美国长期照护保险制度研究及对中国的启示

摘要

本文对美国长期照护（以下简称“长护”）保险计划——社区生活援助服务及支持计划（Community Living Assistance Services and Support Program，简称CLASS计划）的背景、计划内容及失败的原因进行了论述和分析，发现CLASS计划推出前，美国老年人长护服务需求旺盛，但费用高昂且上涨速度快；医疗保障体系对长护的保障有限；老年人商业长护保单持有率较低。CLASS计划失败主要有三个原因：逆向选择风险高；保费偏低，缺乏财政支持；保险金设定不合理。CLASS计划失败对我国长护保险制度建设的启示有：控制逆向选择风险；合理确定保费，明确政府财政补贴责任；保障水平应与实际护理成本相适应。%This Article analyzes and discusses the background, the contents and the causes of failure of the Long-Term Care insurance program of the USA——Community Living Assistance Services and Support Program (CLASS program, and finds that before the CLASS program being lunched, there have been huge demands of long-term care from the older people, while the long-term care service was too expensive to be affordable, and the price has been increasing dramatically; Social medical security system only provided limited long-term care security;only small number of people bought private long-term care insurance. The causes of the failure of the CLASS program include: there was high adverse selection risk; the premium was too low and lacked of fiscal support;and the compensation was unreasonable. The failure of CLASS program suggests that adverse selection risk must be controlled; the premium should be determined reasonably and the responsibility of the governments in fiscal subsidies should be cleared;and the security level should match the actual long-term care cost.