Ye Bei, Xu Yingxin, Chan Wing Kit, Zhang Zhongyan, Lobanov-Rostovsky Sophia, Curry Natasha, Brunner Eric John, Liao Jing
Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2 Road, Guangzhou, China.
Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-Sen University, No. 74, Zhongshan 2nd Road, Guangzhou, China.
BMC Health Serv Res. 2024 Dec 24;24(1):1646. doi: 10.1186/s12913-024-12126-1.
There is a growing demand for dementia care to be funded by long-term care insurance (LTCI). However, evidence indicates that people with dementia are overlooked in China's LTCI policy and empirical research on this issue is notably scarce. Among the first seven LTCI pilot cities that officially enrolled people with dementia, Guangzhou is unique for roll-back LTCI policies related to eligibility criteria and benefits. This study aims to explore why people with dementia are overlooked in China's LTCI policy, using Guangzhou as a case study.
Semi-structured interviews were conducted with stakeholders involved in LTCI need assessment and care delivery in Guangzhou. Eight LTCI assessment specialists, 22 formal caregivers, and six informal caregivers were interviewed from December 2021 to October 2022. Data was analyzed using NVivo 11.0 software and the Gilbert welfare framework to identify themes.
Interviewees reported that need assessment lacked a clear definition, were poorly supervised, and had high moral hazards. Challenges to care delivery included unprofessionalism of formal caregivers, shortage of resources, unprepared informal caregivers, a lack of a supportive environment and the negative impact of COVID-19. DISCUSSION AND IMPLICATIONS: People with dementia are overlooked in LTCI policy which may result from difficulties in implementing dementia-related assessment criteria, and hampered service delivery due to a shortage of skilled caregivers. These issues need to be carefully considered before scaling up the coverage of LTCI policy nationwide.
长期护理保险（LTCI）资助痴呆症护理的需求日益增长。然而，有证据表明，中国的长期护理保险政策忽视了痴呆症患者，对此问题的实证研究也极为匮乏。在首批正式纳入痴呆症患者的七个长期护理保险试点城市中，广州在放宽与资格标准和福利相关的长期护理保险政策方面独具特色。本研究旨在以广州为例，探讨中国长期护理保险政策为何忽视痴呆症患者。
对参与广州长期护理保险需求评估和护理服务的利益相关者进行了半结构化访谈。2021年12月至2022年10月期间，共访谈了8名长期护理保险评估专家、22名正式护理人员和6名非正式护理人员。使用NVivo 11.0软件和吉尔伯特福利框架对数据进行分析，以确定主题。
受访者表示，需求评估缺乏明确的定义，监管不力，且存在较高的道德风险。护理服务面临的挑战包括正式护理人员不专业、资源短缺、非正式护理人员准备不足、缺乏支持性环境以及新冠疫情的负面影响。
痴呆症患者在长期护理保险政策中被忽视，这可能是由于实施与痴呆症相关的评估标准存在困难，以及熟练护理人员短缺阻碍了服务提供。在全国范围内扩大长期护理保险政策覆盖范围之前，需要仔细考虑这些问题。
