Application of Smart Healthcare in LTCI, Outpatient Mutual-Aid Guarantee Mechanism, and Sustainability of Medical Insurance Fund for Urban Employees.

Yating Ren,Zhe Yang,Kalidoss Rajakani

doi:10.1155/2022/3406977

Abstract

With the aggravation of population aging and the increase of life expectancy, long-term care insurance (LTCI) system has been established to meet the medical and long-term care needs of the increasing elderly population. In China, LTCI system is currently not a stand-alone insurance, but it is attached to the national basic medical insurance fund for urban employees (MIUE). As a result, the expenditure of LTCI is a part of the expenditure of the MIUE, which has an impact on the sustainability of the MIUE. By modeling the income and expenditure of MIUE, especially including the expenditure of LTCI, this study optimized an LTCI system with a higher individual out-of-pocket payment ratio of LTCI and implementation of the outpatient mutual-aid guarantee mechanism (OMAGM), which could improve the sustainability of the MIUE. The study also reveals the following: (i) solely increasing individual out-of-pocket payment ratio of LTCI to 20%–50% can only postpone the deficit on Social Pooling Accounts (SPAs) by 1 or 2 years, and the effect is very limited. (ii) Besides a higher individual out-of-pocket payment ratio, further implementation of a partial OMAGM from 2022 will postpone the deficit on SPAs by 7–9 years, and the implementation of a complete OMAGM from 2022 will postpone the deficit by 14–18 years. Accordingly, China should implement OMAGM as soon as possible to enhance the solvency of MIUE fund, and, in the long run, an independent LTCI scheme should be established to ensure the stability and sustainability of the LTCI fund and the MIUE fund.

Highlights

Long-term care insurance (LTCI) refers to a type of health insurance for people who lose all or part of body functions and are unable to live independently due to old age, serious or chronic illness, accidental disability, and so forth and compensates for their various expenses during a long-term care in hospice or at home.With the aggravation of population aging and the increase of life expectancy, the number of disabled population keeps rising
To more intuitively reflect the policy effects of LTCI and outpatient mutual-aid guarantee mechanism (OMAGM), we simulated the following scenarios: the operation of Social Pooling Accounts (SPAs) of Chinese medical insurance fund for urban employees (MIUE) during 2021–2050 when LTCI is implemented at different individual out-of-pocket payment ratios and when OMAGM is implemented as a partial OMAGM or a complete OMAGM, which are medium- and long-term projections
— –33.15 –38.40 –43.73 –54.33 partial OMAGM can augment the financial operation of SPAs, the fund will still have current and accumulated deficits. us, this study further considers the case of implementing a complete OMAGM; that is, abolishing Medical Savings Accounts (MSAs) and all contribution from enterprises and individuals will be allocated to SPAs, at which point SPAs should cover all inpatient expenses and 50% of outpatient and medicine expenses

Summary

Introduction

Long-term care insurance (LTCI) refers to a type of health insurance for people who lose all or part of body functions and are unable to live independently due to old age, serious or chronic illness, accidental disability, and so forth and compensates for their various expenses during a long-term care in hospice or at home.With the aggravation of population aging and the increase of life expectancy, the number of disabled population keeps rising. Long-term care insurance (LTCI) refers to a type of health insurance for people who lose all or part of body functions and are unable to live independently due to old age, serious or chronic illness, accidental disability, and so forth and compensates for their various expenses during a long-term care in hospice or at home. Many countries have established long-term care insurance system to meet the medical and long-term care needs of the increasing elderly population. Some countries in Northern and Southern Europe establish an LTCI scheme as a part of welfare system with universal coverage, no individual contributions, and comprehensive treatment. Germany, Japan, and some other countries establish an LTCI scheme in social insurance system managed by the government, which mandates contribution from the government, enterprises, and individuals, and the insured are entitled to certain treatment according to their incapacity level when long-term care needs arise. The academics widely accept that the LTCI scheme in social insurance system, which has a large coverage and diversified funding sources, mitigates government’s fiscal burden and has a better sustainability

Results

Discussion

Conclusion