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 program established to provide service or funding protection for the basic life care and related medical nursing of 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 3 years, a long-term care insurance system suited to China’s national conditions be basically established. This marks the shift of the long-term care insurance system from pilot programs in limited areas to nationwide implementation.

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

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

Guan Bo, Researcher at the Macroeconomic Research Institute of the National Development and Reform Commission: In our social insurance, the law of large numbers is emphasized. The broader the pool of insured participants and the more insured people there are, the stronger the fund’s ability to withstand risks.

How much is the long-term care insurance premium? Wang Zhen, a researcher at the Institute of Economics, Chinese Academy of Social Sciences, said that employed workers are financed at 0.3% of their personal wages; 0.3% is the average split burden between individuals and their work units. For non-employed urban and rural residents, the payment base is based on local urban and rural residents’ per-capita disposable income; individuals and the fiscal departments each bear half—starting at 0.15% first. The amount individuals pay is roughly more than 30 yuan per year.

It is understood that long-term care insurance and basic medical insurance use integrated financing, with separate accounts and separate management.

Guan Bo: Basic medical insurance already has a relatively well-developed enrollment and mobilization mechanism, which can ensure that long-term care insurance covers everyone who should be covered and pays everyone who should receive benefits. This fund operates independently, reflecting the characteristics of long-term care insurance as a separate insurance type.

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

Who needs to pay into long-term care insurance? Unlike medical insurance, retirees also need to pay. People under 18 participate together with their parents or guardians and do not need to pay, yet they can still receive benefits.

Wang Zhen, Researcher at the Institute of Economics, Chinese Academy of Social Sciences: More than 90% of people who are unable to care for themselves are elderly. So asking elderly people to pay also reflects consistency between rights and obligations. Retired employees use their personal retirement pensions as the payment base.

Who can enjoy the coverage and protection of long-term care insurance?

In the initial stage of the system, the beneficiaries are mainly “persons with severe loss of capacity” whose need is most urgent and whose families bear the heaviest burden. They are primarily those who are bedridden for the long term and cannot take care of their own daily life.

Wang Zhen: He has lost his basic ability to live independently—lying in bed, unable to eat on his own, unable to drink water on his own, unable to use the toilet on his own, and unable to bathe on his own. These are people with severe loss of capacity.

In the future, as China’s economy develops and its capacity for social security improves, at the national level the government will uniformly study and expand coverage to people with moderate loss of capacity. To ensure fairness of benefits and the safety of the fund, for the determination of loss-of-capacity levels, local areas will use “the same ruler,” applying nationwide unified assessment standards.

How is long-term care insurance reimbursed? What is the reimbursement ratio?

The long-term care insurance fund, as a rule, does not directly issue cash to people with loss of capacity. Instead, it provides services through institutions and reimburses the related expenses. Long-term care insurance has no deductible line. To ensure the fund’s sustainability, an annual maximum payment limit is set for each beneficiary, which does not exceed 50% of the previous year’s per-capita disposable income of urban and rural residents in the pooled area.

At present, there are mainly three types of venues providing care services for people with loss of capacity, and insured persons choose independently.

For those choosing home care, designated institutions send staff to provide services at home;

For those choosing community institutions such as designated day care centers, they receive care services nearby for convenience;

For those choosing to stay in designated long-term care institutions, the institution provides full-day care services.

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

Long-term care insurance “lends a hand” to families of people with loss of capacity

Since the pilot was launched in 2016, China’s long-term care insurance system has been continuously improved. It currently covers 308 million people, and has cumulatively benefited more than 3.3 million people with loss of capacity, reducing care burdens for the public by more than 100 billion yuan.

Zhejiang has already achieved full coverage of the long-term care insurance system last year, with an enrollment rate of 93%. It has cumulatively reduced the burden by 4 billion yuan for 212,000 people with loss of capacity. In Ningbo, focusing on remote areas such as mountainous regions and islands, the city set up grassroots service points and recruited and trained remaining rural labor force as caregivers. After village resident Huang Qi-qin completed training and qualified, she took care of six elderly people in her hometown and could earn more than 4,000 yuan per month.

In addition to providing 42 items of daily living care for people with loss of capacity, Ningbo also provides 10 items of home-based medical nursing care for them.

A long-term care service institution in Ningbo, Zhejiang: Li Qiqi: It’s like the elderly person we serve now—she has been bedridden for many years. Each time we need to go to the hospital to change a urinary catheter, the three children have to move the elderly person from the bed onto a tricycle, tuck the blanket in properly, then go to the hospital to line up and register, and to have the catheter placed. Now that we have nurses from our care station who come to perform the procedures, honestly, from start to finish, the whole process takes 15 minutes.

Shenyang, Liaoning, has been officially implementing the long-term care insurance system since January 1 of this year, and 80-year-old paralyzed resident Wang Zhenhai therefore benefited.

Wang Zhenhai’s wife, Wei Qi: Every month I hire an aunt for six thousand yuan. Even taking out a whole paycheck isn’t enough. After the country has this policy, they come to provide free massages and free bathing, and I’m really happy.

Based on Wang Zhenhai’s home-care needs, the long-term care insurance fund can cover up to 24 hours of at-home nursing per month; the fund reimburses 80%, and the individual pays 20%.

Assessment of loss-of-capacity levels “tightens the faucet” of long-term care insurance

Enjoying benefits under long-term care insurance requires a strict assessment of the loss-of-capacity level. To learn more deeply about this policy, the reporter, in Xindu District of Chengdu, Sichuan Province, visited in-home along with a long-term care insurance assessment team composed of two doctors from Xindu District People’s Hospital and a staff member from the district’s medical insurance bureau.

To ensure that limited insurance funds are used where they matter most, the assessors strictly followed the “Long-Term Care Loss-of-Capacity Level Assessment Standards” to evaluate the elderly person’s ability in activities of daily living and cognitive ability, etc., striving to achieve: “If you should enjoy it, you should enjoy it; you should receive what you are entitled to—receive it in full.”

(Editor: Wen Jing)

Keywords:

                                                            Long-term care insurance