GA4 (398745346)

Professional evaluation + Internet + supervision China Life Insurance carefully polishes the “Jilin model” of long-term care insurance

Professional evaluation + Internet + supervision China Life Insurance carefully polishes the “Jilin model” of long-term care insurance

  The breeze blew in slowly from the window, and on the hospital bed on the second floor of Xinxin Nursing Home in Changchun High-tech Zone,Caregiver Du Jun is giving a body massage to Sun Jiashu (pseudonym), a 72-year-old severely disabled person..

Sun Jiashu, who suffers from Parkinson’s disease and diabetes, was admitted to this nursing home in February last year. Under the careful care of the caregivers, he has been in good condition. When Ms. Zhang, Sun Jiashu’s granddaughter, came to visit, she said: “Disabled elderly people who coexist with multiple diseases need daily care and medical care, which is difficult for ordinary families to provide. Long-term care insurance solves the practical difficulties of disabled patients’ families. My grandfather is here not only With the professional care we receive, the monthly long-term care insurance compensation can also help us reduce our medical care expenses by more than 2,000 yuan.”

It is understood that the hospital is one of the designated medical care institutions in Changchun City. Du Jun, who has 5 years of nursing experience, said, “This is the fourth disabled elderly person we have taken care of this morning. Our work includes 42 basic living items.” Nursing and clinical care services, such as massage, cleaning, expectoration, nasogastric feeding, dressing change, etc. for the elderly.”

Jilin Province is the key province to contact for the pilot program of long-term care insurance

  “If one person is disabled, the whole family will be out of balance.” The issue of basic life care for disabled persons has always been a serious problem plaguing families of disabled persons. The report of the 20th National Congress of the Communist Party of China proposed: “We must improve a multi-level social security system that covers the entire population, coordinates urban and rural areas, is fair and unified, safe and standardized, and is sustainable.” Among them, it is clearly proposed to establish a long-term care insurance system.Long-term care insurance (hereinafter referred to as “long-term care insurance”), as an important institutional arrangement that actively responds to the aging of the population, has become an important part of supporting the health system of the elderly.

Picture: Nursing staff provide care services to disabled elderly people

  In June 2016, the Ministry of Human Resources and Social Security issued the “Guiding Opinions on Carrying out the Pilot of Long-term Care Insurance System” to explore the establishment of a social mutual aid method to raise funds to provide basic life care for long-term disabled people and those closely related to their basic lives. A social insurance system that provides funding or service guarantees for related medical care.Jilin Province has been designated as the key province in contact with the long-term care insurance pilot program, and Changchun City has been listed as one of the first 15 pilot cities in the country. At present, Changchun City, Jilin City, Songyuan City, Tonghua City, Meihekou City, Hunchun City and the provincial government have launched pilot projects in Jilin Province.

Undertakes long-term care insurance business, covering 3.03 million people in Jilin Province

“When I applied for long-term care insurance, I thought that filling out the form would be complicated and the procedures would be tedious. However, under the patient and professional guidance of the staff of China Life Changchun Branch, the process was completed quickly, and the on-site evaluation process was also smooth. It helped us a lot.” The relevant person in charge of the Ivy League Elderly Care Service Center in Kuancheng District, Changchun City commented.

It is understood that since China Life Insurance Jilin Branch obtained the qualification to undertake the pilot work, it has given full play to its professional and technical advantages, adhered to the main line of “innovating management measures and providing considerate services”, and gradually established a “warm and standard” , Supervision” characteristic long-term care insurance management service system. After the pilot work was carried out, a “Jilin model” for the sustainable development of “professional assessment + Internet + supervision” was created.

On December 9, 2022, the Changchun Municipal Social Medical Insurance Administration issued a bidding announcement for long-term care insurance underwriting and business handling services to the public. China Life Insurance Jilin Branch actively fulfills its corporate social responsibilities, assists in the construction of a multi-level social security system, responds quickly and participates in bidding, and successfully wins the first package of long-term care insurance business handling services. The service area includes Kuancheng District, Changchun City, and Changchun City. Changchun New District and Changchun Economic Development Zone. As of September last year, 1.21 million insured people were covered, and a total of 8,621 people enjoyed benefits.

More professional care, less burden on families

“The nursing staff take good care of me, and my quality of life has been greatly improved.” Liu Ping (pseudonym), 68, is very satisfied with her current life. She currently lives in Liguodian, Changchun Changfa Nursing Home. Liu Ping was unable to take care of herself after suffering from cerebral thrombosis. However, since she was admitted to a designated medical care institution in Changchun City, she not only received careful care in her daily life, but also received systematic rehabilitation training with the company of professionals. What makes her even more reassured is that with the long-term care insurance subsidy, she only needs to pay 2,000 yuan for the monthly service fee of more than 5,000 yuan. The rest of the cost is paid by the long-term care insurance of China Life Insurance Changchun Branch, which greatly reduces the family’s financial burden. financial burden.

  Zhang Lan’s (pseudonym) mother has been bedridden for many years.It’s too much for her to take care of herself, and hiring a nanny would be expensive.I had no choice but to send my mother to Xiangzhiyuan Nursing Home in Changchun. At first, Zhang Lan was full of worries, but a few months later, she was pleasantly surprised to find that not only was her mother’s daily life well taken care of, but she also recovered quickly.

“What’s even more rare is that my mother, who used to be alone at home, has become friends with many caregivers, and even has her own nickname, ‘Aunt Lan Lan.'” Zhang Lan said, watching the smile on her mother’s face getting bigger and bigger. The more she feels, the more thankful she is that she made the right choice. “Now, not only do I plan to retire in a professional medical care facility, I also recommend this approach to my relatives and friends.”

Strictly adhere to the “rules and regulations” of evaluation work

  “Can you dress yourself now?” “Can you use chopsticks to pick up food normally when eating?” “Do you need help with urination?”… Wang Yihuan, a front-line evaluator of long-term care insurance, from the Health Insurance Department of China Life Changchun Branch, is here Fill out a disability level assessment form, which includes10She asked a question very carefully, while entering and uploading information through the mobile terminal of her mobile phone.

  “After receiving the application, we will immediately arrange evaluators to go to the nursing home to evaluate the disabled elderly.” Wang Yihuan said, in accordance with the unified standards of the Changchun Municipal Medical Insurance Bureau“Daily Living Activities Ability Assessment Form”An assessment is conducted, and the assessment results are divided into two levels: moderate and severe. Once determined, the elderly can enjoy long-term care insurance compensation accordingly every month.

“In order to ensure that long-term care insurance funds are actually used, there are rules that must be followed for the evaluation basis, evaluation behavior, evaluation methods, etc.” said Guo Liying, manager of the health insurance department of China Life Insurance Changchun Branch.

  It is understood thatIn accordance with the requirements of the Changchun Municipal Medical Insurance Bureau, the insured’s condition will be comprehensively assessed and scored through on-site physical examination and questioning of nursing staff. Through scientific and fair assessment methods, we ensure that disabled people can enjoy timely benefits and ensure the safe use of care funds.

Picture: Nursing staff provide care services to disabled elderly people

“Adhering to a professional attitude and approach, we will do a solid job in piloting the long-term care insurance system so that good policies can better serve the people.” A relevant person from the Jilin Branch of China Life Insurance said, “We will build on the existing experience and We will continue to optimize and facilitate the service process, continue to work hard on refinement and standardization, and further shorten the evaluation time.”

  During the implementation process, China Life Insurance Jilin Branch adhered to a problem-oriented and goal-oriented approach to optimize the entire process management of long-term care insurance evaluation.In terms of team building, the company has established a professional service team of 20 people, 15 of whom are medical and nursing professionals, who provide professional assessment services.

  “Evaluators must pass professional examinations and hold certificates to work. Three evaluators must come to the door at the same time, and at least one of them must beMedical and nursing professionals“Wang Yihuan said.

At present, the evaluation timeliness has been shortened to 5 working days. The evaluation team evaluates the insured person according to the process of on-site physical examination, checking the information of the insured person, and recording the video. For insured persons with poor physical condition and severe mood swings, the assessment will be based on a combination of on-site conditions and viewing of surveillance videos.

  Carry out comprehensive and systematic training for designated service agencies to ensure that care services are promoted in high-quality dimensions of standardization, standardization, and professionalism.“The provincial company will regularly conduct training and assessment for more than 400 caregivers who are registered and certified by the Medical Insurance Bureau. Institutions and individuals that cannot provide high-quality services will be eliminated. Ensure that every disabled person can enjoy high-quality care service.” said a relevant person from China Life Insurance Jilin Branch.

“Internet + Supervision” to maintain the bottom line of fund safety

In order to meet the diverse needs of long-term care insurance participants, China Life Jilin Branch relies on the “Changchun Care Service Smart System” platform built by the Changchun Social Medical Insurance Administration to implement appointment applications, health assessments, video uploads, etc. The entire business process is handled online. At the same time, the entire chain of business processes and the behaviors of each business entity are included in the monitoring, and supervision functions such as pre-appointment, in-process supervision, and post-event follow-up visits are embedded to maintain the bottom line of fund safety through “Internet + supervision” means.

“During the undertaking, our company re-evaluated all disabled people in hospitals in Jilin City, and eliminated a total of 1,202 people who were not qualified for assessment, died or left the hospital, effectively reducing unreasonable expenditures on long-term care funds and ensuring the safety of long-term care funds.” Chen Li, manager of the health insurance department of China Life Insurance Jilin Branch, said.

Guo Liying said, “In 2023, we will be responsible for undertaking long-term care insurance business involving 24 designated elderly care institutions, 7 designated home service institutions and 3 short-term designated care hospitals in the Changchun area. As of the end of June 2023, a total of 876 people have been evaluated .”

For insured persons who have passed away or who need to be hospitalized for emergency treatment, the insured persons will be evaluated by reviewing surveillance videos, and after passing the review, they will be notified in a timely manner to designated elderly care institutions for enrollment and fee settlement.

In addition, while ensuring that disabled persons can enjoy long-term care insurance benefits, China Life Insurance Jilin Branch has also strengthened risk management and control of home care services and ensured that insured persons can enjoy normal benefits through on-site inspections.

Explore better solutions for the implementation of long-term care insurance system

  The implementation of the long-term care insurance system in the pilot areas of Jilin Province has reduced the care burden and financial pressure of many ordinary families and improved the quality of life of disabled and semi-disabled elderly people.Created by China Life Insurance Jilin Branch“Professional Assessment + Internet + Supervision”The model provides professional assessment for long-term care insurance, provides personalized warm services, and improves the quality of life of the disabled and demented elderly. At the same time, from urban workers to urban and rural residents, from home care to rehabilitation treatment in nursing homes, from solving medical care to ensuring life care, a “Jilin Model” of sustainable development has been created to formulate application, assessment, service, settlement, and supervision and other full-chain institutional systems, promoting the management level and service quality of long-term care insurance in Jilin Province to gradually become standardized and refined, supporting the “protective umbrella” for disabled and demented elderly people, and writing a “new answer sheet” for the development of high-quality people’s livelihood.

  In the process of implementing and improving the long-term care insurance system, China Life Insurance Jilin BranchWe always regard “serving people’s livelihood and serving society” as our development mission.Adhere to the origin of insuranceparticipate in the construction of the social security system in an all-round and multi-level manner, and implementActively respond to the national strategy of population aging, improve and implement policies in detail, and promote the long-term care insurance system pilot to be stable and practical.We are committed to giving the people of Jilin a greater sense of happiness, security and gain by providing more comprehensive insurance protection services.

Source link