《保险研究》20240307-《精算平衡还是制度公平？长期护理保险试点推广的财政负担研究》（郭瑜、谢雨凝）

［摘   要］长期护理保险是人口老龄化背景下健全多层次社会保障体系、在发展中保障和改善民生的重要战略举措。然而，在试点推广的进程中，精算平衡与制度公平之间存在矛盾关系。厘清财政负担的概念、现状和未来趋势，对于协同促进长期照护服务体系建设具有重要作用。本文基于对试点方案的分类梳理，通过计算分年龄、分性别失能率和中/重度失能老年人口规模，测算得出2024~2050年试点方案推广情形下城镇职工与城乡居民长护险的需求成本规模，从而预估其财政补贴状况与兜底负担。研究发现，2050年低、中、高方案下财政负担总额预计分别为168.9亿元、2832.0亿元、7016.4亿元，占当年政府卫生支出的比例为0.23%、3.90%、9.66%。现行筹资机制能够基本保证低方案和中方案中城镇职工部分的财政负担稳定在合理范围内，中方案中城乡居民部分则需要大量财政补贴，整体不可持续，高方案基本不具备财务可持续性。

［关键词］长期护理保险；财政负担；精算平衡；制度公平

［基金项目］中国人民大学科学研究基金(中央高校基本科研业务费专项资金资助)项目成果(23XNH075)。

［作者简介］郭瑜，中国人民大学劳动人事学院教授、博士生导师，研究方向：社会保障，社会保险；谢雨凝(通讯作者)，中国人民大学劳动人事学院博士研究生。

Actuarial Balance or Inter-institutional Fairness?A Research on the Fiscal Burden of Pilot Expansion of Long-Term Care Insurance

GUO Yu,XIE Yuning

Abstract：Long-term care insurance (LTCI) is an important strategy to improve the multi-level social security system in the context of population aging and to ensure people′s protection and living standards through development.However,the process of pilot expansion is characterized by a contradiction between actuarial balance and inter-institutional fairness.Clarifying the concept,current situation,and future trends of fiscal burden plays a crucial role in advancing the establishment of the uniform system.Based on the typology of the pilot,the research calculates the age- and gender-specific disability rate and the scale of the moderate/severe disabled population,and in turn,the LTCI costs for urban employees and urban and rural residents′ systems in 2024-2050 are then estimated,respectively.Thus,the burden of fiscal subsidies and “safety net” expenditure are predicted.The research fin that the total fiscal burden according to the low,medium,and high scenarios in 2050 is estimated to be 16.89 billion yuan,283.20 billion yuan,and 701.64 billion yuan,accounting for 0.23%,3.90%,and 9.66% of the government′s health expenditure of the year.The current financing mechanism can ensure that the fiscal burden of the urban employees′ systems is stabilized within a reasonable range among low and medium programs.However,urban and rural residents′ system may face serious challenges for the fiscal burden.To enhance the balance and accessibility of basic public services,the research put forward policy recommendations on the design and practice of the LTCI system.

Key words：long-term care insurance;fiscal burden;actuarial balance;inter-institutional fairness