济宁市“五维协同”推动长期护理保险制度惠民生见实效

Core Insights - The Jining Medical Insurance Bureau aims to optimize long-term care insurance (LTCI) services by focusing on "expansion, quality improvement, and efficiency enhancement" since 2025, achieving full coverage by the end of 2023 with 7.8883 million insured individuals and a cumulative fund expenditure of 625 million yuan by December 2025 [2] Group 1: Institutional Foundation - Jining has established a scientific annual control quota for 234 nursing institutions, implementing total expenditure control for LTCI to ensure balanced income and expenditure [3] - The city has strengthened agreement management by renewing cooperation agreements with six commercial insurance companies, creating standardized service centers across the city [3] Group 2: Evaluation Mechanism - A pilot program for third-party evaluation began in Wenshang County in 2024, completing 3,356 evaluations and establishing a database for disability level assessments [4] - The city has utilized big data to verify suspicious data points, resulting in the removal of 1,232 individuals who did not meet eligibility criteria [4] Group 3: Resource Optimization - To address weak rural services, Jining has issued notifications to enhance support for disabled individuals in remote areas, establishing a three-tier service network [5] - As of now, 411 individuals from rural areas have been newly included in LTCI services, promoting equity and accessibility [5] Group 4: Service Supply Enhancement - The inclusion of five types of assistive devices in the LTCI payment scope has been initiated, with an annual payment limit of 4,000 yuan per person [6] - A total of 506 disabled individuals have utilized assistive device rental services, saving 5.19 million yuan in purchase costs [7] Group 5: Regulatory Collaboration - The collaboration between medical insurance and commercial insurance has been deepened, with monthly audits and annual performance assessments implemented [8] - A smart regulatory system is being developed to enhance monitoring accuracy, including features for real-time data tracking [8] Group 6: Future Directions - In 2026, Jining will continue to align with national requirements, focusing on improved mechanisms, precise services, and strict supervision to enhance the quality of LTCI [11]