In 2018, the "Local Pilot Implementation Plan for the Long-term Care Insurance System" was proposed for the first time, breaking the pattern of the five basic insurances in mainland China - endowment, medical care, work-related injury, unemployment, and maternity.
"Long-term care insurance", that is, long-term care insurance, has received widespread attention as the "sixth insurance". Its importance is undoubted, and the disability assessment link is the gatekeeper of long-term care insurance funds.
Recently, the National Health Insurance Administration, together with the Ministry of Finance, announced the "Administrative Measures for the Assessment of Disability Levels of Long-term Care Insurance (Trial)", aiming to create a good environment for the protection of the rights and interests of the insured people and the standardization of assessment management.
What are the main contents of the "Administrative Measures"?
At present, the problem of aging in mainland China is becoming more and more serious, and the standardization and management of the assessment of the disability level of long-term care insurance is particularly important. Therefore, the promulgation of the Administrative Measures provides better conditions for the protection of the legitimate rights and interests of the insured.
The "Administrative Measures" is the first industry regulation specifically issued for the assessment of the disability level of long-term care insurance, which contains five main aspects: the management of designated assessment institutions, the conditions and responsibilities of assessors, the unification of disability level assessment standards, the specification of the assessment process and other assessment situations and supervision and management requirements.
First of all, for the assessment agency, the "Management Measures" proposes that the overall regional medical security agency and the specific assessment agency sign the assessment service contract, and implement fixed-point management in the assessment agency.
This clearly stipulates that the designated assessment agency shall not undertake the long-term care service work carried out according to the assessment conclusion at the same time, and cannot also handle the work at the same time. This undoubtedly gives encouragement and support to the development of independent evaluation institutions, and provides a high threshold for institutions that can compete in the future.
Secondly, for assessors, two roles including appraisers and appraisal experts are clarified, and they need to meet certain basic conditions such as relevant professional background, experience and professional ethics.
Finally, the Administrative Measures standardize the assessment criteria and processes, establish a nationally consistent disability rating assessment criteria, and clarify a clear and transparent assessment process.
What positive impacts will be had?
The promulgation of the "Administrative Measures" will have a positive impact on the treatment of the insured people, the construction of the long-term care insurance system and the coordinated development of related fields.
First, it will help ensure that the insured are treated fairly. The enhancement of the assessment process and the accuracy of the results of the new standard will facilitate a more accurate identification of the target of protection, so as to ensure that the public deserves to enjoy it. In addition, clear management requirements and division of powers and responsibilities of the assessment body will also help to ensure fair treatment of the public.
Second, the management measures can also ensure the lasting stability of the system. Strengthening evaluation management will help prevent the abuse of services on the basis of institutional safeguards. In addition, promoting the standardization of assessment management will improve the effectiveness and efficiency of governance and promote the coordinated development of the system in a wider range of areas.
Finally, this will promote the coordinated development of related fields. The introduction of independent evaluation bodies and social participation will ensure fair competition and orderly growth in the market. At the same time, the implementation of standardized assessment will help guide and promote the orderly and standardized development of the service system.
Sustainable system: put an end to the chaos of insurance fraud
In the implementation of the policy, there will always be some "black sheep". For example, in previous insurance fraud cases, some elderly people who instinctively walked and talked, but pretended not to be able to take care of themselves during the assessment. This kind of insurance fraud not only causes the loss of long-term care insurance funds, but also may deprive the disabled people who really need long-term care from the right to enjoy professional services. In this regard, the promulgation and implementation of the "Management Measures" will effectively put an end to such absurd and sad behavior.
According to the National Health Insurance Administration, the next step will be to further improve the "management measures" and promote the standardized management of long-term care insurance disability level assessment nationwide, so as to establish a solid foundation for the long-term care insurance system.
In general, the promulgation of the "Management Measures" not only standardizes the assessment of the disability level of long-term care insurance, but also ensures the fairness and effectiveness of the long-term care insurance system, so that the "sixth insurance" can better realize its due social value.