长期护理保险对老年人健康的影响研究

A Study on the Impact of Long-Term Care Insurance on the Health of the Elderly

摘要: 本研究旨在探讨中国长期护理保险制度设计中“提升专业服务供给”与“增加资金补贴”两种政策路径对老年人健康影响的差异，以回应当前城市长期护理服务体系建设的核心议题。长期护理保险自试点以来，逐步形成了以服务给付为主、现金补贴为辅的混合模式，但关于保险资金究竟应当优先用于购买专业化护理服务，还是通过现金形式增强个人购买力，在政策实践中仍存在取向分歧。本文基于中国健康与养老追踪调查(CHARLS) 2015年和2020年面板数据，采用双重差分(DID)模型，通过比较试点地区在制度实施前后老年人健康指标的变化，研究发现，政策偏向于扩大专业护理服务可及性(如上门护理、社区康复和短期托养服务)的地区，其参保老年人在自评健康改善、抑郁症状减少及功能状态维持方面，均显著优于政策侧重于提供护理现金补贴的地区。进一步的机制分析显示，专业服务直接回应了失能老人的照护刚需，提升了照护质量与康复专业性，而现金补贴的健康效应则高度依赖于家庭非正式照护的可得性，且可能因补贴标准偏低或被挪作他用而未能有效转化为健康产出。因此，本研究认为，在长期护理保险“保基本”的总体目标与有限资源的双重约束下，政策优化应明确以提升城市专业护理服务体系的供给能力为核心导向，而非简单地扩大现金补贴的覆盖与额度。建议未来制度发展应着力构建多层次、专业化的社区与居家护理服务网络，加强对服务质量的监管与标准化，引导保险资金更多流向能够直接产生健康效益的服务项目，从而更有效率、更可持续地促进老年人的健康老龄化，实现从“经济补偿”向“服务保障”的制度转型。

Abstract: This study aims to examine the differences in the impact on older adults’ health between the two policy approaches—“enhancing the supply of professional services” and “increasing financial subsidies”—in the design of China’s long-term care insurance system, thereby addressing a core issue in the current development of urban long-term care service systems. Since its pilot phase, long-term care insurance has gradually evolved into a hybrid model characterized by service-based benefits supplemented by cash subsidies. However, there remains a divergence in policy practice regarding whether insurance funds should be prioritized for purchasing professional care services or for enhancing individual purchasing power through cash payments. Based on panel data from the China Health and Retirement Longitudinal Study (CHARLS) for 2015 and 2020, this paper employs a difference-in-differences (DID) model. By comparing changes in health indicators among older adults in pilot regions before and after the implementation of the system, the study found that in regions where policies prioritized expanding access to professional care services (such as home care, community rehabilitation, and short-term respite care), insured older adults demonstrated significantly greater improvements in self-rated health, reduced depressive symptoms, and maintained functional status, compared to regions where policies focused on providing cash subsidies for care. Further mechanism analysis indicates that professional services directly address the urgent care needs of frail older adults, enhancing care quality and rehabilitation expertise, whereas the health effects of cash subsidies are highly dependent on the availability of informal family care and may fail to translate effectively into health outcomes due to low subsidy standards or diversion of funds for other purposes. Therefore, this study concludes that, under the dual constraints of the long-term care insurance system’s overarching goal of “providing basic coverage” and limited resources, policy optimization should clearly prioritize enhancing the supply capacity of urban professional care service systems, rather than simply expanding the coverage and amounts of cash subsidies. It is recommended that future institutional development focuses on building a multi-tiered, professionalized network of community and home-based care services, strengthening supervision and standardization of service quality, and directing insurance funds toward service programs that directly generate health benefits. This approach will more efficiently and sustainably promote healthy aging among the elderly and facilitate a systemic transition from “economic compensation” to “service security”.