来源：中国医疗保险 2025年是很不平凡的一年，我国医疗保障体系在服务人口高质量发展和中国式现代化中向新向优发展， 展现强大的制度韧性和民生温度。站在岁末回望，这一年涌现的众多热词，如一个个生动的切片，记录 下医保改革的进程、治理水平提升的风向，共同"拼"绘出一幅以人民健康为中心的奋斗图景。以 下，"中国医疗保险"为您解读2025年医疗保障领域的十大热词。 热词1："1+3+N" 国家医保局一直强调要健全"1+3+N"多层次医疗保障体系。具体来说，"1"是构建以全国统一的医保信 息平台、医保大数据为核心的医保基础设施及服务能力；"3"是完善基本医疗保险、大病保险、医疗救 助三重梯次减负的基本医疗保障制度体系；"N"是引导支持商业健康保险、慈善捐赠、医疗互助、工会 职工互助等其他保障力量发挥作用。 近年来，国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重 基本医疗保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和 70%左右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大 病保险进一步减负，城乡居民大病保 ...

Core Viewpoint - The article discusses the implementation and benefits of long-term care insurance in China, particularly focusing on its impact on elderly individuals with disabilities and their families, highlighting the financial and emotional support it provides [1][15][30]. Group 1: Long-term Care Insurance Implementation - Since 2016, long-term care insurance trials have been conducted in 49 cities across China, with nearly 190 million participants and over 100 billion yuan in funds raised by the end of 2024 [1][12]. - The insurance system, referred to as the "sixth social insurance," aims to establish a comprehensive care system for elderly individuals suffering from disabilities or dementia [1][30]. Group 2: Benefits for Families - The long-term care insurance provides financial support, such as a monthly subsidy of 1,077 yuan for care services, significantly reducing the economic burden on families [5][15]. - Families of disabled elderly individuals report improved emotional well-being and reduced stress due to the support from caregivers and the insurance system [5][13]. Group 3: Growing Demand and Workforce - The aging population in Chengdu, with over 20% of residents aged 60 and above, has led to an increasing demand for long-term care services [9][30]. - The number of long-term care service providers in Chengdu has expanded from 43 to 393, with nearly 8,000 professionals entering the field, indicating a growing workforce in this sector [21][30]. Group 4: Funding and Sustainability - The funding for long-term care insurance comes from personal contributions, employer contributions, and government subsidies, with specific amounts outlined for urban workers and rural residents [33][35]. - Future plans include adjusting contributions based on individuals' financial capabilities to ensure fairness in funding [33][35]. Group 5: Policy Coordination and Expansion - Chengdu is exploring collaborative policies with other departments to enhance the long-term care insurance system, including mutual recognition of assessments and services across regions [35][30]. - The goal is to create a more integrated and equitable long-term care insurance system that can adapt to the needs of various populations, including the unemployed and low-income families [35][30].

Core Insights - The first long-term care nurse vocational skills assessment in Shaanxi Province took place in Hanzhong, with 50 candidates passing both theoretical and practical evaluations, marking a significant step towards professionalization and standardization of the long-term care service system in the province [1][2] Group 1: Examination Details - The examination utilized a national unified question bank, focusing on service standards and legal regulations in the theoretical section, while the practical assessment simulated real care scenarios, requiring candidates to complete eight tasks within 45 minutes [1] - Candidates ranged in age from 20 to 60 years, primarily from long-term care service institutions and integrated medical-care facilities in Hanzhong, showcasing a diverse educational background and experience level [1] Group 2: Long-term Care Insurance Impact - Hanzhong City, as a pilot city for long-term care insurance since 2021, has seen 403,900 insured individuals, with 3,938 receiving benefits and a total fund expenditure of 69 million yuan, improving the quality of life for disabled individuals and alleviating family care burdens [2] - The strict practical assessment aims to ensure that long-term care nurses can provide professional services to disabled individuals, with ongoing training and evaluation mechanisms being established to support the profession's development [2]

Core Viewpoint - The establishment of the long-term care insurance (LTCI) system is a significant decision to address population aging and improve social welfare, aiming to provide care and financial support for individuals who are disabled or elderly and require long-term care [2][3]. Group 1: Long-term Care Insurance System - The LTCI system was initiated in 2016, with pilot programs expanding to 49 cities by 2020, covering nearly 190 million people by the end of last year [2][3]. - Over 2.7 million disabled insured individuals have benefited from the LTCI, with total fund expenditures exceeding 85 billion [2]. - The LTCI has created approximately 300,000 jobs and attracted around 60 billion in social capital investment in related industries [2]. Group 2: Challenges and Innovations - The pilot programs have revealed challenges such as insufficient sustainable funding, lack of professional care workforce, and the need for improved technology integration [3]. - Some regions have innovated by achieving full coverage of LTCI despite financial constraints and have developed new care models like the "time bank" system [3]. - The establishment of a unified national LTCI system is essential for the welfare of millions of disabled individuals and requires collaborative efforts across society [3].

Core Viewpoint - The article highlights the severe shortage of professional caregivers in China, particularly for the elderly, and discusses the government's efforts to address this issue through the establishment of the Long-term Caregiver profession and the involvement of the insurance industry in talent development [1][4][6]. Group 1: Current Situation of Caregivers - Approximately 35 million disabled elderly individuals exist in China, representing 11.6% of the total elderly population, while only about 500,000 certified caregivers are available, indicating a significant supply-demand gap [1]. - The average age of caregivers is high, with nearly 40% aged between 50 and 55, and only 3% under 30, leading to a situation where older caregivers are looking after other elderly individuals [2]. - The working conditions for caregivers are challenging, with 44.39% working 9 to 12 hours a day, and 36.49% earning less than 4,000 yuan per month, deterring younger individuals from entering the profession [2][3]. Group 2: Policy Initiatives - In 2022, the government added the "Long-term Caregiver" profession to the occupational classification system, with national standards released in February 2024 to promote the professionalization of caregiving [4]. - The National Health Commission has included care for disabled elderly individuals as a key focus in various planning documents, emphasizing the need for a robust caregiving service system [4]. Group 3: Role of the Insurance Industry - The insurance industry is leveraging its resources to address the talent shortage in the caregiving sector by creating high-end elderly care communities that generate employment opportunities for various caregiving roles [6][7]. - Insurance companies are collaborating with training institutions and universities to provide comprehensive training programs for caregivers, enhancing their professional skills and knowledge [7]. - Specialized insurance products, such as liability and accident insurance for caregivers, are being developed to mitigate occupational risks and improve job satisfaction among caregivers [7][8]. Group 4: Challenges Ahead - Despite the initiatives, the insurance industry's involvement in caregiver training and service system development is still limited, necessitating stronger collaboration with government, educational institutions, and healthcare providers to effectively tackle the challenges in elderly care [8].

Core Viewpoint - The long-term care insurance (LTCI) system in China has created a new workforce of 300,000 long-term care professionals over the past nine years, but there is a significant gap between the demand for care services and the supply of qualified personnel, which poses a challenge for the system's development [1][2][3]. Group 1: Current Situation and Demand - There are approximately 35 million disabled elderly individuals in China, representing 11.6% of the total elderly population, leading to a projected demand for around 10 million long-term care workers [2][3]. - Research indicates that the labor demand gap for socialized elderly care services could reach between 3.6 million and 5.8 million, with future needs potentially rising to 10.9 million to 14 million by mid-century [3]. Group 2: Workforce Challenges - The long-term care workforce is characterized by low educational levels, low pay, low professional recognition, high average age, high work intensity, and high turnover rates [4]. - The average age of long-term care workers in certain regions is around 50, with a significant portion of the workforce being over 50 years old, making recruitment of younger staff a major challenge [4][5]. Group 3: Policy and Training Initiatives - The National Healthcare Security Administration has initiated training programs for long-term care professionals, aiming to enhance talent cultivation and attract more individuals to the industry [2][7]. - The introduction of the long-term care worker certification system is expected to improve the professionalization and attractiveness of the industry, as well as enhance public recognition of the role [9][13]. Group 4: International Comparisons and Best Practices - Learning from Japan and South Korea, the development of the long-term care workforce is closely linked to the establishment and improvement of long-term care insurance systems, which include measures to attract and retain talent [7][12]. - Japan's experience shows that despite efforts to improve working conditions and recognition, high turnover rates persist, indicating the need for ongoing efforts to enhance the appeal of the profession [12]. Group 5: Future Outlook - The professionalization of long-term care workers is seen as a critical step towards addressing the industry's challenges, with a focus on creating a supportive environment that recognizes the value of care work [11][14]. - The ongoing development of training programs and certification standards is expected to facilitate a younger and more skilled workforce in the long-term care sector [13][14].

Core Insights - Jiangsu Province has positioned long-term care insurance (LTCI) as the "sixth insurance," aiming to provide basic care protection for disabled individuals through a balanced funding model and social insurance system [3][4] - The elderly population aged 60 and above in Jiangsu has surpassed 20 million in 2023, accelerating the demand for long-term care services due to aging [2][4] Group 1: Long-Term Care Insurance Framework - The LTCI system in Jiangsu is designed to alleviate family care burdens and reduce the impact of aging on society by providing economic and care support for disabled individuals [3][4] - The system focuses on two main functions: reducing care burdens and improving care quality, while also supporting the development of the silver economy [3][4] - To address issues such as policy fragmentation and unequal benefits, pilot cities are implementing a unified approach in the design of the LTCI framework, funding mechanisms, benefit standards, and management services [3][4] Group 2: Care Service Supply and Workforce - Jiangsu currently has 2,610 designated care service institutions, including 388 medical institutions, 872 elderly care institutions, and 1,315 home care service providers, with a total of 68,000 service personnel and 94,000 nursing beds [4][5] - The supply of care services is lagging, particularly in rural areas, leading to challenges in accessing quality care [5] - The introduction of the new profession of long-term care workers aims to address service provision issues and stimulate demand in the care industry, promoting the integration of elderly care, medical care, and rehabilitation services [5][6] Group 3: Professionalization of Care Services - The certification of long-term care workers is a step towards standardizing and professionalizing the care industry, with ongoing efforts needed to enhance the attractiveness of this profession [6] - Policies will be implemented to incentivize care institutions to prioritize hiring certified personnel and to link service quality with insurance payment mechanisms [6] - Continuous training and skill enhancement for certified long-term care workers will be organized to improve service standards and elevate the overall quality of care [6] Group 4: Cross-Region Service Accessibility - Current challenges exist in the standardization of assessments and service provisions for long-term care insurance, particularly for individuals residing in different regions [7] - A pilot program has been initiated in Nanjing, Suzhou, and Nantong to allow for cross-region access to LTCI benefits, focusing on mutual recognition of assessments and benefit settlements [7]

Core Viewpoint - The establishment of the Long-term Care Worker profession aims to strengthen the talent pool for long-term care services and promote the professional development of this field [1] Group 1 - The first national examination for junior Long-term Care Workers (Level 5) was held in Nantong, Jiangsu [1] - Successful candidates will receive the first national Long-term Care Worker vocational skill level certificates, marking the implementation of this new profession in Jiangsu [1]