BY YANG XIAOHAN
Recently, the National Healthcare Security Administration (hereinafter referred to as "NHSA") released an interpretation of the "Long-Term Care Insurance Nursing Service Plan" (hereinafter "the Plan").
Experts noted that the release of the interpretive guide for the "Action Plan" helps bridge the management gap between long-term care insurance (hereinafter referred to as LTCI) assessment and implementation, improving both the precision of benefit delivery for individuals with disabilities and the security of fund operations.
The Care Plan serves as the key document linking disability assessment results to personalized care services and enabling long-term care insurance benefits for insured individuals. It also forms the basis for daily nursing services provided by designated long-term care facilities. After an insured individual completes their disability level assessment and a service file is established, the designated facility develops the Care Plan based on the individual's disability level, health status, and actual care needs. The plan becomes effective upon confirmation by the insured individual or their guardian (authorized representative), the long-term care specialist, and the designated facility.
Specifically, the Plan consists of three sections: Service Recipient Information, Detailed Service Needs, and Signature/Seal Area. The Service Recipient Information section confirms the recipient's identity, level of disability, and service mode. The Detailed Service Needs section is structured according to regulatory requirements and includes two categories: Daily Living Care and Medical Nursing. There are 20 items under Daily Living Care for routine daily assistance, and 16 items under Medical Nursing for medical care needs. The Signature/Seal Area requires confirmation from three parties: the insured person or guardian (authorized agent), the Long-Term Care Specialist, and the designated Long-Term Care facility.
Long Ge, Deputy Director of the Center for Innovation and Risk Management at the University of International Business and Economics, told Securities Daily that the Plan addresses the management gap between simply issuing benefits upon completion of disability assessments and ensuring services are delivered as scheduled with full visibility into fund flows. It shifts designated institutions from passively accepting tasks to proactively fulfilling agreed-upon plans, thereby improving the precision of benefit delivery for persons with disabilities and enhancing the security of fund operations.
Regarding implementation details, the National Healthcare Security Administration emphasized that all service items, frequencies, and durations must be based on the assessment conclusion of disability levels, the insured person's physical condition, and records in their files. Services should be selected according to actual needs, with no false additions or inflated time reports, ensuring that service plans match actual care needs. If service requirements change, the plan must be updated promptly and confirmation procedures re-executed.
Long Ge stated that this move aims to systematically prevent three types of loopholes in the implementation of long-term care insurance: first, the "select-all" stacking of service items.
Second, falsely reporting service duration;
Third, providing medical care services without clear clinical indications.
In recent years, the long-term care insurance (LTCI) market has continued to grow rapidly. According to data from the State Council Information Office press conference on 9 month 4, the number of people enrolled in the LTCI system has exceeded 3.2 billion, with cumulative fund expenditures reaching 1142 billion yuan. Over 460 million individuals with disabilities have received nursing services. The number of designated LTC service institutions nationwide has reached 1.3 ten thousand, representing a 10-fold increase compared to the pilot phase. Approximately 40 hundred thousand nursing service personnel are currently employed, and more than 7 hundred thousand certified long-term care workers have been trained. Estimates indicate that LTCI has stimulated nearly 700 billion yuan in social capital investment into nursing services and related industries.
"As the population ages, the demand for long-term care from disabled and partially disabled elderly continues to rise, making long-term care insurance increasingly critical," said Yang Fan, General Manager of Beijing PaiPaiWang Insurance Agency Co., Ltd., to the Securities Daily. Long-term care insurance does more than address medical expenses; it alleviates the economic and human resource burdens associated with long-term care, particularly reducing the strain on families where one disabled member requires care from all others. Therefore, long-term care insurance is both a key institutional response to population aging and an essential component of a multi-layered social security system.
Looking ahead, Yang Fan believes that long-term care insurance (LTCI), with its extended coverage period and prolonged claim duration, demands strong long-term operational capabilities from insurers. Insurers must first address pricing by accounting for disability incidence rates, rising care costs, and increasing life expectancy to avoid underpricing that could lead to long-term claim pressures. Additionally, risks such as moral hazard in disability level assessment, verification of care services, and expense audits require a more unified and standardized evaluation and risk control framework. Beyond mere financial payouts, insurers should also deepen collaboration with nursing homes, medical institutions, and care service providers to enhance resource integration and service management. Ultimately, competing in the LTCI market will hinge not just on products and prices, but on comprehensive capabilities in long-term risk management and elderly care services.
