社保“第六险”迈向全面建制｜展望2026

Core Insights - Long-term care insurance (LTCI) is being implemented across 49 cities in China, addressing the needs of approximately 45 million disabled and cognitively impaired elderly individuals [1][4][5] - The LTCI system aims to alleviate the burden on families and provide a social safety net through a shared responsibility model [4][5] - The government plans to transition LTCI from pilot programs to a fully established system by 2025, with a focus on covering severe disability cases [5][10] Funding Challenges - The LTCI system faces significant funding challenges, primarily relying on limited sources such as health insurance fund transfers and government subsidies, which may not be sustainable [7][9] - The participation of commercial entities in funding is low, limiting the effectiveness of market mechanisms to enhance the system [7][9] - There is a need for diversified funding mechanisms to alleviate pressure on LTCI funds, including subsidies for low-income individuals and involvement from social welfare organizations [9][10] Service Standards and Market Development - The lack of unified standards for elderly care services and disability assessments across regions hampers the establishment of a cohesive national market [8][10] - The LTCI system is expected to evolve with the release of supporting guidelines and standards, enhancing service quality and operational processes [5][10] Commercial Long-term Care Insurance - The demand for long-term care services is projected to grow significantly, with a potential funding gap reaching 1.9 trillion yuan by 2030 [12] - Commercial long-term care insurance is seen as a complementary solution to the government-backed LTCI, providing higher levels of coverage and personalized care [12][13] - Current commercial long-term care insurance products are limited in number and market penetration, with a need for improved consumer awareness and simplified product offerings [13][14] Strategic Recommendations - To overcome the challenges faced by commercial long-term care insurance, it is essential to integrate it into a broader elderly care framework, enhancing its perceived value [14] - Insurance companies should focus on developing differentiated products for under-covered areas and collaborate with care providers to improve service delivery [14]