德国与日本长期护理保险制度比较研究

Long-Term Care Insurance in Germany and Japan: A Comparative Analysis

摘要: 德国与日本是较早以独立社会保险险种应对长期照护风险的国家。采用比较制度分析方法，从制度定位、筹资机制、需求评估与给付设计、服务供给与治理、改革趋势五个角度比较德国社会护理保险与日本介护保险的制度框架及其改革动态。比较表明，德日两国建制路径分殊，德国依附医疗保险、保留现金给付、以费率调整为主要平衡工具，日本独立建制、纯服务给付、实行“保费加公费”的混合筹资，但两国改革方向趋同于居家化、预防化与数字化。进一步分析五个角度之间的内在关联，重点考察筹资、给付与服务三者相互制约所形成的关系，以及德日两国调适这一关系以实现制度目标的不同路径。

Abstract: Germany and Japan are among the earliest countries to address long-term care risks through standalone social insurance programs. Adopting a comparative institutional analysis approach, this study compares the institutional frameworks and reform dynamics of Germany’s Social Long-Term Care Insurance (Soziale Pflegeversicherung) and Japan’s Long-Term Care Insurance (Kaigo Hoken) across five dimensions: institutional positioning, financing mechanisms, needs assessment and benefit design, service provision and governance, and reform trends. The comparison reveals that Germany and Japan have followed divergent institutional pathways. Germany’s system is affiliated with health insurance, retains cash benefits, and relies primarily on premium rate adjustments as its main balancing instrument, whereas Japan operates an independent scheme with purely in-kind benefits and a mixed financing model combining premiums and public funds. Nevertheless, both countries are converging toward home-based care, prevention, and digitalization in their reform trajectories. This study further examines the internal interconnections among the five dimensions, with particular emphasis on the interlocking relationships among financing, benefits, and services, as well as the distinct pathways through which Germany and Japan adjust these relationships to achieve their respective institutional objectives.