Karagiannidou Maria, Wittenberg Raphael
The London School of Economics and Political Science, London, United Kingdom.
J Popul Ageing. 2022;15(2):557-575. doi: 10.1007/s12062-022-09366-6. Epub 2022 Jun 1.
The issue of how best to finance long-term care (LTC) is the subject of recent reforms, forthcoming reforms or continuing debate in various countries and remains as relevant and challenging as ever. LTC services are crucial to the wellbeing of large numbers of older adults who need help with everyday tasks. Demand for LTC for older adults is projected to rise across developed and developing countries as the number of older adults rises. Supply of care services is likely to remain constrained due to shortages of long-term care workforce and financial constraints in many countries, and the financial risks associated with LTC remain. Financing of LTC is a complicated issue which raises considerations of economic efficiency and incentives, equity including intergenerational equity, the balance of risk between public and private funding, and sustainability of public expenditures. The aim of this paper is to discuss analytically the case for social insurance as an equitable and efficient way to finance LTC. The paper considers social insurance systems, especially in Germany and Japan, in comparison with safety net tax funded systems such as in England and the USA and more generous tax funded systems such as in Sweden and Denmark. Social insurance has advantages and disadvantages compared with these other systems. It tends to be associated with greater clarity and acceptability since it involves collection of revenues ear marked for LTC and, at least in principle, a link between contributions and benefits on the basis of clear eligibility criteria.
如何以最佳方式为长期护理（LTC）筹资这一问题，是近期各国改革、即将到来的改革或持续辩论的主题，并且一如既往地既重要又具有挑战性。长期护理服务对于大量在日常任务方面需要帮助的老年人的福祉至关重要。随着老年人数量的增加，预计发达国家和发展中国家对老年人长期护理的需求都会上升。由于许多国家长期护理劳动力短缺和资金限制，护理服务供应可能仍会受到制约，而且与长期护理相关的财务风险依然存在。长期护理筹资是一个复杂的问题，它引发了对经济效率和激励措施、公平性（包括代际公平）、公共和私人资金之间的风险平衡以及公共支出可持续性的考量。本文的目的是从分析角度讨论社会保险作为一种公平且高效的长期护理筹资方式的情况。本文将德国和日本等社会保险体系，与英国和美国等安全网税收资助体系以及瑞典和丹麦等更慷慨的税收资助体系进行了比较。与这些其他体系相比，社会保险有其优点和缺点。它往往具有更高的清晰度和可接受性，因为它涉及专门为长期护理征收的收入，并且至少在原则上，基于明确的资格标准，缴费与福利之间存在联系。
