The Coverage of Social Insurance for Long-Term Care in China and Its Legal Construction
Long-term care social insurance aims at preventing the independent social risk of care needs.Taking this risk as the subject matter of insurance,the abstract coverage of long-term care insurance can be constructed from the positive and the negative aspects.The needs for long-term care that affect daily life and health to a certain degree of severity are cov-ered while those that do not cause a burden on survival and damage to health are excluded.The specific coverage can be defined in terms of the external dimension and the internal dimension.The external dimension refers to the boundaries and connections between insurance benefits and other related social welfare benefits,while the internal dimension includes the determination of the subjects of the right,the coverage of protection and its realization.The risk of care needs is related not only to the derogation of freedom,dignity and other fundamental rights caused by the inability to take care of oneself,but also to the cost burden on the individual and the family re-sulting from the care needs.As far as the former is concerned,long-term care insurance aims at guaranteeing the quality of life and health as well as the basic dignity of the person in need of care.Such insurance benefits are different from health insurance benefits and disability bene-fits.As far as the latter is concerned,long-term care insurance aims at preventing the risk of o-ver-expenditure rather than insufficient income for families with care needs,thus distinguishing itself from income replacement insurances.The legislation on long-term care insurance coverage involves three core elements:subjects of the right,subject matters of the coverage and insur-ance benefits.The subjects of rights guaranteed by long-term care insurance include the insured and the beneficiary.It is recommended that,at the initial stage of the implementation of the system,the group of the elderly over 60 years of age should be the first type of the insured,with premiums deducted from individual pension accounts;and the group of persons aged between 40 and 59 years should be the second type of the insured,with premiums shared by the state,the local government,the individual and the employer.The beneficiaries are limited to the severely disabled and mentally retarded group of the insured persons.The objects of coverage are the needs for care that are expected to last more than six months and reach a certain level of intensi-ty.At the same time,"medical treatment for a period of not less than six months"should not be taken as a precondition.The benefits should mainly take the form of service benefits,sup-plemented by monetary benefits.The purpose of service benefits is to enhance the insured per-son's access to long-term care services,ensure the quality of long-term care services,and up-hold the autonomy and dignity of the individual.Monetary benefits are designed to provide fi-nancial support to the insured person and his/her family,so as to prevent them from falling into poverty as a result of the burden of care.
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