我国城镇失能老人长期护理社会保险法律制度研究

发布时间：2018-02-28 04:45

本文关键词： 失能老人长期护理保险适用对象保险给付　出处：《西南大学》2014年硕士论文　论文类型：学位论文

【摘要】：中国老龄化的加速发展,带来一系列社会问题,其中,慢性病的发展以及我国高龄人口的迅速提高将引发失能老人的剧增现象,老年长期护理问题将成社会风险,同时由于失能老人的生存对于持续性的长期生活照料的必需,因此保障这一特殊弱势群体,解决其长期护理问题成为必要。而另一方面劳动力人口的迁移,计划生育政策的实施,家庭规模的小型化,又使得传统家庭照料模式已经不能支持老人特别是失能老人长期护理的供给体系。因此本文通过对长期护理社会保险制度的研究,借鉴德国和日本解决该社会问题的经验,建立我国的失能老人长期护理社会保险制度,希望对解决我国的这一社会矛盾有所裨益。本文共分为五部分：第一部分：长期护理保险理论问题。本部分通过辨析长期护理及长期护理保险的定义,界定出本文研究对象的范围,并挖掘和阐述了长期护理社会保险的政治、经济、社会和制度功能。第二部分：长期护理社会保险制度建立的必要性。本部分通过分析现有社会保险制度保障的不足以及采取社会救助和商业保险模式的缺陷,得出必须采取社会保险模式解决失能老人长期护理问题的结论,并通过阐述社会保险模式的优势进行进一步论证。第三部分：分析我国城镇失能老人长期护理社会保险制度建立的法理、道德、现实和实践基础。法理基础的微观方面,由于社会保障制度与其他法律制度不同,它是对生存权的一种预防型保护,所以建立长期护理社会保险制度能充分实现失能老人的生存权,而随着社会的发展,生存权也有了新的含义,能帮助权利主体实现有尊严的生活是当代社会生存权的应有之义；宏观方面,为失能老人提供长期护理保障是国家责任的体现,也是维护和调整社会实质正义的必然要求。而我国自古以来对尊老敬老价值观的社会认同则构成为失能老人建立该制度的道德基础。老龄化背景下,我国家庭功能逐步弱化,支撑不起失能老人的长期护理,这构成了建立该制度的现实基础。最后,中央到地方的养老探索成为我国建立该制度的实践基础。第四部分：国外长期护理社会保险法律制度以及对我国的启示。本部分主要对德国和日本的长期护理社会保险制度进行了梳理,并且将两者比较最终在宏观方面得出我国建立该制度的启示。建议立法先行,并充分考虑该制度与我国法律文化环境、经济发展程度以及社会保障制度大环境的结合,并建议在制度中引入福利多元化理念。第五部分：我国城镇失能老人长期护理社会保险制度的具体构建。主要是立法原则和具体内容两部分。适合性原则要求我国该制度的建立必须与我国国情相适应,重点是与我国的经济发展水平相适应,提供符合经济发展程度的筹资水平和护理服务供给水平；差别性原则要求建立一个保险内容有差异、制度模式一致的长期护理社会保险法律制度,合理确定各地保费费率和待遇给付的方式等；补充性原则要求护理保险制度作为社会保障制度的补充存在,跟随医疗保险制度建立,降低成本达到资源整合的目的。具体内容部分主要是借鉴德日的护理保险制度并结合我国自身特点提出的初步设想。保险的适用对象应主要集中在老年人口。保险资金筹集方面,应建立国家、企业、个人三方承担的社会共济制度,并坚持部分积累模式,筹资标准设东、中、西三个档次。保险基金的管理方面,应建立起省级统筹的管理制度,注意与医疗保险基金分开管理、独立核算,同时在“保基本”基础上实现护理保险基金的“促收益”。保险待遇的领取方面,应将失能条件作为领取条件的重点,建立严格的护理等级制度,并将它与保险待遇的给付标准挂钩,给付方式上东中部地区实行实物给付为主,西部地区实行现金给付为主。护理保险费用的控制方面,应采取一次付清理论和共担理论结合的方式控制总支出,并利用该方法引导居家护理的方向。护理服务的提供方面,应努力引入市场化的第三方,同时建立政府主导的公立护理服务机构。法律责任方面,应规定政府、个人、护理服务机构的法律责任,保证护理社会保险制度能顺利运行。
[Abstract]:To accelerate the development of China aging, brought a series of social problems, the development of chronic diseases and the rapid increase of China's elderly population will lead to loss of explosion of elderly, long-term care for the elderly will become the problem of social risk, at the same time as the disabled elderly living for sustainable essential long-term life care, so protect the special vulnerable groups, as necessary to solve the problem of long-term care. On the other hand, labor migration, family planning policy, family size, and the traditional family care mode especially disabled elderly long-term care supply system has been unable to support the elderly. So the study of long-term care for the society the insurance system through the use of Germany and Japan to solve the social problems of the experience, the establishment of China's disabled elderly long-term care social insurance system, hoping to solve me This social contradiction in the country is beneficial.
This article is divided into five parts:
The first part: the theoretical problems of long term care insurance. In this part, we define the scope of this study by analyzing the definition of long-term care and long-term care insurance, and dig out and elaborate the political, economic, social and institutional functions of long-term care social insurance.
The second part: the necessity of establishing the long-term care of the social insurance system. This part analyzes the shortcomings of the current social insurance system and the defects of social assistance and take commercial insurance mode, it must take the social insurance model to solve the problem of long-term care of disabled elderly conclusion, and further demonstrated through the elaboration of social insurance model.
The third part: the analysis of China's urban disability law, establish long-term care insurance system of social morality, realistic and practical basis. The micro aspect of legal basis, due to the different social security system and other legal system, it is a kind of preventive protection of the right to life, so to establish long-term care insurance system can fully realize the society the disabled elderly living right, but with the development of society, the survival right also has a new meaning, can help achieve the right subject to a life of dignity is the proper meaning of contemporary social rights; the macroscopic aspect, for the disabled is the embodiment of national responsibility for the elderly to provide long-term care insurance, but also the maintenance and adjustment requirement social justice and social identity in China since ancient times of respecting values constitute the moral foundation for the disabled elderly to establish this system. Under the background of aging, our family. It can gradually weaken and support the long-term care of the elderly without disability. This constitutes the realistic basis for the establishment of the system. Finally, the exploration from the central government to the local community has become the practical basis for the establishment of the system in China.
The fourth part: foreign social long-term care insurance legal system and the enlightenment to our country. This part mainly carried out on Germany and Japan's long term care social insurance system, and the comparison of the final draw in the macroscopic aspect of the establishment of the system of the enlightenment. Legislative proposals in advance, and give full consideration to the system and the environment Chinese legal culture, the degree of economic development and the combination of the social security system environment, and propose the introduction of concept of welfare pluralism in the system.
The fifth part: China's urban disabled elderly long-term care specific construction of social insurance system. The two part is the main legislative principles and specific content. For the establishment of the principle of the system in China must adapt to the situation of our country, is the key point of China's economic development level is matched with the level of financing, and the nursing service supply level of economic development; the difference principle requires the establishment of an insurance system contents are different, consistent patterns of long term care social insurance legal system, reasonably determine the premium rates and payment across the way; the principle of complementarity requirements of nursing care insurance system exists as a supplement of the social security system, medical insurance system should follow to reduce the cost, achieve the goal of resource integration. The specific content of part is to learn from the German and Japanese nursing insurance system and combined with our own characteristics put forward The preliminary idea. Suitable for insurance should be mainly concentrated in the elderly population. The insurance fund raising, should establish a national, enterprise, individual three party social aid system, and adhere to the accumulation mode, financing standard, located east, west of the three grade. The insurance fund management, should be established at the provincial level the overall management system, pay attention to the management of medical insurance fund, separate and independent accounting, at the same time in the "basic security" can be realized on the basis of nursing insurance fund "to promote revenue. For aspects of insurance benefits, should be disabled as a key condition of receiving conditions, establish a strict nursing grading system, and payment standards linked to it with the treatment of insurance payment, the central region of East West implementation of physical payment, cash payment. Control of nursing insurance costs, should take a lump sum theory and sharing theory The way to control spending, and using this method to guide the nursing home. Nursing service, should strive to lead the market of the third party, and establish public nursing service organization led by the government. The government should stipulate the legal liability, legal liability, personal care services, social insurance system can ensure nursing running smoothly.

【学位授予单位】：西南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D922.182.3

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