老龄化背景下失能老人长期照护保障的政策供给与优化路径——基于21个省市政策文本的量化分析

A Study on the Optimization of Long-Term Care Insurance Policies from the Perspective of Care Needs of the Elderly—A Quantitative Analysis Based on Policy Texts from 21 Provinces and Municipalities

摘要: 在人口老龄化加速推进的背景下，长期护理保险承载着为失能老年群体构筑基本照护安全网的核心使命。本文从老年照护需求与政策供给匹配的视角出发，以2016~2025年全国21个省市的长护险专项政策文本为样本，采用内容分析法与文本量化分析法，系统考察供给型、需求型与环境型三类政策工具在不同层次照护需求上的配置特征与匹配状况。研究发现：当前长护险政策呈现“强供给、弱需求”的总体格局，供给型工具占比44.2%，高度集中于基础生存型照护需求，而在回应家庭支持型与社会参与型需求方面力度不足；需求型工具整体薄弱，服务便捷化与社会力量激励尤为欠缺；环境型工具内部“重规制、轻协同”特征明显，多元主体协作机制与社会宣传引导严重不足；东部与西部地区在工具选择偏好上存在显著差异，西部地区更依赖供给型与环境型工具。针对上述结构性问题，本文提出强化需求侧激励、构建整合型照护体系、聚焦农村与低收入老年群体、推动智慧护理创新等优化路径，以期为提升长护险制度对老年失能群体的保障效能提供参考。

Abstract: Against the backdrop of accelerating population aging, long-term care insurance bears the core mission of building a basic care safety net for disabled older adults. From the perspective of matching elderly care needs with policy supply, this study takes 21 specialized LTCI policy documents from provinces and cities across China during 2016~2025 as samples, employing content analysis and quantitative text analysis to systematically examine the allocation characteristics and matching conditions of supply-oriented, demand-oriented, and environment-oriented policy instruments across different levels of care needs. The findings reveal that the current LTCI policy framework exhibits an overall pattern of “strong supply, weak demand”: supply-oriented instruments account for 44.2%, highly concentrated on basic survival care needs, while responses to family support and social participation needs remain insufficient; demand-oriented instruments are generally weak, with service accessibility measures and social force incentives particularly lacking; environment-oriented instruments show a clear tendency of “emphasizing regulation while neglecting coordination”, with multi-stakeholder collaboration mechanisms and public awareness campaigns significantly underdeveloped; notable regional differences exist between eastern and western regions in instrument selection preferences, with western regions relying more heavily on supply- and environment-oriented instruments. To address these structural issues, this study proposes optimization pathways including strengthening demand-side incentives, building an integrated care system, focusing on rural and low-income elderly groups, and promoting smart nursing innovations, aiming to provide references for enhancing the effectiveness of LTCI in safeguarding disabled older adults.