Long-term care insurance nationwide rollout! Who are the eligible groups? Here's the explanation.

The long-term care insurance system is a social insurance system established to provide service support or funding protection for basic living care and related medical nursing for people who are unable to care for themselves due to disability or dementia.

On March 25, the General Office of the CPC Central Committee and the General Office of the State Council issued the “Opinions on Accelerating the Establishment of a Long-Term Care Insurance System,” requiring that within about three years, a long-term care insurance system basically suited to China’s national conditions be established. This marks that the long-term care insurance system has shifted from localized pilot programs to nationwide rollout.

How is it different from basic medical insurance and pension insurance?

The long-term care insurance system covers the entire population, and all employees and residents participate in long-term care insurance. Long-term care insurance no longer distinguishes between employed and non-employed persons. In the same pooling area, expenses are reimbursed from the same fund pool, and people receive benefits accordingly.

Guan Bo, a researcher at the Macroeconomic Research Institute of the National Development and Reform Commission: Our social insurance emphasizes the law of large numbers. The broader the pool of participants and the more people enrolled, the stronger the fund’s ability to withstand risks.

How much is the premium for long-term care insurance? Wang Zhen, a researcher at the Institute of Economic Research, Chinese Academy of Social Sciences, said that employed workers are funded at 0.3% of their individual wages; 0.3% is the average contribution burden shared by individuals and their units. For non-employed urban and rural residents, the contribution base is based on the per capita disposable income of local urban and rural residents. Individuals and the fiscal departments each bear half of the cost, starting with 0.15% first. What individuals pay is roughly more than 30 yuan per year.

It is understood that long-term care insurance and basic medical insurance are jointly financed as a single arrangement, but they are accounted for separately and managed separately.

Guan Bo: Basic medical insurance already has a relatively well-developed enrollment and mobilization mechanism, which can achieve “coverage should be extended and should be enrolled,” and “payments should be made and should be paid in full” for long-term care insurance. This fund operates independently, reflecting the characteristics of long-term care insurance as a separate line of insurance.

Retirees need to pay; minors don’t pay but receive benefits

What groups need to contribute to long-term care insurance? Unlike medical insurance, retirees also need to pay. People under 18 enroll together with their parents or guardians, and they do not need to pay in order to receive benefits.

Wang Zhen, a researcher at the Institute of Economic Research, Chinese Academy of Social Sciences: More than 90% of people who are unable to care for themselves are elderly. So requiring elderly people to pay also reflects consistency between rights and obligations. Retired employees use their individual retirement pensions as the contribution base.

Who can enjoy long-term care insurance protection?

In the system’s initial stage, the beneficiaries are “severely disabled persons” whose needs are most urgent and whose families bear the heaviest burden—mainly those who are bedridden for the long term and cannot take care of their own daily lives.

Wang Zhen: His basic ability to live independently is gone. He lies on the bed, cannot feed himself, cannot drink water himself, cannot manage his own bowel movements, and cannot bathe himself either—these severely disabled persons.

In the future, as China’s economy develops and the government’s capacity for保障 increases, at the national level the program will be studied and expanded to include people with moderate disability. To ensure fairness in benefits and fund safety, for the determination of disability levels, each locality will use “the same ruler,” applying nationally unified assessment standards.

How are long-term care insurance benefits reimbursed? What are the reimbursement proportions?

In principle, the long-term care insurance fund does not directly issue cash to persons unable to care for themselves. Instead, it provides services through institutions and reimburses the costs. Long-term care insurance has no deductible threshold. To ensure the fund’s sustainability, an annual maximum payment limit is set for each beneficiary—no more than 50% of the per capita disposable income of urban and rural residents in the pooling area from the previous year.

At present, there are mainly three types of settings that provide care services for persons unable to care for themselves, and enrolled persons can choose independently.

If they choose home-based care, designated institutions will send staff to provide services at the person’s home;

If they choose community institutions such as designated day-care centers, they can receive nearby and convenient care services;

If they choose to live in designated long-term care institutions, the institutions will provide full-day care services.

Since most elderly people hope to “age without leaving home,” the “Opinions” encourages the use of home-based and community-based care services, and provides a tilt in fund payments.

Long-term care insurance “lends a hand” to families of those who can’t care for themselves

Since the pilot program began in 2016, China’s long-term care insurance system has been continuously improved. It now covers 308 million people, and has cumulatively benefited more than 3.3 million people unable to care for themselves, reducing care burdens for the public by more than 100 billion yuan.

Last year, Zhejiang achieved full coverage of the long-term care insurance system. The enrollment rate reached 93%, and it cumulatively relieved 212,000 people unable to care for themselves by 4 billion yuan. In Ningbo, the city set up grassroots service points in remote areas such as mountainous regions and islands, recruiting and training remaining rural labor force to serve as caregivers. After villagers Huang Qi qin passed the training, she took care of six elderly people in her hometown. She could earn more than 4,000 yuan a month.

In addition to providing 42 items of living care for people unable to care for themselves, Ningbo also provides 10 items of home-based medical nursing care for them.

Li Qiqi, a long-term care service institution in Ningbo, Zhejiang: It’s like a household of an elderly person we serve now—she has been bedridden for many years. Every time she needs to go to the hospital to change a urinary catheter, it requires her three children to lift her from the bed onto a tricycle, tuck in the bedding, and then go to the hospital to line up for registration and go through the catheter placement. As it is now, when our nurses from the nursing station come to perform the procedure, actually the whole process takes about 15 minutes.

Shenyang, Liaoning, began officially implementing the long-term care insurance system on January 1 this year. Wang Zhenhai, a 80-year-old paralyzed resident, benefited as a result.

Wang Zhenhai’s wife, Wei Qi: I pay the helper 6,000 yuan every month. Even if I put an entire salary into it, it still isn’t enough. After the state introduced this policy, they come for free massage and free bathing—honestly, I’m so happy.

According to Wang Zhenhai’s household care needs, the long-term care insurance fund can pay up to 24 hours of in-home care per month. The fund reimburses 80%, and the individual pays 20%.

Assessment of disability levels tightens the “water faucet” of long-term care insurance

To receive long-term care insurance benefits, it is necessary to go through a strict assessment of disability levels. To better understand this policy, the reporter, in Xindu District, Chengdu, Sichuan Province, joined a long-term care insurance assessment team that consisted of two doctors from the People’s Hospital of the district and a staff member from the district medical insurance bureau, and conducted a home visit.

In order to use limited insurance funds where they are most needed, assessors strictly followed the “Long-Term Care Disability Level Assessment Standard” to evaluate the elderly person’s ability in activities of daily living, cognitive ability, and so on, striving to achieve “benefit should be granted when it should be granted, and should be granted in full when it should be received in full.”

(Editor: Wen Jing)

Keywords:

                                                            Long-term care insurance