论我国长期护理保险制度试点中的争议问题与理论回应

伴随人口老龄化,家庭护理已难以满足失能老人的照护需求。为此,“十三五”规划提出“探索建立长期护理保险制度”,“十四五”规划建议进一步要求“稳步建立长期护理保险制度”。部分地区已开展试点工作,但是对于参保对象、基金筹集、保险待遇等核心问题试点不一。就参保对象,存在覆盖全民与仅面向老年居民之不同制度设计;就基金筹集,各地对于个人、单位及政府是否负担筹资义务规定不一;就保险待遇,各地对于给付对象、给付方式及给付标准规定不同。对家庭、单位、国家的职责定位以及对弥补家庭护理能力不足的路径选择,是构建长期护理保险制度的基础。基于平等原则、补充性原则,我国应建立覆盖全民、以参保人自行筹资为主体的长期护理保险制度。面对家庭护理能力之不足,立法应兼采支持劳动力回归家庭与护理社会化的应对路径,同时设立实物与现金给付方式,建立护理假等配套制度。

On the Controversial Issues and Theoretical Responses in the Pilot Rules of Long-term-care Insurance System

With the aging of the population and the declining birthrate of families,traditional home care has been unable to meet the needs of disabled elderly people.The“13th Five-Year Plan”proposed to“explore to establish a long-term care insurance system”,and the“14th Five-Year Plan”further requires“establishing a long-term care insurance system steadily.”Under the deployment of the“13th Five-Year Plan”,pilot work has been carried out in various regions,but there are different designs of pilot projects on the core substantive issues such as insured objects,fund raising and insurance benefits.As far as the insured object is concerned,there are different system designs that some covers the whole people while others only focus on the elderly residents.In terms of the fund raising,there are different regulations on whether individuals,units and governments should bear the obligation of raising funds.Concerning insurance benefits,there are different regulations on the object,mode and standard of payment in diverse regions.The construction of the system depends on the positioning of the responsibility of the family,the unit and the state as well as the choice of the path to deal with the lack of family nursing ability.Based on the principle of equality and subsidiarity,China should establish a long-term care insurance system that covers the whole people and takes the insured’s self-financing as the main body.Faced with the shortage of family nursing labor force caused by declining birthrate,legislation should adopt the coping path which supports labor force to return to family and propel nursing socialization.At the same time,we should set up payment methods concerning nursing service and cash subsidy,and establish supporting systems of nursing leave.