《保险研究》20260305-《老年人长期护理保障缺口研究——基于失能发展轨迹视角》（陈璐、高金燕、时晓爽）

［摘   要］本文利用2018~2020年中国健康与养老追踪调查数据，聚焦60岁及以上老年人余寿的失能发展轨迹，运用Markov模型和多状态生命表法测算老年人在各健康状态的持续时间，进而估算长期护理保障缺口及财务压力。研究发现，随着年龄的增长，老年人预期余寿和自理持续时间逐渐缩短，女性预期余寿高于男性，但自理持续时间比男性短。选择机构护理的老年人在余寿失能轨迹内长期照护需求成本约为12.15万~26.06万元；选择居家护理的老年人的显性需求成本约为9.45万~20.55万元。按照长期护理保险制度试点政策的低、中、高三类失能给付标准，城镇职工老年人在机构护理方式下，余寿可能产生的护理保障缺口为11.83万~25.54万元、10.87万~24.14万元、8.74万~21.14万元；在居家护理方式下，保障缺口分别为9.19万~20.13万元、8.33万~18.87万元、5.67万~15.13万元。城乡居民老年人机构护理和居家护理保障缺口更大。85岁及以上老年人因长期护理保障缺口所承受的财务压力，平均水平约为60～64岁群体的2.41倍。本文的研究为科学评估长期护理保障缺口提供参考。

［关键词］失能发展轨迹；长期护理需求成本；长期护理保险政策试点；长期护理保障缺口

［基金项目］国家社会科学基金项目“基于经济价值评估视角的家庭老年照料支持政策研究”（21BRK003）。

［作者简介］陈璐，南开大学金融学院教授、博士生导师；高金燕，南开大学金融学院博士研究生；时晓爽，就职于中国人民健康保险股份有限公司团体客户业务部。

Long-Term Care Security Gaps among Elder Chinese Adults：A Disability Trajectory Perspective

CHEN Lu，GAO Jin-yan，SHI Xiao-shuang

Abstract：Using data from the 2018-2020 waves of the China Health and Retirement Longitudinal Study （CHARLS），and with a particular focus on disability trajectories of people aged 60 or above，this study applies a Markov model and the multi-state life table method to estimates the duration elder adults are expected to spend in different health states，and further assesses the security gaps of long-term care （LTC），and associated financial pressure across their remaining lifespans.The results show that both remaining life expectancy and self-care duration of elder Chinese adults decline with advancing age.Although females have a longer remaining life expectancy than males，they spend fewer years in a self-care state.Regarding the LTC costs within the disability trajectory over the remaining life，the estimated cost for institutional care ranges from 121.5 to 260.6 thousand yuan，while the corresponding care cost （explicit cost） for home care ranges from 94.5 to 205.5 thousand yuan.Based on the disability benefit standards of low-，medium-，and high-generosity long-term care insurance （LTCI） schemes，the LTC security gaps for individuals enrolled in the Urban Employee Basic Medical Insurance scheme under institutional care are estimated to range from 118.3 to 255.4 thousand yuan，from 108.7 to 241.4 thousand yuan，and from 87.4 to 211.4 thousand yuan，respectively.Under home-based care，these corresponding gaps range from 91.9 to 201.3 thousand yuan，from 83.3 to 188.7 thousand yuan，and from 56.7 to 151.3 thousand yuan，respectively.In comparison，elder individuals enrolled in the Urban-Rural Resident Basic Medical Insurance scheme face even larger protection gaps under both institutional and home-based care scenarios.On average，the financial pressure stemming from the LTC security gaps among the elderly aged 85 and above is approximately 2.41 times that among those aged 60-64.This study provides references for scientifically assessing the LTC security gap，and conducting risk management in China.

Key words：disability trajectory;long-term care cost;long-term care insurance pilot program;long-term care security gaps