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Article(id=1322168504502042989, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168481081049284, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.09.009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1766419200000, receivedDateStr=2025-12-23, revisedDate=1773849600000, revisedDateStr=2026-03-19, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159136176, onlineDateStr=2026-10-28, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159136176, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159136176, creator=13701087609, updateTime=1793159136176, updator=13701087609, issue=Issue{id=1322168481081049284, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='9', pageStart='1425', pageEnd='1616', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159130592, creator='13701087609', updateTime=1793159130592, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1495, endPage=1500, ext={EN=ArticleExt(id=1322168506372702574, articleId=1322168504502042989, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Study on appropriateness of long-term care insurance financing levels based on the coupling coordination degree, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To focus on the appropriateness of long-term care insurance(LTCI) financing levels. It measured the coordination between LTCI financing levels and regional economic capacity,as well as aging pressure.The goal is to provide empirical evidence and policy recommendations for sustainable LTCI development.

Methods

We built a coupling coordination degree model with three subsystems:financing level,economic development,and population structure.We selected three cities as samples:city X(northern Jiangsu),city N(central Jiangsu),and city C(southern Jiangsu).Data came from field surveys, statistical yearbooks,and government reports.We used the entropy method to determine indicator weights.We calculated composite indices for each subsystem and assessed the coupling coordination levels.

Results

The results showed significant regional differences and dynamic changes.City N improved steadily and reached a "barely coordinated" stage.City X remained trapped in a state of "slight imbalance" at the antagonistic stage, plagued by the "scissors effect" between fixed-amount financing, population outflow,and rising service costs.In contrast,economically developed city C experienced a mismatch between high economic carrying capacity and low financing levels due to the rigid model of "fixed contributions coupled with medical insurance dependency," causing its coupling coordination degree to shift from "slight imbalance" to "on the verge of imbalance".

Conclusions

The appropriateness of LTCI financing depends on multiple factors.These include financing mechanisms,population structure,and payment structures.It is also closely linked to regional economic development.We recommend establishing a long-term "proportional financing+dynamic adjustment" mechanism.We also suggest implementing region-specific strategies based on a two-dimensional matrix of "economic level+aging degree".Finally,we propose optimizing the linkage between payment structures and financing mechanisms.

, authors=Ping LI, Changchun ZHAN, authorsList=Ping LI, Changchun ZHAN, authorCompany=null, correspAuthors=Changchun ZHAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168507312226673, articleId=1322168504502042989, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于耦合协调度的长期护理保险筹资水平适宜度研究, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

聚焦长期护理保险筹资水平适宜度问题，科学测度长期护理保险筹资水平与区域经济承载力、老龄化压力的协调匹配程度，为促进长期护理保险制度可持续发展提供实证依据与政策参考。

方法

构建“筹资水平-经济发展-人口结构”耦合协调度模型，选取苏北X市、苏中N市、苏南C市为样本，通过实地调研、统计年鉴及统计公报获取研究数据，运用熵值法确定指标权重，量化测度各子系统综合指数，判别三地耦合协调度等级与发展阶段。

结果

样本地区耦合协调度呈现显著区域异质性与动态演化特征，苏中N市得益于“比例制+动态调整”的筹资机制，协调度稳步提升并迈入“勉强协调”的磨合阶段；苏北X市受困于人口外流、定额筹资与服务成本攀升的“剪刀差”效应，长期陷于“轻度失调”的颉颃阶段；经济发达的苏南C市则因“定额缴费+医保依赖”的僵化模式导致高经济承载力与低筹资错配，耦合协调度由“轻度失调”转至“濒临失调”状态。

结论

长期护理保险筹资水平适宜性受筹资机制、人口结构、支付结构等多重因素影响，且与区域经济发展高度关联；应建立“比例制+动态调整”长效筹资机制，实施基于“经济水平-老龄化程度”二维矩阵的区域差异化策略，优化支付结构与筹资联动机制，提升长期护理保险筹资水平适宜性。

, authors=李萍, 詹长春*, *, authorsList=李萍, 詹长春, authorCompany=null, correspAuthors=詹长春, authorNote=

李萍，硕士研究生

, correspAuthorsNote=
詹长春，E-mail：
ZHAN Changchun, E-mail:
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figs=[ArticleFig(id=1322531028137263142, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Figure 1, caption=Coupling coordination degree model of "financing level–economic development–population structure"for long–term care insurance, figureFileSmall=crW6Lj6q4Cq+7VGjMT0w0w==, figureFileBig=sl8a1m/gc5IV6BCTlJpasA==, tableContent=null), ArticleFig(id=1322531028212760615, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=图1, caption=长期护理保险“筹资水平-经济发展-人口结构”耦合协调度模型, figureFileSmall=crW6Lj6q4Cq+7VGjMT0w0w==, figureFileBig=sl8a1m/gc5IV6BCTlJpasA==, tableContent=null), ArticleFig(id=1322531028300841000, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Table 1, caption=

Enrollment status of long-term care insurance in sample areas in 2022—2024

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样本地区年份实际参保人数
X市2022年955.4
2023年945.9
2024年934.4
N市2022年726.8
2023年721.1
2024年721.6
C市2022年441.0
2023年449.0
2024年455.0
), ArticleFig(id=1322531028363755561, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表1, caption=

样本地区2022—2024年长期护理保险参保情况

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样本地区年份实际参保人数
X市2022年955.4
2023年945.9
2024年934.4
N市2022年726.8
2023年721.1
2024年721.6
C市2022年441.0
2023年449.0
2024年455.0
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Revenue and expenditure of long-term care insurance fund in sample areas in 2022—2024

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样本地区年份资金收入资金支出资金结余
X市2022年6.693.693.00
2023年6.625.421.20
2024年6.545.461.08
N市2022年7.275.891.38
2023年8.107.430.67
2024年8.728.010.71
C市2022年4.402.561.84
2023年4.503.121.38
2024年4.603.461.14
), ArticleFig(id=1322531028535722027, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表2, caption=

样本地区2022—2024年长期护理保险资金收支情况

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样本地区年份资金收入资金支出资金结余
X市2022年6.693.693.00
2023年6.625.421.20
2024年6.545.461.08
N市2022年7.275.891.38
2023年8.107.430.67
2024年8.728.010.71
C市2022年4.402.561.84
2023年4.503.121.38
2024年4.603.461.14
), ArticleFig(id=1322531028602830892, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Table 3, caption=

Payment structure of long-term care insurance funds in sample areas in 2022—2024

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样本地区年份医疗机构护理养老机构护理居家护理其他
X市2022年0.2780.1902.7560.466
2023年0.4060.2304.3930.391
2024年0.5320.2574.2820.389
N市2022年0.0640.5764.8320.418
2023年0.0960.8636.0190.452
2024年0.1520.9586.4070.493
C市2022年0.0270.0891.9760.468
2023年0.0460.1362.5920.346
2024年0.1170.2192.6460.478
), ArticleFig(id=1322531028682522669, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表3, caption=

样本地区2022—2024年长期护理保险资金支付结构

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样本地区年份医疗机构护理养老机构护理居家护理其他
X市2022年0.2780.1902.7560.466
2023年0.4060.2304.3930.391
2024年0.5320.2574.2820.389
N市2022年0.0640.5764.8320.418
2023年0.0960.8636.0190.452
2024年0.1520.9586.4070.493
C市2022年0.0270.0891.9760.468
2023年0.0460.1362.5920.346
2024年0.1170.2192.6460.478
), ArticleFig(id=1322531028753825838, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Table 4, caption=

Index system and weights for coupling coordination degree

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系统层面指标层面权重
筹资水平评价系统长期护理保险参保人数7.59
长期护理保险资金收入7.10
长期护理保险资金支出4.59
参保人员缴费水平7.62
人均财政补贴水平8.69
经济发展水平评价系统地区生产总值4.87
国内生产总值（GDP）增长率2.45
地方一般公共预算收入4.68
地方一般公共预算支出8.13
人均可支配收入5.74
第三产业增加值占GDP比重4.36
人均消费支出4.83
人口结构评价系统老年人口比例4.97
老年抚养比6.59
城镇化率6.30
人口自然增长率5.06
在岗职工比例6.43
), ArticleFig(id=1322531028812546095, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表4, caption=

耦合协调度指标体系及权重

, figureFileSmall=null, figureFileBig=null, tableContent=
系统层面指标层面权重
筹资水平评价系统长期护理保险参保人数7.59
长期护理保险资金收入7.10
长期护理保险资金支出4.59
参保人员缴费水平7.62
人均财政补贴水平8.69
经济发展水平评价系统地区生产总值4.87
国内生产总值（GDP）增长率2.45
地方一般公共预算收入4.68
地方一般公共预算支出8.13
人均可支配收入5.74
第三产业增加值占GDP比重4.36
人均消费支出4.83
人口结构评价系统老年人口比例4.97
老年抚养比6.59
城镇化率6.30
人口自然增长率5.06
在岗职工比例6.43
), ArticleFig(id=1322531028879654960, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Table 5, caption=

Classification of coupling degree levels

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协调度区间等级发展阶段
[0.00,0.10)极度失调低水平耦合
[0.10,0.20)严重失调低水平耦合
[0.20,0.30)中度失调低水平耦合
[0.30,0.40)轻度失调颉颃阶段
[0.40,0.50)濒临失调颉颃阶段
[0.50,0.60)勉强协调磨合阶段
[0.60,0.70)初级协调磨合阶段
[0.70,0.80)中级协调磨合阶段
[0.80,0.90)良好协调高水平耦合
[0.90,1.00]优质协调高水平耦合
), ArticleFig(id=1322531028955152433, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表5, caption=

耦合协调度等级划分

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协调度区间等级发展阶段
[0.00,0.10)极度失调低水平耦合
[0.10,0.20)严重失调低水平耦合
[0.20,0.30)中度失调低水平耦合
[0.30,0.40)轻度失调颉颃阶段
[0.40,0.50)濒临失调颉颃阶段
[0.50,0.60)勉强协调磨合阶段
[0.60,0.70)初级协调磨合阶段
[0.70,0.80)中级协调磨合阶段
[0.80,0.90)良好协调高水平耦合
[0.90,1.00]优质协调高水平耦合
), ArticleFig(id=1322531029030649906, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Table 6, caption=

Comprehensive evaluation indices of three subsystems in three cities

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样本地区年份U1U2U3
X市2022年0.1820.2410.064
2023年0.1800.2630.065
2024年0.1780.2840.066
N市2022年0.2390.3100.090
2023年0.2770.3390.093
2024年0.3260.4660.120
C市2022年0.1690.2860.072
2023年0.1720.3160.074
2024年0.1750.3420.078
), ArticleFig(id=1322531029110341683, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表6, caption=

三地3个子系统综合评价指数

, figureFileSmall=null, figureFileBig=null, tableContent=
样本地区年份U1U2U3
X市2022年0.1820.2410.064
2023年0.1800.2630.065
2024年0.1780.2840.066
N市2022年0.2390.3100.090
2023年0.2770.3390.093
2024年0.3260.4660.120
C市2022年0.1690.2860.072
2023年0.1720.3160.074
2024年0.1750.3420.078
), ArticleFig(id=1322531029177450548, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=EN, label=Table 7, caption=

Coupling degree and coordination degree results in three cities

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样本地区年份耦合度（C）协调度（D）协调度等级发展阶段
X市2022年0.8690.376轻度失调颉颃阶段
2023年0.8590.381轻度失调颉颃阶段
2024年0.8490.387轻度失调颉颃阶段
N市2022年0.8840.434濒临失调颉颃阶段
2023年0.8710.454濒临失调颉颃阶段
2024年0.8660.513勉强协调磨合阶段
C市2022年0.8630.389轻度失调颉颃阶段
2023年0.8490.399轻度失调颉颃阶段
2024年0.8430.409濒临失调颉颃阶段
), ArticleFig(id=1322531029273919541, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168504502042989, language=CN, label=表7, caption=

三地耦合度和协调度结果

, figureFileSmall=null, figureFileBig=null, tableContent=
样本地区年份耦合度（C）协调度（D）协调度等级发展阶段
X市2022年0.8690.376轻度失调颉颃阶段
2023年0.8590.381轻度失调颉颃阶段
2024年0.8490.387轻度失调颉颃阶段
N市2022年0.8840.434濒临失调颉颃阶段
2023年0.8710.454濒临失调颉颃阶段
2024年0.8660.513勉强协调磨合阶段
C市2022年0.8630.389轻度失调颉颃阶段
2023年0.8490.399轻度失调颉颃阶段
2024年0.8430.409濒临失调颉颃阶段
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基于耦合协调度的长期护理保险筹资水平适宜度研究
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李萍 , 詹长春 *, *
护理研究 | 科研论著 2026,40(9): 1495-1500
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护理研究 |科研论著 2026 , 40 (9) : 1495 -1500
基于耦合协调度的长期护理保险筹资水平适宜度研究
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李萍, 詹长春*, *
作者信息
  • 1江苏大学管理学院，江苏 212013
通讯作者:
詹长春，E-mail：
ZHAN Changchun, E-mail:
作者简介:

李萍，硕士研究生

Study on appropriateness of long-term care insurance financing levels based on the coupling coordination degree
Ping LI, Changchun ZHAN
Affiliations
  • 1School of Management, Jiangsu University, Jiangsu 212013 China
出版时间: 2026-05-10 doi: 10.12102/j.issn.1009-6493.2026.09.009
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摘要
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目的

聚焦长期护理保险筹资水平适宜度问题，科学测度长期护理保险筹资水平与区域经济承载力、老龄化压力的协调匹配程度，为促进长期护理保险制度可持续发展提供实证依据与政策参考。

方法

构建“筹资水平-经济发展-人口结构”耦合协调度模型，选取苏北X市、苏中N市、苏南C市为样本，通过实地调研、统计年鉴及统计公报获取研究数据，运用熵值法确定指标权重，量化测度各子系统综合指数，判别三地耦合协调度等级与发展阶段。

结果

样本地区耦合协调度呈现显著区域异质性与动态演化特征，苏中N市得益于“比例制+动态调整”的筹资机制，协调度稳步提升并迈入“勉强协调”的磨合阶段；苏北X市受困于人口外流、定额筹资与服务成本攀升的“剪刀差”效应，长期陷于“轻度失调”的颉颃阶段；经济发达的苏南C市则因“定额缴费+医保依赖”的僵化模式导致高经济承载力与低筹资错配，耦合协调度由“轻度失调”转至“濒临失调”状态。

结论

长期护理保险筹资水平适宜性受筹资机制、人口结构、支付结构等多重因素影响，且与区域经济发展高度关联；应建立“比例制+动态调整”长效筹资机制，实施基于“经济水平-老龄化程度”二维矩阵的区域差异化策略，优化支付结构与筹资联动机制，提升长期护理保险筹资水平适宜性。

长期护理保险  /  筹资  /  适宜度  /  耦合协调度模型  /  老年护理
Objective

To focus on the appropriateness of long-term care insurance(LTCI) financing levels. It measured the coordination between LTCI financing levels and regional economic capacity,as well as aging pressure.The goal is to provide empirical evidence and policy recommendations for sustainable LTCI development.

Methods

We built a coupling coordination degree model with three subsystems:financing level,economic development,and population structure.We selected three cities as samples:city X(northern Jiangsu),city N(central Jiangsu),and city C(southern Jiangsu).Data came from field surveys, statistical yearbooks,and government reports.We used the entropy method to determine indicator weights.We calculated composite indices for each subsystem and assessed the coupling coordination levels.

Results

The results showed significant regional differences and dynamic changes.City N improved steadily and reached a "barely coordinated" stage.City X remained trapped in a state of "slight imbalance" at the antagonistic stage, plagued by the "scissors effect" between fixed-amount financing, population outflow,and rising service costs.In contrast,economically developed city C experienced a mismatch between high economic carrying capacity and low financing levels due to the rigid model of "fixed contributions coupled with medical insurance dependency," causing its coupling coordination degree to shift from "slight imbalance" to "on the verge of imbalance".

Conclusions

The appropriateness of LTCI financing depends on multiple factors.These include financing mechanisms,population structure,and payment structures.It is also closely linked to regional economic development.We recommend establishing a long-term "proportional financing+dynamic adjustment" mechanism.We also suggest implementing region-specific strategies based on a two-dimensional matrix of "economic level+aging degree".Finally,we propose optimizing the linkage between payment structures and financing mechanisms.

long-term care insurance  /  financing  /  appropriateness  /  coupling coordination degree model  /  elderly care
李萍, 詹长春. 基于耦合协调度的长期护理保险筹资水平适宜度研究. 护理研究, 2026 , 40 (9) : 1495 -1500 . DOI: 10.12102/j.issn.1009-6493.2026.09.009
Ping LI, Changchun ZHAN. Study on appropriateness of long-term care insurance financing levels based on the coupling coordination degree[J]. Chinese Nursing Research, 2026 , 40 (9) : 1495 -1500 . DOI: 10.12102/j.issn.1009-6493.2026.09.009
正文
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世界卫生组织（WHO）指出，老龄化带来的长期照护需求激增已成为各国社会保障体系面临的核心挑战之一。聚焦中国情境，老龄化进程呈现出“规模大、速度快、高龄化、失能化”叠加的复杂特征，其严峻性与紧迫性尤为凸显。《中国老龄产业发展报告》显示，我国目前失能和半失能老年人规模已超4 400万人，尤其在80岁以上高龄群体中，失能比例高达40%[1]。这一庞大的群体对专业化、持续性的医疗护理与长期照护服务存在刚性需求，照护成本高昂，对家庭照料能力与社会保障体系造成了巨大压力，亟须研究解决。基于此，本研究拟选取苏北X市、苏中N市、苏南C市为样本地区（应样本地区的脱敏要求，以X、N、C市代替具体城市名称），实地调研收集三地长期护理保险运行数据，构建“筹资水平-经济发展-人口结构”耦合协调模型，系统测度三地长期护理保险筹资水平适宜度，进而提出相关政策建议，以促进长期护理保险的可持续发展。
1　样本地区长期护理保险运行现况
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1.1　参保情况
从总体来看，2022—2024年苏北X市、苏中N市、苏南C市的长期护理保险参保规模存在显著的区域差异。苏北X市始终保持最高参保规模，苏中N市次之，苏南C市最低。从时间趋势看，三地长期护理保险参保覆盖可概括为“苏北收缩、苏中稳定、苏南扩张”。详见表1。
1.2　收入与支出情况
从资金收入看，2022—2024年三地呈现分化趋势。N市表现出较强的增长韧性，C市资金收入微幅增长，而X市连续下降。从资金支出看，三地均呈逐年增长态势。从资金结余看，三地结余均呈收缩趋势，资金收支平衡压力逐步显现。见表2。
1.3　资金支付结构情况
从资金支付结构上看，三地2022—2024年长期护理保险资金支付结构呈现“居家护理主导”的共性特征，居家护理支出占比始终最高，年均占比超过70%。医疗机构护理支出呈普遍增长态势。养老机构护理支出中，X市、N市增长稳定，C市波动较大。见表3。
2　长期护理保险筹资水平耦合协调度模型的构建
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2.1　耦合协调度模型（coupling coordination degree model,CCDM）
耦合协调度模型源于物理学耦合概念，后经区域经济学、公共管理等学科引入，用于量化多系统间相互作用的强度与和谐程度。本研究对长期护理保险财务可持续性、区域经济适配性及人口结构关联的分析，构建筹资水平、区域经济承载力与人口老龄化压力典型的“政策-经济-人口”三元耦合系统，模型将筹资水平与经济发展、人口结构三系统间的非线性关系转化为［0,1］区间内的可比较数值，以评估三系统间的匹配程度。筹资水平子系统（U1）聚焦制度财务可持续性，反映筹资规模与责任分担能力；经济发展子系统（U2）反映区域财政实力与居民经济承载力，为筹资提供物质基础；人口结构子系统（U3）量化老龄化压力与抚养负担，直接决定长期护理需求的刚性程度。三系统通过“筹资水平-经济发展-人口结构”的互动机制，共同构成长期护理保险筹资适宜度的评价核心。见图1。
2.2　耦合协调度指标选取及权重确定
依据耦合协调度模型，并参考我国相关政策文件，选取耦合协调度指标。以《国家医保局财政部关于扩大长期护理保险制度试点的指导意见》（医保发〔2020〕37号）[2]为核心参考政策，将“参保范围扩面”“筹资渠道多元化”“待遇与经济承载力匹配”等政策要点转化为可量化指标。其中，筹资水平子系统（U1）参考陈鹤等[3-4]对长期护理保险资金的分析，提取参保人数、资金收入/支出等核心指标；结合高凯[5]的多层次筹资机制研究，将参保人员缴费水平和人均财政补贴水平纳入责任分担评估。经济发展子系统（U2）拟纳入地区生产总值与增长率作为衡量经济规模与增长潜力的核心指标，借鉴汤薇等[6]对区域财政负担与长期护理保险协同关系的研究，选取地方财政收入/支出、人均可支配收入等指标；同时，纳入第三产业占比用于预测护理服务供给潜力。参考穆怀中等[7]研究，将老年人口比例和老年抚养比作为衡量老龄化压力的核心指标。结合张熠等[8]在研究劳动力流动研究，以在岗职工比例、城镇化率评估劳动力对长期护理保险的支撑潜力。参考张盈华等[9]筹资可持续性研究，采用人口自然增长率评估未来人口结构变化趋势。研究采用熵值法确定权重，该方法基于指标信息熵的大小客观赋权。具体指标及权重见表4。
2.3　综合评价指数计算及耦合协调度判别
基于熵值法所得权重wj，计算三地各子系统指数 Uk（k=1，2，3，分别代表筹资水平、经济发展水平、人口结构，其中q为子系统指标数：
Uk=∑j=1qkwj⋅zj(k=1,2,3,q1=5,q2=7,q3=5)
耦合度C反映子系统间相互依赖程度，C∈[0,1]，值越大表明系统间相互作用越强。
          C=U1U2U3(U1+U2+U33)31/3
协调度D为避免高耦合、低发展、伪协调，取α=β=γ=1/3，T为综合发展指数。
D=C⋅T,T=αU1+βU2+γU3
参考实证研究惯例，将协调度划分为10级协调等级。见表5。
3　长期护理保险筹资水平适宜度实证评价
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本研究实证评价涉及的所有数据均来自课题组实地调研、各样本地区统计年鉴以及各样本地区经济与社会发展统计公报。
3.1　子系统综合指数测度
从子系统综合指数（U1、U2、U3）来看，苏北X市、苏中N市、苏南C市三地呈现明显的区域差异，各系统内部的动态变化与区域经济社会特征存在关联。其中，在筹资水平子系统（U1）方面，N市表现最优且呈稳定增长态势；在经济发展子系统（U2）方面，呈现苏中>苏南>苏北的梯度特征，在人口结构子系统（U3）方面，N市表现最佳。见表6。
3.2　耦合协调度结果判别
从耦合协调度的时序变化来看，协调度均呈现上升趋势，但所处等级与发展阶段存在差异。X市协调度始终处于“轻度失调”等级，均处于颉颃阶段；N市协调度等级从“濒临失调”进阶至“勉强协调”，从“颉颃阶段”发展到“磨合阶段”；C市协调度等级从“轻度失调”过渡至“濒临失调”，颉颃阶段。见表7。
4　讨论
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4.1　制度设计弹性影响筹资可持续性
N市在耦合协调度中表现最优，其核心在于“动态筹资机制”的制度调整。在调研中得知，N市2023年起实行“职工按医保筹资总额3.0%、居民按1.5%”的比例制划转，相较于定额或固定比例划转，其能随医保资金自然增长动态调整，这直接推动其资金收入保持稳定增长。同时，N市财政补助高于X市和C市，个人缴费与财政补助形成合理配比，既避免了“定额划转+依赖医保”的路径依赖，也突破了“职工与居民均定额缴费”的刚性约束[10]。可见，筹资机制的灵活性是平衡需求与供给的关键。
4.2　人口结构的区域差异对长期护理保险造成差异化压力
苏北X市参保人数累计减少21万人，而老年抚养比攀升，背后是劳动力外流导致的筹资供给端萎缩。老年人口比例上升推高失能需求，形成“供给降、需求升”的剪刀差，这也是其耦合度持续下降的核心原因。C市的矛盾在于“人口结构优势未被制度利用”。由于采用定额筹资的办法导致经济与人口优势难以转化为筹资能力，最终呈现“经济子系统（U2）持续提升”与“筹资子系统（U1）上升平缓”的错配。从N市的相对平衡中可以看出，其得益于人口与制度的良性互动：覆盖面广，参保人数稳定，及时动态调整缴费责任，使老年抚养比上升的压力被制度弹性部分消化。
4.3　老龄化需求升级与护理服务供给面临适配性挑战
三市基金支付均呈现“居家护理主导”特征，这与我国老年人“偏好居家照护”的文化习惯一致，但X市、N市医疗机构护理支出两年间均实现规模倍增，随着失能程度加深和慢性病共存，老年人群对医养结合服务的需求日益迫切，但课题组调研中发现专业护理人力资源供给短缺且结构失衡，受访部门负责人表示“招不到人”“招不到合适的人”。如长护险筹集的资金不能有效转化为护理人员的工资报酬提升，就难以吸引和留住足够数量和质量的专业化护理人员，最终导致“有钱付不起服务”的困境。
5　建议
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5.1　建立“比例制+动态调整”的筹资机制
长期护理保险筹资机制的可持续性，核心在于其对人口结构转型与经济周期波动的动态适配能力。筹资标准需与医保资金总量、居民可支配收入等宏观变量建立联动关系。据此，职工长期护理保险可采用“基准比例+弹性调整”模式，从医保统筹资金按年度动态划转，确保筹资规模与风险池同步变化；居民长期护理保险则构建“个人缴费与财政补贴协同”的弹性框架，个人缴费比例与财政补贴占比根据资金中长期支付压力进行动态调整，进而形成“经济上行期个人多担、下行期财政托底”的平衡机制。
5.2　实施基于“经济水平-老龄化程度”二维矩阵的区域差异化策略
为平衡经济承载力与人口压力，研究基于“经济水平-老龄化程度”的二维矩阵，区域优化可采取以下措施：对于高经济-高老龄化地区，通过提高个人缴费占比，降低对医保资金的依赖；对于低经济-高老龄化地区，应强化政府财政的协同托底，同时拓宽社会筹资渠道；对于中等经济-中度老龄化地区，主动优化“医保划转+个人+财政”的三元模式。
5.3　优化支付结构与护理服务供给
护理需求升级已成为制约长期护理保险可持续性的潜在矛盾，支付结构失衡会加剧资金支付压力[11]。基于此，建议优化支付结构延伸至服务供给端改革：一是鼓励专业护理机构、基层医疗卫生机构和家庭照护者等多主体参与，加强对护理人员的职业技能培训，以增强护理服务供给；二是将提高护理人员工资报酬纳入政策考量，规定待遇报销水平与老年照料工资报酬水平相关；三是实施分类支付精细化，对基础生活照料、专业医疗护理、康复服务设定差异化的支付比例，引导资源向核心刚性需求倾斜，以应对护理需求升级带来的供给端挑战。
6　小结
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本研究通过构建“筹资水平-经济发展-人口结构”耦合协调度模型揭示筹资机制设计、区域人口结构与护理需求升级对长期护理保险可持续性的交互影响，为优化长期护理保险筹资政策提供了实证依据。未来应在动态调整机制、区域差异化策略及护理服务供给等方面持续推进制度改革。本研究局限性在于数据时间跨度仅为3年，难以总结更长周期的制度演变规律，后续研究可进一步扩展数据时间范围。

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doi: 10.12102/j.issn.1009-6493.2026.09.009
  • 接收时间：2025-12-23
  • 首发时间：2026-10-28
  • 出版时间：2026-05-10
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  • 收稿日期：2025-12-23
  • 修回日期：2026-03-19
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    1江苏大学管理学院，江苏 212013

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2种不同金属材料的力学参数
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Number of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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