Long-term care insurance provides a safety net and peace of mind for disabled seniors

Ask AI · How can pilot cities integrate resources for long-term care insurance to connect medical, nursing, and eldercare services?

The General Office of the Communist Party of China Central Committee and the General Office of the State Council recently issued the “Opinions on Accelerating the Establishment of a Long-Term Care Insurance System.” The goal is to better meet the basic security needs for long-term care for persons with disabilities by building a long-term care insurance system (hereinafter referred to as “long-term care insurance”).

The latest data show that in China, more than 45 million elderly people who have disabilities and cognitive impairments need long-term care provided by family members or eldercare medical institutions. With the population aged 60 and above exceeding 300 million, problems such as a high incidence of chronic diseases, functional decline, and dependence on caregiving are increasing. The traditional medical system centered on acute treatment can no longer meet real-world needs. Building a continuous care system covering the whole life cycle, and beyond the foundation of basic medical insurance coverage, also requires long-term care insurance to work in tandem with medical insurance.

Long-term care insurance is an insurance coverage that provides financial protection for insured persons who are physically frail, cannot take care of their own daily life or cannot fully take care of it, and therefore need assistance from others with all or part of their daily living activities. It provides economic保障 insurance for them to receive long-term medical nursing or custodial care services. At present, the focus of China’s development of medical-nursing-eldercare is shifting from facility construction to the stage of mechanism integration. In many places, long-term care insurance serves as a link to integrate resources from hospitals, rehabilitation centers, and eldercare institutions, preliminarily forming a “medical—rehabilitation—eldercare” continuous care chain based on needs assessment, backed by service supply, and guaranteed by cost sharing. For example, in places such as Qingdao in Shandong and Shanghai, unified disability evaluation standards are used, tiered service catalogs are developed, and multiple service providers are established as entities, enabling insured individuals to choose, according to their needs, care provided at home, care in community daytime settings, or centralized care in institutions. Relevant costs are reimbursed by the long-term care insurance fund according to regulations, effectively easing the pressure on family caregiving. Some insurance institutions also actively participate in the construction of basic eldercare service infrastructure. However, whether their investment behavior is sustainable hinges on whether they can establish stable expectations and orderly, compliant norms. What needs more attention now is how to use long-term care insurance to guide medical resources downward, stimulate grassroots service capacity, and rebuild incentive mechanisms for medical institutions.

Based on international experience, there are significant differences in long-term care protection pathways. For instance, Germany, as the first country in the world to establish a social long-term care insurance system, has implemented a model featuring compulsory enrollment, shared responsibility between labor and employers, and a fiscal backstop since 1995. It covers the entire population and also has a five-tier disability assessment system. It further emphasizes economic compensation for family caregivers, encourages relatives to participate in daily caregiving, and reflects recognition of the value of informal care systems. China is striving to explore a road with its own characteristics. On one hand, it adheres to government-led, steady advancement, embedding the functions of long-term care insurance within the existing medical insurance management framework to reduce operating costs. On the other hand, it takes into account differences between urban and rural areas as well as across regions, adopting category-based guidance and a phased, tiered implementation strategy, while also leaving room for development of commercial insurance to build a multi-tiered protection structure.

To further optimize long-term care insurance and ease the burden for disabled elderly people by providing a backstop, it is necessary to focus on multiple aspects and improve the resilience and accessibility of the medical-nursing-eldercare industry system.

First, accelerate the legislative process for long-term care insurance and incorporate it into the social security law system. Clarify the independent line-of-insurance status of long-term care insurance, unify its name, enrollment scope, funding responsibilities, and regulatory rules, and achieve a leap from “pilot policies” to the level of law. Optimize the funding structure and explore a diversified shared-responsibility mechanism featuring “personal contributions as the main source, employer cost-sharing, fiscal subsidies, and supplementation from public-interest funds” to enhance fiscal soundness.

Second, strengthen the capacity for service provision and unify standards. Support localities in building regional long-term care talent training bases relying on vocational colleges and medical institutions, and expand the size of specialized teams for elderly health and care. Develop nationally unified disability assessment standards, nursing service guidelines, and technical operation manuals to prevent wide variations in service quality. Promote data connectivity between medical insurance information systems and platforms for health, health administration, and civil affairs and eldercare, so that disability assessment results can be mutually recognized, service records can be shared, and reimbursement and settlement processes can be integrated. Explore adopting “per-capita bundled payment” for continuous care units to incentivize institutions to provide integrated, efficient services.

The medical-nursing-eldercare industry is a people’s livelihood project related to the wellbeing of hundreds of millions of families and social stability. Based on doing fine and strengthening medical insurance, and through coordinated efforts to develop long-term care insurance, we will reshape the value coordinates of China’s health services system—extending from disease treatment to the maintenance of function and the improvement of quality of life. By breaking through bottlenecks and pooling strengths, we will build a fair, accessible, sustainable, reliable, and warm elderly health care system that will lay a solid foundation for people’s livelihood in Chinese-style modernization. (Author: Zhang Luwen Source: Economic Daily)