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Turnover in Zero-Premium Status Among Health Insurance Marketplace Plans Available to Low-Income Enrollees

Recent subsidy enhancements in Affordable Care Act (ACA) Marketplaces made many low-income enrolles (below 150% of the federal poverty level [FPL]) eligible for 2 free silver-tier plans. eligible for 2 free silver-tier plans. However, an unintended consequence of this structure is that the identity of which silver plans are free will often "turn over" between years, requiring that enrollees actively initiate premium payment (or lose coverage). The prevalence of this free-plan turnover is not known. To measure the prevalence of free-plan turnover in ACA Marketplaces and to estimate how many enrollees below 150% of FPL are likely to be affected. This observational cross-sectional study used data on plan offerings and premiums in 33 state ACA Marketplaces using HealthCare.gov in 2021 and 2022, along with estimates of county-level enrollee characteristics and plan selection patterns. The enrollment-weighted share of county markets affected by free-plan turnover was quantified, along with the association of turnover with enrollee and market characteristics. Estimates of the number of affected low-income enrollees were calculated using the data plus statistics reported in past research. Data were analyzed from November 21, 2021, to February 28, 2022. This study found that turnover of zero-premium plans was quite common, with 93% of HealthCare.gov counties (weighted by enrollment) experiencing at least 1 zero-premium plan in 2021 turning over to nonfree in 2022; 84% of counties experienced turnover of all $0 silver plans from 2021 to 2022. This turnover affected an estimated 1.36 million people with incomes below 150% of FPL. Turnover was more common in counties with a higher share of non-White enrollees, in Medicaid nonexpansion states, in counties with more carriers, and in counties with changes in the number of offered plans. The findings of this cross-sectional study suggest that owing to the prevalence of zero-premium plan turnover, many low-income ACA enrollees faced elevated risk of disenrollment at the start of 2022. Outreach to affected enrollees and other actions to encourage coverage retention and midyear reenrollment could help mitigate coverage losses.

Operational and structural factors influencing enrolment in community-based health insurance schemes: an observational study using 12 waves of nationwide panel data from Senegal.

Community-based health insurance (CBHI) has been implemented in many low- and middle-income countries to increase financial risk protection in populations without access to formal health insurance. While the design of such social programmes is fundamental to ensuring equitable access to care, little is known about the operational and structural factors influencing enrolment in CBHI schemes. In this study, we took advantage of newly established data monitoring requirements in Senegal to explore the association between the operational capacity and structure of CBHI schemes—also termed ‘mutual health organizations’ (MHO) in francophone countries—and their enrolment levels. The dataset comprised 12 waves of quarterly data over 2017–2019 and covered all 676 MHOs registered in the country. Primary analyses were conducted using dynamic panel data regression analysis. We found that higher operational capacity significantly predicted higher performance: enrolment was positively associated with the presence of a salaried manager at the MHO level (12% more total enrolees, 23% more poor members) and with stronger cooperation between MHOs and local health posts (for each additional contract signed, total enrolees and poor members increased by 7% and 5%, respectively). However, higher operational capacity was only modestly associated with higher sustainability proxied by the proportion of enrolees up to date with premium payment. We also found that structural factors were influential, with MHOs located within a health facility enrolling fewer poor members (−16%). Sensitivity analyses showed that these associations were robust. Our findings suggest that policies aimed at professionalizing and reinforcing the operational capacity of MHOs could accelerate the expansion of CBHI coverage, including in the most impoverished populations. However, they also suggest that increasing operational capacity alone may be insufficient to make CBHI schemes sustainable over time.

PERBANDINGAN PERHITUNGAN PREMI ASURANSI JIWA BERJANGKA, SEUMUR HIDUP, DAN DWIGUNA PADA KASUS LAKI-LAKI DAN PEREMPUAN

Life insurance is insurance that handles the risks that occur in human life. Insurance company as a handler where the insurance company will pay a certain amount of money in case of death risk to the insurance policyholder. There are two types of premiums, namely net premiums and gross premiums. The premium to be calculated is a single premium. Premium payments on life insurance in the same time, lifetime and bi-use in this study are payments made at once or can be called a single premium. Based on the example of the case of prebandan term life insurance premiums, life insurance for life and bipurpose life insurance between men and women. The value of a single premium of life insurance as long as life has a lower pemi niai and the single lai pemi of bipurpose life insurance has a higher pemi value

Transfer Payment Systems and Financial Distress: Insights from Health Insurance Premium Subsidies

Abstract How should payment systems of means-tested benefits be designed to improve the financial situation of needy recipients most effectively? We study this question in the context of mandatory health insurance in Switzerland, where recipients initially receive either a cash transfer or subsidized insurance premiums (a form of in-kind transfer). A federal reform in 2014 forced cantons (i.e. states) to universally switch to in-kind provision. We exploit this setting based on a difference-in-differences design, analyzing eight years of rich individual-level accounting data and applying a machine learning approach to identify cash recipients prior to the reform. We find that switching from cash to in-kind transfers persistently reduces the likelihood of late premium payments by about 20% and of government debt collection for long-term missed payments by approximately 12%. There is no evidence for a negative spillover effect on the timely payment of the non-subsidized co-pay bills for health services after the regime change.

Technical Municipal Radius Clause Interpretations to Avoid Coronavirus Liability and Perspectives from the OECD and Vienna Convention on the Law of Treaties 1969—Guardrisk Insurance Limited v Café Chameleon CC (case no 632/20) [2020] ZASCA 173

Approximately fifteen years ago, most insurers inserted a radius clause to avoid paying claims based on financial losses and/or damages resulting from bacteria or viruses—known as notifiable diseases—that originate outside the radius. Other insurers tried to regulate liability for losses as a result of bacteria or otherwise, by inserting a force majeure clause (which is not a radius clause) in their insurance contracts. In this way, the insurer was not liable to pay for business interruption claims, irrespective of where the bacteria or viruses had originated. To avoid paying claims where a virus or otherwise originated within a specific radius, many insurers in OECD member states are willing to refund all paid premiums to their policyholders. Other insurers have given technical radius clause interpretations to avoid liability (coronavirus did not originate within the specified radius) or to grant premium payment holidays to policyholders as long as Covid-19 exists. The OECD considers these radius interpretations or arguments unreasonable, and for this reason it drafted a policy on gap cover to be implemented by its members. South Africa is not yet a full OECD member, and this article investigates whether a South African court would have a similar approach to radius clauses, which are considered unreasonable. To understand unreasonableness, the Vienna Convention on the Law of Treaties, 1969, which regulates the interpretation of treaties, is also discussed in this article.

The sustainability of premium payment of national health insurance's self-enrolled members in Jakarta Greater Area.

Background: The sustainability of the National Health Insurance (NHI) program heavily relies on the premium of its member. The negligence of a large number of members at pay the premium lead to the failure of the Social Security Agency for Health (SSAH) to deliver its services. This study aims at analyzing important factors that influence the sustainability of premium payment of NHI’s self-enrolled members in the Jakarta Greater Area.Design and methods: This study performed an econometric analysis from the panel and the same respondent’s data in 2015 and 2017. The population of the study was NHI’s self-enrolled members who lived in the City of Jakarta, Bogor, Depok, Tangerang, Bekasi, (Jakarta Greater Area) and it represents the urban area of Indonesia. The ordinal logistic regression model was used to determine the type of sustainability NHI premium payment.Results: The survey shows that around 28.3% of self-enrolled members do not pay the NHI insurance premium regularly. Applying ordered logit this study statistically confirms that age of household head, income per month, never experience economic hardship, 1st/2nd class registration, and benefits of SSAH are positively correlated with compliance rate to pay NHI insurance premium. Whereas tobacco consumption, health-seeking behavior, and the 2016 increase of premium are negatively correlated with regular premium payment.Conclusions: This study calls for policy intervention to improve compliance of premium payment such as i) massive promotion of insurance literacy and benefits of insurance through a health professional, internet, and government officer; ii) expanding auto-debit and installment premium payment; iii) incentive for paying premium regularly and not smoking; and iv) improving access and quality of health services. Significance for public health The innovation of National Health Insurance (NHI) organized by the Social Security Agency for Health (SSAH) is an essential step for the Indonesian government in its goal of achieving Universal Health Coverage (UHC). The existence of the NHI can improve access and quality of health services for the community. The community gets access to the comprehensive health service guarantees, starting from improving health (promotive), preventing illness (preventive), treating diseases (curative), and restoring health (rehabilitative). Therefore, it is important to regularly pay NHI premium, especially for the self-enrolled member/informal sector workers (Pekerja Bukan Penerima Upah) for the continuation of the NHI program which become a global problem, especially in developing countries where the majority of the population is working in the informal sector.

Optimizing the Life-Cycle Path of Pension Premium Payments and the Pension Ambition in the Netherlands

We determine the optimal life-cycle path of pension premiums during the working ages and pension benefits during retirement, assuming that households can choose these freely. We calibrate the model on Dutch data. The optimization takes into account the fact that incomes generally rise during the working ages and that children are generally present in young households. Both features lead to an upward sloping path of optimal pension premium rates over the working life, while under the current pension system this is rather flat. The welfare gains from implementing the optimal pension system depend on the specification of the model, but can be sizable. A potentially lower return on pension assets in the future implies a further delay of optimal pension premiums during the working ages and a lower optimal pension benefit after retirement. Differentiating the path of pension premiums and benefits according to the level of educational attainment of the main income earner brings only small additional welfare gains compared to the situation in which pension premium rates are based on the average income profile in the Dutch economy.

Community perceptions of enrolment of indigents into the National Health Insurance Scheme in Ghana: a case study of the Livelihood Empowerment against Poverty Programme

BackgroundThe Livelihood Empowerment against Poverty (LEAP) programme in Ghana as part of its beneficiary programme, identifies the poor/indigents for exemptions from premium payments in the National Health Insurance Scheme (NHIS). This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAP in order to inform policy.MethodsThe study adopted a descriptive cross-sectional study design by using a qualitative approach. The study was conducted in three geographical regions of Ghana: Greater Accra, Brong-Ahafo and Northern region representing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staff and social welfare officers/social development officers. Eighty-one in-depth interviews and 23 Focus Group Discussions were conducted across the three regions. Data were analysed thematically and verbatim quotes from participants were used to support the views of participants.ResultsThe study shows that participants were aware of the existence of LEAP and its benefits. There was, however, a general belief that the process of LEAP had been politicized and therefore favours only people who were sympathizers of the ruling government as they got enrolled into the NHIS. Participants held the view that the process of selecting beneficiaries lacked transparency, thus, they were not satisfied with the selection process. However, the study shows the ability of the community to identify the poor. The study reports varying concepts of poverty and its identification across the three ecological zones of Ghana.ConclusionThere is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP programme in Ghana. Community-based approaches in the selection of the indigent are recommended to safeguard the NHIS-LEAP beneficiary process.

Risk Self-Selection and the Concept of Equilibrium in a Competitive Insurance Market

The purpose of this paper is an analysis of the presence of self-selection mechanisms on the market that could bring the market closer to the separating equilibrium state, in line with the Rothschild–Stiglitz equilibrium model and its subsequent modifications. An example is the Polish market of compulsory third-party liability insurance of vehicle owners. This paper describes this market in terms of both its structure and its financial results. The main focus is on describing the assumptions of the Rothschild–Stiglitz model for markets operating under the conditions of information asymmetry and based on the self-selection mechanism, allowing for an unequivocal determination of the insured’s profile without the need to actually observe the insured’s behaviour. Finally, we show that thanks to the self-selection induced by the possibility of driving behaviour monitoring, the industry can minimise the negative effect information asymmetry has on the motor insurance market. This can be achieved, for example, by observing the choices made by the insured after being offered a new voluntary contract with a premium based on telematics data. Our analysis was carried out with the use of three selected characteristics that can determine the insured’s risk profile, i.e., distance covered, self-assessment, and insurance premium paid; the significance of the latter—although it may be intuitive—is questionable at commonly accepted significance levels. Therefore, the main result is that although there is some evidence on the disputed matter, there can be no definitive conclusion—especially in terms of risk as measured by insurance premium.

Interdependence of insurance need and development insurance markets

On the one hand, the insurance market is no different from other markets, as it has market entities, supply, demand, price and "product" (sale of security). Still, on the other hand, it is specific in relation to all other markets; the market subject to sale is a risk that may or may not be realized in the future. Insurance is a form of risk management, primarily moderate to reduce financial losses or transfer of risk from the insured to the insurance company, with insurance premium payment. The security market has its own branch institutional network consisting of: companies (important factors in the global financial economy), intermediaries (brokers), insurance agents (banks, companies), directorates for business supervision of insurance organizations, professional associations (insurance associations), the association of actuaries, etc. In addition to them, an important place belongs to the individuals and legal entities like insured objects. This topic has been insufficiently researched in practice, so the authors consider it important.

Impact of Price Sensitive Demand and Premium Payment Scheme on Bullwhip Effect

Bullwhip effect reduces the efficiency, responsiveness, and value of the supply chain. There are some indirect causes like lead time, the number of echelons, and some direct causes of bullwhip effect such as rationing or price variation. Due to capacity constraints, retailers are forced to experience rationing of their demands. Fear of rationing usually gives rise to manipulable demand and hence increases the bullwhip effect. Moreover, if the retailer’s demand is price sensitive then it will cause price variation. The offerings of premium payment by retailers due to unfulfilled demand lure the supplier to extend his existing capacity and to allocate them more supply. In this paper, an attempt has been made to mitigate the impact of the bullwhip effect using a premium payment scheme. A technique has been coined that will help in reducing the bullwhip effect. The increased value of the supply chain on using a premium payment scheme is proof of the reduction of the bullwhip effect. Results are validated through numerical analysis.

Study on the Influencing Factors and Willingness to Pay of Consumers Purchasing Ecological Agricultural Products.

With the steady rise of China's agricultural production and management level, the market of ecological agricultural products has developed rapidly, and consumers are increasingly concerned about ecological agricultural products. Consumers' cognition and purchase intention are the keys to determine their future development. This research is aimed at ensuring that consumers have access to high-quality ecological agricultural products, thereby promoting the supply and production of ecological agricultural products, minimizing agricultural carbon emissions, and providing information on sustainable food pricing. Based on the research status at home and abroad, this study combines the questionnaire survey method to study the influencing factors and willingness to pay of consumers purchasing ecological agricultural products. A total of 601 online questionnaires from consumers in Harbin, a city in northeastern China, were collected, and statistical factor analysis, principal component analysis, and regression analysis were used to study the influencing factors of consumers' purchase of ecological agricultural products from both positive and negative aspects, and in-depth analysis of the reasons why consumers refuse to pay, get the most real willingness to pay and related influencing factors, and quantify the influence of various variables on consumers' purchasing behavior was done. On this basis, a logit model of survival analysis is constructed to study the premium payment level of consumers for ecological agricultural products, and the payment premium is 24.95%. The research results show that married, who have purchased ecological agricultural products, the higher the understanding of ecological agricultural products, the consumers who buy ecological agricultural products in farmers' markets, Meituan and community group purchases, and the households with higher monthly consumption of agricultural products have a significant positive correlation with consumers' purchase of ecological agricultural products. The higher the education level, the older the age, and the larger the family size were significantly negatively correlated with consumers' purchase of ecological agricultural products.

A study on sum insured, premium paid and cost of cultivation of paddy insured farmers of Tamil Nadu

Crop insurance is a means to protecting the cultivators against financial loss on account ofanticipated crop-loss arising out of practically all-natural factors beyond their control such as natural fire, weather, floods, pests, diseases etc.,the sum insured by non-loanee farmers under NAIS were Rs.29066per ha, in case of MNAIS it was Rs.29555per ha and in case of WBCIS it was Rs.22644 per ha and the average being Rs. 27088 per ha. 2 per cent of premium amount has to paid by the farmer, and the government provides the subsidy of 1 per cent, thus the farmers have to pay 1 per cent as premium from their sum insured.the Cost A1was Rs.38547.90 per ha for insured farmers and for non-insured farmers, it was 34667.70per ha, and for loanee farmers it was Rs.38319.30per ha and for non- loanee farmers it was Rs.39449.40perha. The costC3 for insured farmers were Rs.57189.60per ha and for non-insured farmers it was Rs.52049.30 per ha.

СОВЕРШЕНСТВОВАНИЕ СИСТЕМЫ СПЕЦИАЛЬНЫХ НАЛОГОВЫХ РЕЖИМОВ ДЛЯ СУБЪЕКТОВ МАЛОГО ПРЕДПРИНИМАТЕЛЬСТВА

The article discusses new special tax regimes that are being implemented as an experiment in the taxation system of small businesses and are designed for a ten-year period. We are talking about the “Professional Income Tax” regime for individuals and individual entrepreneurs: its attractiveness exceeded all expectations, covering more than 6 million self-employed. Another regime is an improved version of the simplified taxation system, which provides for zero payments of insurance premiums and exemption from tax reporting and calculations on insurance premiums. The calculations confirming the financial efficiency of the use of the automated simplified taxation system in comparison with the traditional one are presented.

СТРАХОВАНИЕ СЕЛЬСКОХОЗЯЙСТВЕННЫХ КУЛЬТУР С ГОСУДАРСТВЕННОЙ ПОДДЕРЖКОЙ В РЕСПУБЛИКЕ БУРЯТИЯ: ПРОБЛЕМЫ И ПЕРСПЕКТИВЫ РАЗВИТИЯ

The article gives the concept of agricultural insurance with state support. The purpose of state support for agricultural crop insurance is to protect the property interests of agricultural producers from possible damage associated with the presence of natural climatic risk factors. In modern conditions, agricultural insurance is not effective, since it does not provide agricultural producers as a source of funds to compensate for losses in the event of an insured event. The article uses statistical data of the Ministry of Agriculture of the Republic of Buryatia for 2019-2021, as well as periodicals and Internet resources. The following methods were used: comparison, monographic, static. In Russia, the share of agricultural organizations in the total number of agricultural producers that have entered into crop insurance contracts and plantings of perennial plantings amounted to 59.2%. In the Republic of Buryatia, insurance companies have concluded insurance contracts with 27 farms. There are three organizations interested in concluding insurance contracts - CJSC "VSK", LLC "SK Soglasie", OJSC "Absolut Insurance" in the Republic of Buryatia. The need to use agricultural insurance with adverse natural and climatic conditions caused the decision to sign an Agreement between the Government of the Republic of Buryatia and the National Union of Agricultural Insurers. The main problems that agricultural organizations face when insuring are low solvency of agricultural producers; refusal to pay insurance premiums due to agricultural organizations by insurance companies; distrust of farmers on the part of the insurance company; low level of qualification of insurers in the field of agricultural insurance. Insurance companies offered: payment under insurance contracts concluded during the sowing period, in installments.

Material incentives for innovative activity of enterprise personnel based on key productivity indicators of innovation

Development and implementation of innovation is one of the means of providing competitive advantages for a business in a market economy. Innovative activity of a company ought to be expedient from the economic viewpoint and result in reduction of costs and maximizing the profitability of the company’s activity in the long-term perspective. One of essential factors of economic effectiveness of innovation is innovation-active personnel able to generate ideas and quickly adapt to changes, willing and motivated to participate in implementing innovation strategy of the company’s development. Not all employees a priori possess such features, and therefore the company ought to develop and take measures to facilitate their innovative activity. The article introduces the method of material incentives for innovative activity of the personnel suggested by the authors. The method is based on adapting a well-known system of key productivity indicators to innovative activity of a company. Personnel of the company is divided into three categories of employees according to their roles in realization of the organization’s innovative policy, and the authors defined a set of four or five key productivity indicators of their activity for each category. The authors defined a range of quantitative interpretation of the achievable result for each indicator. They suggested a mechanism for calculating the total amount of the incentive bonus which takes into account key performance indicators coefficients of innovative productivity and their value, the size of the bonus wage fund for the employee, the employee’s affiliation to one of the personnel categories established, the number of rewarded employees and the frequency of premium payments. Implementation of the suggested mechanism will ensure objective assessment and reward for the contributions made by all the interested employees into innovative development of the company increasing effectiveness of the production.

Everyday life and work of Polish doctors of the interwar period : according to the diaries

The purpose of the article is to reveal the image and everyday practice of doctors of state medical institutions in interwar Poland through diaries written by them. Research methods: historical-genetic, historical-comparative, descriptive, historical-typological. The main results: the article highlights the views of Sickness Funds patients on everyday life, profession and its importance. The life paths of doctors, their motives for work, survival strategies in the province and in the capital are clarified. The author’s focus is on everyday professional life, relationships with patients, which generally depicts the status of doctors in the Second Polish Republic. The content of Polish doctors’ activities, their efforts to improve health of population are revealed. Much attention is paid to the analysis of the diaries and the nature of problems and challenges faced by doctors of Sickness Funds. Working conditions of Polish doctors in the interwar period were not easy and the main reason of this was the economic crisis of the 30’s of the 20th century. First of all, the lack of material support, low level of consciousness of the population, patients’ distrust and contempt of patients for doctors, the activities of healers and quacks were also noticeable. At the same time, insufficient salary and limited opportunities often forced doctors to buy the necessary things at their own expense. The psychological atmosphere of the doctor’s work was not easy either and it was often manifested in abusive or dishonest attitude of patients, daily risks, provocations from the local population or their stereotypes about treatment. Constant fatigue, stress and exhaustion accompanied most doctors during this period. The diaries represent a social portrait of a doctor of the interwar period, a new generation of young people, whose professional activity coincided with the years of the independent Polish state, however, it was limited primarily by the challenges of the economic crisis. At the same time, the idea of competition was aimed at PR, advertising and promotion of the Social Insurance Administration of Poland. The main goal was to strengthen the confidence of Poles in the main state institution of social security and encourage the population to pay insurance premiums. The life destinies of the contest participants are also traced. As it turned out, all the doctors whose diaries were published in 1939 were killed during the war. Practical significance: the obtained results can be used in preparation of monographic studies, generalizations, textbooks and manuals on the history of Poland, socio-cultural history of Central and Eastern Europe, biographies. Scientific novelty: for the first time the analysis of diaries and memoirs of Polish doctors are performed, their views and work are studied; attitude to the chosen profession, an attempt to trace the strategies of popularization of the doctor’s profession in interwar Poland are described. Article type: research.

Insurance Payment Predicting Financial Risk Management Satisfaction of Malaysian Public Sector Employees

Risks are faced daily leading to unexpected bad events and incurring high costs. Notwithstanding, the differences in the ability to handle the situation may depend on their risk protection and financial preparedness. Thus, this study focused on the effect of insurance payment and financial preparedness among others, on the individuals’ financial risk management satisfaction. A multistage random sampling resulted in 500 respondents selected among public sector employees. Logistic regression for 472 data from self-administered questionnaires identified financial preparedness for old age, self-worth, financial risk knowledge, net-worth and insurance payment as influential predictors predicting the likelihood of the financial risk management satisfaction. Higher self-worth and financial risk knowledge, positive net-worth and higher insurance premium payment to cover risks faced would more likely predict individuals to be more satisfied with their financial risk management. Insurance payment was found to be the most influential predictor. Despite public workers having a low probability of the risk of losing jobs, nevertheless there is a need to have insurance protection for other financial risks. Hence, by purchasing insurance for various purposes, they would most probably be having a peace of mind in view of their risks.

Problems of the Aged in Nigeria: The Issue of Housing and Health Care in Calabar, Cross River State, Nigeria

The issue of the aged particularly in Nigeria has become a major concern to the government in particular and society in recent years. But little or no policies have been put in place to reduce the burden on this people (aged). The study sought to investigate into the healthcare and housing, issues of the aged, and examine the various policies meant to support their wellbeing in Calabar Metropolis. Purposive sampling technique was adopted for the selection of the study area while accidental was used in locating the respondents. Interview guide and questionnaire were used for the collection of data from the respondents. The statistical package for the social sciences (SPSS, 2007 version) was then used for the analysis of the data. Seventy-eight percent of the aged either live in rented or family house. About 58 percent of the aged suffer from a multiple or more than one illness while 24 percent had bodily/joint pains. Beside pension scheme which is documented in the National Aged Policy and largely skewed towards those in the formal employment, this paper revealed that there was no other policy directly made to support the aged. Institutions such the Social Welfare and other NGOs also have no clear and direct policy towards supporting all aged. This paper however recommended that; a fund be put in place called ‘aged fund’ which would seek to ensure the aged wellbeing. The age at which one qualifies for a free or subsidized premium payment of the national health insurance scheme should be reduced to 65 years. Long term housing policy be established to ensure that every worker have his/her own house before reaching the retirement age.

A Research on the Different Financing Models of Long-term Care Insurance in China

Establishing a long-term care insurance (LTCI) system covering the whole people and balancing urban and rural areas is an important strategic plan for China to deal with the aging and disability of the population. Since the establishment of the LTCI system at the national level in 2016, China has 49 pilot areas for LTCI by 2020. Each pilot area is seriously fragmented, and the financing model of LTCI has not yet been finalized. So what is the financing model of LTCI that suits China’s national conditions? In addition, different financing models have their own advantages and disadvantages. The optimal financing model may depend on economic, social and demographic factors. Since the fund funded system does not have the function of mutual assistance in social insurance, this paper limits the financing model of LTCI between the pay-as-you-go system and the mixed system. Which one is optimal for the long-term sustainable development of China’s LTCI? Starting from the evolutionary law of the health status of elderly individuals, this paper explores the operation of China’s LTCI system under different financing models.This paper uses multi-period micro-tracking survey data, through the continuous time homogeneous Markov process and the generalized linear model, to describe the movement law of the health status transition of the elderly in China, and combines the seven census data and the age shift algorithm to calculate the size and structure of the disabled elderly population from 2020 to 2040. Further, based on the social insurance actuarial balance theory, a dynamic actuarial model under the pay-as-you-go system and three mixed systems is constructed to simulate the equilibrium premium rate and payment amount of LTCI for urban employees and urban and rural residents in the next 20 years. The study finds that, in terms of the size of disabled population, the female elderly are the main body of disabled population; the scale of disabled population in urban areas is significantly higher than that in rural areas. The main reason is that rural-urban migration has made urban elderly population larger, and the urban disability rate is higher than that in rural areas. In addition, in terms of funding pressure, the study shows that at any time and under any financing model, the relative payment pressure of LTCI for urban employees is significantly lower than that of urban and rural residents, but the absolute payment pressure is slightly higher than that of urban and rural residents. Finally, in terms of the selection of financing models, this paper believes that LTCI for urban employees should adopt a mixed system, and LTCI for urban and rural residents should adopt a pay-as-you-go system.The contribution of this paper is mainly reflected in two aspects: First, at the level of empirical research, it combines macro and micro data to describe the evolution of the health status of the elderly from the micro level, predicts the size of disabled population in China from the macro level, and finally establishes a LTCI system that covers the entire population. This not only deepens the research on individual health, but also enriches the research results in the social insurance actuarial field. Second, at the policy level, based on the results of the research, it provides an optimal financing model for LTCI for urban employees and LTCI for urban and rural residents. This optimal model can alleviate the payment burden of financing entities and enhance the stability of the LTCI system. It has important practical significance for the work focus and further promotion of China’s LTCI system.