长期护理保险促进河北省养老服务消费的现实基础、制约因素与优化路径

The Realistic Foundation, Constraints, and Optimization Paths of Long-Term Care Insurance in Promoting Elderly Care Service Consumption in Hebei Province

摘要: 长期护理保险通过稳定支付预期、降低正式照护服务使用成本，将部分家庭内部承担或未满足的照护需求转化为专业化、市场化养老服务消费。河北省长期护理保险已形成一定制度基础，2026年4月起在全省统一实施，但从保险支付向实际服务消费转化仍受需求识别、待遇支付、服务供给、专业人才和协同治理等因素制约。本文基于“失能风险–需求形成–保险支付–服务消费–供给响应”的分析逻辑，采用基于政策文本和公开资料的制度分析方法，从需求端、支付端、供给端、人才端和治理端五个维度，分析河北省长期护理保险促进养老服务消费的现实基础与制约因素，并提出优化路径。研究发现，需求识别不精准、待遇设计粗放、居家社区供给不足、护理人才短缺和部门数据分割等问题制约了“保险支付–有效需求–专业服务”的转化效率，提升该转化效率是发挥长期护理保险促进养老服务消费作用的关键，政策优化应推动从扩大覆盖向提高实际获得感、从统一待遇向按需保障、从费用报销向战略购买服务、从部门分治向跨部门协同的转变。

Abstract: Long-term care insurance (LTCI) transforms a portion of care needs that are either borne within families or remain unmet into professional and marketized elderly care service consumption by stabilizing payment expectations and lowering the effective cost of formal care services. In Hebei Province, LTCI has established a preliminary institutional foundation and has been implemented province-wide since April 2026. However, the transition from insurance payment to actual service consumption remains constrained by factors such as demand identification, benefit payment, service supply, professional workforce, and coordinated governance. Based on the analytical logic of “disability risk-demand formation-insurance payment-service consumption-supply response”, this paper adopts an institutional analysis approach grounded in policy texts and publicly available data, and examines the current foundation and constraints of LTCI in promoting elderly care service consumption in Hebei Province from five dimensions: the demand side, the payment side, the supply side, the workforce side, and the governance side, before proposing optimization paths. The study finds that imprecise demand identification, undifferentiated benefit design, insufficient home- and community-based service supply, shortage of nursing personnel, and fragmented departmental data have constrained the transformation efficiency of the “insurance payment-effective demand-professional services” chain. Enhancing this transformation efficiency is key to leveraging the role of LTCI in promoting elderly care service consumption. Policy optimization should thus promote a shift from expanding coverage to improving tangible benefits, from uniform benefits to needs-based security, from fee reimbursement to strategic purchasing of services, and from fragmented departmental governance to cross-departmental coordination.