Recently, the National Health Insurance Bureau issued the Measures for the Administration of Designated Long term Care Insurance Disability Rating Assessment Institutions (for Trial Implementation) (hereinafter referred to as the Measures), which aims to ensure that the masses of the people enjoy long-term care insurance benefits more fairly, fairly and in a timely manner, and promote the standardized, standardized and scientific management of designated long-term care insurance disability rating assessment institutions.

The relevant experts interviewed by the reporter said that the above Measures provided a basic guarantee for the large-scale promotion of long-term care insurance and the effective use of medical insurance funds. This is not only a deepening of China's social security system, but also creates conditions for the development of domestic commercial nursing insurance.

Who is the assessment subject of disability level of long-term protection insurance? How to evaluate? How to supervise? The insiders suggested that to promote the large-scale implementation of long-term care insurance in China, it is necessary to play the role of market mechanism and coordinate the two guarantee functions of long-term care insurance at the social security level, namely, "basic insurance" and commercial care insurance "personality supplement".

Disability level assessment will be improved day by day

Long term care insurance is called the "sixth insurance" in addition to the five social insurances of pension, medical treatment, work-related injury, unemployment and maternity. It aims to provide basic life care and closely related medical care for the disabled, so as to reduce the burden of family care costs for the disabled. In recent years, China's medical insurance department has continuously improved all aspects of the system, accelerating the solution to the problem of "one person is disabled, the whole family is unbalanced".

According to the Administrative Measures for Disability Rating Assessment of Long term Care Insurance (Trial) issued by the State Medical Insurance Bureau and the Ministry of Finance in December 2023, the designated assessment institution refers to the institution that is included in the designated management of long-term care insurance disability rating assessment institutions in the overall planning area, and carries out disability rating assessment on long-term care insurance participants in accordance with relevant regulations.

It is also clear from the policy interpretation of the Administrative Measures for the Assessment of Disability Levels of Long term Care Insurance (Trial) released on the website of the National Health Insurance Administration that, as an important part of the long-term care insurance system, the assessment of disability levels of long-term care insurance is an important basis for treatment enjoyment and fund payment.

The insiders believe that the Measures issued this time are the refinement and improvement of disability rating assessment institutions after the Administrative Measures for Disability Rating Assessment of Long term Care Insurance (Trial), which will promote the solution of the problem of access mechanism for disabled people to enjoy long-term care insurance.

Pan Huagang, General Manager of Love Life Insurance Co., Ltd., said: "The introduction of the Measures is very important and timely, which also means that long-term care work is deepening from the pilot level to the national system level, and also creates better conditions for the future expansion of the scale and the benefit of more disabled people."

Pan Huagang said that regulating the entry mechanism for disabled people to enjoy long-term care insurance can provide basic guarantee for large-scale promotion of long-term care insurance and effective use of medical insurance funds.

The designated evaluation institution is under strict supervision

The above Measures further clarify the specific requirements for the designated management of evaluation institutions, and promote the standardized and unified management of the designated management of evaluation institutions.

According to the regulations, when applying to become a designated assessment institution, it should also meet the following basic conditions: it has been registered in accordance with the law, can carry out disability level assessment, and has been in operation for at least three months; Have professional personnel team suitable for the evaluation work; Having fixed office space, equipped with software and hardware equipment and corresponding management and maintenance personnel that meet the requirements of the evaluation service agreement; Have the conditions to use the national unified medical insurance information platform for long-term care insurance related functions; It has service management, financial management, information statistics, internal control management, personnel management, file management and other systems that meet the requirements of the evaluation service agreement; Comply with laws and regulations and other conditions stipulated by medical security administrative departments at provincial level and above.

The Measures put forward requirements for the operation and management of designated assessment institutions. For example, the designated evaluation institutions should use the relevant functional modules and information business codes of the national unified medical insurance information platform, cooperate with the daily inspection and spot check, accept the supervision and inspection, and timely apply for changes in case of major information changes.

In terms of supervision measures, the Measures specify the requirements of the medical security department for strengthening supervision, assessment and daily management of the designated evaluation institutions, and mainly propose four supervision and management measures: first, the medical security agency organizes the performance management of the designated evaluation institutions and evaluation personnel. If a breach of contract is found, it shall be handled in a timely manner in accordance with the evaluation service agreement.

Second, the medical security agency should organize the assessment and evaluation of the designated assessment institutions, and the assessment results should be linked to the renewal of the assessment service agreement and the payment of service fees.

Third, the medical security administrative department supervises the evaluation behavior and agreement performance of the designated evaluation institutions, and guides and supervises the work of the medical security agencies.

Fourth, the medical security department should broaden the supervision channels, innovate the supervision methods, and conduct social supervision on the designated evaluation institutions through satisfaction surveys, third-party evaluations, and hiring social supervisors.

Pan Huagang believed that the above Measures gradually included excellent evaluation institutions into the scope of policy procurement, creating conditions for the government and agencies to select the best evaluation institutions. The policy also promoted local governments to actively cultivate long-term care evaluation markets, so as to achieve the survival of the fittest.

"Keep the basics and supplement the personality" to be evaluated

China's long-term care insurance system was piloted in 2016, and the second batch of pilot cities will be expanded in 2020. At present, insurance coverage in 49 pilot cities across the country is about 180 million people, more than 2.35 million people enjoy benefits in total, the accumulated fund expenditure is more than 72 billion yuan, about 8000 designated nursing institutions provide services, and nearly 300000 nursing staff.

The reporter learned that at present, the "infrastructure" on which China's long-term care insurance business depends has basically been built, but it cannot be ignored that the development of commercial care insurance has been slow in recent years.

Data shows that in 2021, the premium income of commercial nursing insurance in China will only account for 1.5% of the premium income of commercial health insurance. In the future, China's long-term care insurance will be implemented in a large area. It is necessary to coordinate the two security functions of long-term care insurance at the social security level, namely, "basic insurance" and commercial care insurance "personality supplement". It is a problem that must be faced to unify the evaluation standards of the two.

The Measures have solved a series of problems such as "who will evaluate" and "who will manage" in the future, and also provided market-oriented solutions for the evaluation of nursing insurance of commercial insurance companies.

According to relevant data, there are more than 42 million disabled people over 60 years old in China. In the context of the continuous release of the economic dividend of Yinfa, commercial long-term insurance, as an important part of China's long-term insurance system, also ushers in the driving force of high-quality development. Experts suggest that diversified products and services should be developed around the care needs of disabled people to help the development of the elderly care industry.

People in the industry are optimistic about the role of the above Measures in promoting the development of commercial long-term protection insurance. Pan Huagang said in an interview: "The introduction of the Measures is not only a deepening of China's social security system, but also creates conditions for the development of domestic commercial nursing insurance, which has a very positive significance."

Pan Huagang said that the "Measures" issued this time considered the market survival of evaluation institutions, and reasonably determined the number of local designated evaluation institutions from the overall size of disabled personnel, the actual development of the evaluation industry, and the management and service capabilities, so as to maintain a reasonable market capacity, avoid vicious competition, and create conditions for social capital to participate in the evaluation market.

Some insiders said to reporters that encouraging and guiding social capital to actively participate in the evaluation of market competition is conducive to guiding the distribution of all parties through market-oriented means, which will be conducive to the construction of China's multi-level nursing security system.

Song Zhanjun, deputy secretary-general of the China Insurance Research Institute of Beijing Technology and Business University, said to the reporter, "I personally think the most important problem is the financing of long-term care insurance in the future. With the release of a series of policies, long-term care insurance management will become increasingly standardized. At present, long-term care insurance mainly relies on the medical insurance fund for financing. The next development, especially the large-scale expansion to residents, the diversification of financing channels and the payment ability of the insured, will be important constraints. "

Song Zhanjun suggested that commercial long-term care insurance should vigorously promote the transformation of life insurance and nursing responsibility, and cultivate the awareness of long-term care insurance. On this basis, we will encourage the development of serious disease long-term protection insurance, incremental long-term protection insurance, tax preferential long-term protection insurance and other types of insurance, and provide policy support in product design, reserve requirements and other aspects.

It is also expected by insiders that the evaluation institutions and commercial insurance companies mentioned in the Measures are only a part of the many participants, and nursing service institutions will undoubtedly play the most critical role in them. It is expected that measures for designated nursing service institutions will be introduced this year to further standardize and promote the development of nursing services.