政策工具视角下中国安宁疗护与长期护理保险的制度耦合性

Policy Tool Perspective: Institutional Coupling of Palliative Care and Long-Term Care Insurance in China

摘要: 目的：基于政策工具的视角，分析安宁疗护与长期护理保险的政策文件，探讨两者在政策目标、服务内容、资源配置和实施机制等方面的耦合现状与问题，为实现“健康中国”与“积极老龄化”提供制度保障。方法：采用内容分析方法，构建“政策工具–制度要素–耦合机制”三维分析框架，对2016~2025年间国家与地方层面相关政策文本进行内容分析。结果：在安宁疗护和长期护理保险相关政策文件中，各类政策工具结构比列不均衡，环境型、供给型和需求型政策工具分别占比为80.44%、18.89%、0.67%和85.98%、9.28%、4.73%。结论：当前政策工具以环境型为主导，供给型与需求型工具应用不足；制度间存在目标重叠但协同机制缺失、资源分散且整合困难、评估标准不统一等问题。建议通过优化政策工具组合、构建跨部门协调机制、统一评估标准、强化筹资与支付联动等方式，提升制度耦合性，推动安宁疗护与长期照护保险的深度融合。

Abstract: Objective: From the perspective of policy tools, this paper analyzes the policy documents of hospice care and long-term care insurance, and discusses the current situation and problems of their coupling in terms of policy objectives, service content, resource allocation and implementation mechanism, so as to provide institutional guarantee for realizing Healthy China and Active Aging. Methods: Content analysis method was adopted to construct a three-dimensional analysis framework of “policy tools-institutional elements-coupling mechanism”, and content analysis was conducted on relevant national and local policy texts from 2016 to 2025. Results: In the relevant policy documents of hospice care and long-term care insurance, the structural proportion of various policy tools is unbalanced. The proportions of environmental, supply-oriented and demand-oriented policy tools are 80.44%, 18.89%, 0.67% and 85.98%, 9.28%, 4.73% respectively. Conclusion: At present, policy tools are dominated by environmental ones, while supply-oriented and demand-oriented tools are insufficiently applied. There are problems such as overlapping objectives but lack of coordination mechanism, scattered and difficult-to-integrate resources, and inconsistent evaluation standards among systems. Suggestions: It is suggested to improve institutional coupling by optimizing the combination of policy tools, building cross-departmental coordination mechanisms, unifying evaluation standards, and strengthening the linkage between financing and payment, so as to promote the in-depth integration of hospice care and long-term care insurance.