失能失智老人养老照护体系的结构性约束和优化路径——基于长期护理保险视角

Structural Constraints and Optimization Pathways in Elderly Care for Disabled and Cognitively Impaired Older Adults—A Perspective from Long-Term Care Insurance

摘要: 在人口老龄化加速与高龄化程度持续加深的背景下，失能失智老年人的长期照护需求快速增长，养老照护质量问题已成为影响老年群体福利水平与社会保障体系有效运行的核心议题。既有研究多从制度供给或支付保障分析长期护理保险政策效果，虽已涉及该保险在复杂照护需求结构中转化为养老照护质量提升的研究，但整体仍待整合与深化。基于长期护理保险全国实施的制度背景，本文从照护质量的提升与结构性约束两个维度展开分析。研究发现，长期护理保险推动照护负担社会化分担、照护方式专业化转型，稳定服务供给预期，总体上提升了失能失智老年人照护质量。但在需求识别、服务供给结构和空间可及性方面有显著结构性约束，制约制度效能释放。由此，提升养老照护质量关键非单纯扩大制度覆盖范围，而是推动保障逻辑从普遍覆盖向精准适配转型，以推动失能失智老人养老照护体系的进一步完善和可持续发展。

Abstract: With the acceleration of population aging and the deepening of demographic old-ageing, the demand for long-term care among disabled and cognitively impaired older adults has grown rapidly, and care quality has become a core issue affecting both the welfare of older adults and the effective functioning of the social security system. Existing studies have mainly examined the policy effects of Long-Term Care Insurance (LTCI) from the perspectives of institutional provision and financing support. Although attention has been paid to how LTCI may be translated into improvements in care quality under complex care-need structures, further integration and refinement are still needed. Against the background of the nationwide implementation of LTCI, this study analyzes care quality improvement and structural constraints. It is found that care quality has been improved through the socialization of care burdens, the professionalization of care provision, and the stabilization of service supply expectations. However, significant structural constraints remain in need identification, service supply structure, and spatial accessibility, which restrict the full release of institutional effects. Therefore, the key lies not in simply expanding coverage, but in shifting from universal coverage to targeted adaptation, so as to promote the further improvement and sustainable development of the care system for disabled and cognitively impaired older adults.