Core Insights - The article discusses the transformation of long-term care insurance (LTCI) management from traditional manual auditing to advanced algorithmic calculations, highlighting the use of AI and real-time data analysis to prevent fraud and improve service delivery [1][4]. Group 1: Fraud Prevention and Management - The new LTCI management system utilizes AI to detect anomalies, such as a "severely disabled" elderly person who is physically active, triggering alerts for potential fraud [1][4]. - The system has shifted from traditional sampling audits to real-time data processing, allowing for immediate identification of irregularities in care service claims [4]. - After implementing the system, a province saw the growth rate of fund expenditures drop from an annual average of 19% to 6%, while the satisfaction rate among genuinely disabled elderly individuals rose to 92% [4]. Group 2: Dynamic Fund Management - The system generates quarterly "fund stress test reports" based on 72 factors, including aging rates and healthcare costs, allowing for proactive adjustments in budget allocations [4]. - The introduction of a "dynamic rate adjustment valve" helps to balance funding across regions, ensuring that areas with increasing needs receive appropriate financial support [4]. Group 3: Transparency and Community Involvement - The "social co-governance" module allows family members to track expenditures through a mobile app, providing transparency with video evidence of care activities and electronic invoices [4]. - This level of transparency empowers families to monitor care services closely, reducing opportunities for fraudulent claims [4]. Group 4: Ethical Considerations in Care - The system includes a "terminal care fund pool" that allocates resources for pain management and psychological support for families when an elderly person is predicted to enter the end-of-life stage [5]. - The focus is not only on preventing fraud but also on ensuring dignity in care, emphasizing the ethical responsibility of the fund management [5].