嵌入性整合：广州市长期护理保险制度的运行逻辑与优化路径

Embedded Integration: The Operational Logic and Optimization Pathways of Guangzhou’s Long-Term Care Insurance System

摘要: 人口老龄化加速背景下，“一人失能、全家失衡”问题日益突出。广州市自2017年启动长期护理保险试点以来，在参保覆盖、资金筹集、服务供给等方面取得明显进展。研究整合嵌入性理论与福利多元主义理论，构建“嵌入性整合”的分析框架，从经济、人口、文化、空间四个维度的要素嵌入，以及政府、市场、社会组织、家庭四类主体的协同互动出发，剖析广州市长护险制度的运行逻辑。研究发现，制度遵循“要素嵌入–主体协同–效能生成”的运行逻辑，通过四维适配融入地方场域，形成多元主体协同网络。针对筹资可持续性、服务供需匹配、人才储备等现实困境，研究从深化制度嵌入、健全协同机制、完善供给体系三方面提出优化路径，以期为完善超大城市长护险制度提供参考。

Abstract: Against the backdrop of rapid population aging, the issue of “one family member’s disability throwing the whole family off balance” has become increasingly prominent. Since launching its Long-Term Care Insurance (LTCI) pilot in 2017, Guangzhou has made significant progress in coverage expansion, fund pooling, and service provision. Integrating embeddedness theory and welfare pluralism theory, this study constructs an “embedded integration” analytical framework to examine the operational logic of Guangzhou’s LTCI system from two dimensions: the embeddedness of economic, demographic, cultural, and spatial factors, and the synergistic interactions among the government, market, social organizations, and families. The study finds that the LTCI system follows an operational logic of “factor embeddedness-actor synergy-effectiveness generation”, adapting to local contexts through four-dimensional embeddedness and forming a multi-actor collaborative network. In response to practical challenges such as financing sustainability, supply-demand mismatches, and workforce shortages, this study proposes optimization pathways in three areas: deepening institutional embeddedness, improving collaborative mechanisms, and refining the service delivery system. The findings aim to provide theoretical and practical references for improving LTCI schemes in megacities.