北京市长期护理保险制度运行问题与对策研究——以石景山区试点为例

Research on the Operational Problems and Countermeasures of the Long-Term Care Insurance System in Beijing—A Case Study of the Pilot Program in Shijingshan District

摘要: 随着人口老龄化进程的不断加速，长期护理保险制度已成为应对社会养老压力的关键性制度安排。本文以北京市石景山区长期护理保险试点实践为研究对象，运用制度分析与发展框架，系统分析北京市长期护险制度的运行问题。研究从行动舞台的构建出发，识别政府部门、服务提供者、参保人及第三方评估机构等核心行动主体，并深入剖析其在外生变量影响下的互动逻辑与现实困境。研究发现，当前制度在规则体系、行动者协同、服务供给与评估反馈等方面面临多重挑战，具体表现为法律体系尚待完善与顶层设计模糊、跨部门协同不畅与筹资机制不可持续、专业服务供给不足以及长效评估机制缺位。在此基础上，本文提出应加快地方立法进程、构建独立多元的筹资机制、大力培育护理服务产业与专业人才队伍，并建立科学动态的评估体系等优化路径，以推动北京市长期护理保险制度从“碎片化试点”向“系统性、可持续”的制度定型迈进。

Abstract: With the accelerating process of population aging, the Long-Term Care Insurance (LTCI) system has become a critical institutional arrangement for addressing societal elderly care pressures. This paper takes the pilot practice of LTCI in Shijingshan District, Beijing, as the research subject, and employs the Institutional Analysis and Development (IAD) framework to systematically analyze the operational challenges of Beijing’s LTCI system. Starting from the construction of the action arena, the study identifies key actors such as government departments, service providers, insured individuals, and third-party assessment agencies, and deeply examines their interactive logic and practical dilemmas under the influence of exogenous variables. The findings reveal that the current system faces multiple challenges in terms of regulatory framework, actor coordination, service provision, and evaluation feedback, including an incomplete legal system and ambiguous top-level design, insufficient inter-departmental coordination and unsustainable financing mechanisms, inadequate professional service supply, and the absence of long-term evaluation mechanisms. Building on this analysis, this paper proposes optimization pathways, including accelerating local legislation, constructing an independent and diversified financing mechanism, vigorously cultivating the care service industry and professional talent pool, and establishing a scientific and dynamic evaluation system, to advance the Beijing LTCI system from a “fragmented pilot” toward a “systematic and sustainable” institutional model.