trend of LTCI funds is predicted from 2020 to 2030 based on the system dynamics model (SDM) of the LTCI financing system. Also, through literature research and expert consultation, we found the intervention goals and analyzed their impact on the balance of LTCI funds. In the current situation, according to the forecast, the revenue and the expenditure of the LTCI funds will increase year by year from 2020 to 2030 in Xiamen, an increase of about 3.7 times and 8.8 times, respectively. After 2029, the expenditure will exceed the revenue of the LTCI funds and the balance will turn into a deficit. From the perspective of fund revenue, by adjusting the individual payment rate, government financial subsidies, and enterprise payment rate, the proportion of LTCI funds can be increased to alleviate the balance deficit under the original forecast. On the contrary, from the perspective of fund expenditure, increasing the proportion of reimbursement and the rate of severe disability will lead to an increase in fund expenditure. In this case, the balance of the funds will turn into a deficit, 7 years in advance. In addition, it was found that the severe disability rate has the greatest impact on the balance of funds. The SDM can objectively reflect the structure and the behavior of the LTCI financing system and has good applicability. By increasing the individual payment rate, government financial subsidies, and enterprise contribution rate, reasonable setting of the reimbursement ratio of nursing services, especially for the prevention of disability among the elderly, to maintain the sustainability of the funds. This study provides strong evidence for policymakers to establish a sustainable LTCI system in China.
本研究旨在通过明确收支关系及其影响因素，预测长期护理保险（LTCI）基金的变化趋势，为建立中国可持续的 LTCI 融资机制提供依据。我们以厦门市为例，基于厦门经济特区年鉴和实地调查数据，运用 LTCI 融资系统的系统动力学模型（SDM）对 2020 年至 2030 年的 LTCI 基金变化趋势进行预测。同时，通过文献研究和专家咨询，确定干预目标并分析其对 LTCI 基金结余的影响。在现有情况下，根据预测，厦门市 LTCI 基金的收支将从 2020 年至 2030 年逐年增加，分别增长约 3.7 倍和 8.8 倍。2029 年后，支出将超过 LTCI 基金的收入，结余将转为赤字。从基金收入来看，通过调整个人缴费率、政府财政补贴和企业缴费率，可以提高 LTCI 基金的比例，缓解原预测下的基金结余赤字。相反，从基金支出来看，增加报销比例和重度残疾率会导致基金支出增加，基金结余将提前 7 年转为赤字。此外，研究还发现重度残疾率对基金结余的影响最大。SDM 可以客观反映 LTCI 融资系统的结构和行为，具有良好的适用性。通过提高个人缴费率、政府财政补贴和企业缴费率，合理设置护理服务报销比例，特别是对老年人残疾的预防，以维持资金的可持续性。本研究为政策制定者在中国建立可持续的 LTCI 制度提供了有力证据。
