《保险研究》20221108-《中国长期护理保险的筹资调整机制及缴费负担》（汤薇、虞幸然、粟芳）

［摘   要］在长期护理保险试点进一步扩大和失能老年人口激增的背景下,完善长期护理保险制度的关键在于建立科学合理的动态筹资机制。本文从长期护理保险的筹资调整频率和调整幅度构建了长期护理保险筹资调整机制的理论框架,综合考虑了预期寿命延长、城乡人口迁移和失能率动态变化等因素,运用长期精算平衡模型分别测算了2020～2050年城镇职工和城乡居民长期护理保险的人均筹资额,并评估了不同制度下的长期护理保险筹资模式及筹资主体的缴费负担。研究发现,应尽快实现城镇职工长期护理保险的独立筹资机制,否则医保基金将无法满足筹资需求,不具备可持续性；谨慎提高城乡居民长期护理保险的保障程度和保障范围,倘若将给付对象从仅为重度失能老人扩大到包含重度失能老人和轻度失能老人时,财政补贴占GDP的比重较高且负担较重,会威胁可持续性。

［关键词］长期护理保险；筹资调整；缴费负担；长期精算平衡

［基金项目］感谢上海财经大学研究生创新基金（CXJJ-2021-416）的支持。

［作者简介］汤薇,上海财经大学金融学院博士研究生；虞幸然,上海财经大学金融学院博士研究生；粟芳,上海财经大学金融学院教授。

Financing Adjustment Mechanism and Payment Burden of Long-term Care Insurance in China

TANG Wei,YU Xing-ran,SU Fang

Abstract：Under the background of the further expansion of the pilot scope of Long-term Care Insurance (LTCI) and the surge of the disabled elderly population,the key to improving the LTCI system is to establish a scientific and dynamic financing mechanism.This paper constructs the theoretical framework of the LTCI financing adjustment mechanism from the two aspects of adjustment frequency and adjustment amplitude,and comprehensively considers many factors such as life expectancy extension,urban and rural population migration,and dynamic change in the disability rate.The long-term actuarial balance model is used to estimate the per capita financing amount of LTCI for urban workers and urban and rural residents from 2020 to 2050,and to evaluate the contribution burden of financing modes and financing subjects under different systems.It is found that the independent financing mechanism of employee LTCI should be realized as soon as possible,and the social medical insurance account will not be able to meet the financing needs of LTCI for urban employees,which is not sustainable.The degree of protection should be prudently increased.If the coverage is extended to the severely and mildly disabled elderly,the proportion of financial subsidy to GDP will be higher,and the heavy burden will threaten the sustainability of LTCI for residents.

Key words：long-term care insurance;financing adjustment;payment burden;long-term actuarial balance