Sunshine Life: Continuously optimizing long-term care insurance handling and service capabilities to help disabled people “age well prepared”

The establishment of a long-term care insurance system is a major decision-making arrangement made by the Party Central Committee and the State Council to actively respond to the aging of the population. It is also a major institutional arrangement to make up for the shortcomings of the social insurance system. Starting in 2022, Sunshine Life will begin to undertake the pilot work of the long-term care insurance system in four districts and counties in Chongqing, providing funds or service guarantees for basic life care and medical care closely related to basic life for long-term disabled people. Under the guidance of the Banan District Medical Insurance Bureau, Sunshine Life continues to optimize its long-term care insurance handling and service capabilities. It has now established a full-chain system of application, evaluation, service, settlement, and supervision, and was awarded the “2023 Chongqing Deepening Annual Typical Cases of Medical Reform”.

Deeply embedded in the pilot work of long-term care management

　　in the endIn August, Duan Jiali, a staff member of Sunshine Life Chongqing Branch in the Banan District Medical Insurance Bureau, entered the applicant’s file, then opened the chat dialog box on her mobile phone and began to answer questions one by one about Mr. Tang’s long-term care insurance in Wuxi City, Jiangsu Province. Report consultation questions.

After Mr. Tang’s father retired in Banan, he lived with Mr. Tang in Wuxi. In February this year, his father was hospitalized due to a stroke and has not been able to regain his mobility. “If you are severely disabled continuously for more than 6 months, you can apply for long-term care insurance.” Duan Jiali explained patiently while carefully checking the electronic information sent by Mr. Tang, hoping to shorten the application time as much as possible.

Since undertaking the pilot work of the long-term care insurance system, Sunshine Life Chongqing Branch has adopted a co-location office model to take root in 4 districts and counties to carry out handling work. It has zero distance and face-to-face contact with the general public to explain policies, accept assessments, review benefits, etc., and strive to open up long-term care insurance. The “last mile” of handling services allows the people to enjoy more efficient and convenient public services. At the same time, it actively participates in the “Mutual Recognition of Conclusions of Long-term Care Insurance in Chengdu and Chongqing Off-site Assessments” project, making it a “standard feature” for residents of the two places to have more data and less errands for the public. Actively participated in the “China Health and Elderly Care Tracking Survey” project, assisted the project team in efficiently and accurately collecting high-quality micro-data, promoted research on aging issues, and received a letter of thanks from the project team.

One stop for two-way travel from assessment to care

In Banan District, a full-coverage “15-minute” long-term care insurance handling service circle has been established, consisting of 1 handling window, 1 training base, and 23 community service points. At the same time, the Banan District Joint Office also assisted in promoting Banan District People’s Hospital and Banan District Second People’s Hospital to become long-term care insurance evaluation agencies, spawning 23 professional nursing institutions in the local area, further improving the quality and quality of long-term care insurance supply The service level allows long-term care management services to continuously extend to the “nerve endings”, helping to improve the quality and efficiency of the entire process of long-term care insurance.

“What did you eat today?” “Do you know what season it is now?” “Can you go to the toilet by yourself?”… Assessment expert Li Yunhui will carefully ask dozens of questions covering daily life cognition, perception and communication skills, and Observe the elderly man’s reaction; on the other side, evaluator Wang Dan is checking the elderly man’s hospitalization medical records and discharge summary, and taking photos to save them so that he can provide more targeted services in the future.

Since the pilot, the Banan District Office has always adhered to a problem-oriented and goal-oriented approach, and continued to optimize the management of the entire long-term care insurance assessment process. “After receiving the application, we will promptly arrange evaluators to evaluate the disabled persons. If the evaluation results meet the severe level, you can choose three types of care subsidies: home, home, and institutional. We will also implement dynamic management of the evaluation results. Arrange re-evaluation and adjust the corresponding levels according to the actual situation. While conducting efficient evaluation, ensure that the long-term care insurance funds are actually used.” said Wang Dan, head of the Banan District Joint Office.

After hanging up their work badges and wearing masks, at 8 a.m., Zhao Hailing and Ruan Renping arrived at Guangyi Street Community, Lianhua Street, Banan District, and knocked on the door of Zhao Lu and Chen Guanglao’s home. After some pleasantries, Zhao Hailing bent down and carefully carried the two elderly people, who were over ninety years old, from the bedside to the sofa in the living room. After Xiao Ruan, who has experience as a nurse, assessed the old man’s basic physical condition that day, the two of them wiped the old man’s body, shaved his beard, and cut his nails… Each home-based care included 24 basic daily care and clinical care services. As a nursing provider, Zhao Hailing had five elderly people in need of care that day, and her schedule was fully booked.

“I feel better now, so I still have to go out and play.” While Zhao Hailing was busy working, she did not forget to chat with the old man. After hearing this, Chen Guang responded slowly: “You have to go out and play.” Regarding this, his son Zhao Ning often lamented, “What she does is much more meticulous than us.” After the three hours of nursing, Zhao Ning did not To pay any fees, the one-time home care fee of 50 yuan per person will be fully paid by the long-term care insurance fund.

At present, there are more than 600 nursing service personnel like Zhao Hailing in Banan. Relying on the advantages of local hospital nursing talents, the Banan Office organizes nursing staff to participate in training from time to time to improve the scientific nature of the nursing process, the standardization of operations and the service. Due to the professionalism, more and more people now choose home care from professional institutions, and disabled families have also experienced an improvement in their quality of life due to professional care.

Serve the people wholeheartedly and build a strong network for nursing care protection

In February this year, Wang Dan, the head of the Banan District Joint Office of Sunshine Life Insurance Chongqing Branch, received an abnormal message pushed by the big data supervision system. “Liu Pu, the recipient of the benefits, has not been in bed for more than 8 hours a day for a week. His physical condition may have changed.” Wang Dan quickly reported the situation to the Banan District Medical Insurance Bureau and observed it in real time through the “Smart Long-term Care Management System” Relevant data, and finally combined with expert opinions, determined that the old man’s physical condition had improved.

Liu Pu, 79, started applying for long-term care insurance in January this year. Since Liu Pu lived with his son in Beijing after his retirement, in order to more accurately assess the elderly’s disability level, a set of intelligent monitoring equipment was sent out immediately upon receiving the elderly’s declaration. “This set of equipment uses a sleeping mat as a sensing device. By entering relevant information of the applicant in advance, it can sense and record movements such as turning over at any time when lying in bed, and transmit the data back to the supervision platform in a timely manner.” Wang Dan introduced that this set of equipment is Connected to the “intelligent long-term care management system”.

Through this system, physical changes of disabled persons can be discovered in a timely manner, and dynamic assessments and determinations can be made based on the actual situation to ensure the normal use of long-term care insurance funds.

Since the start of the handling work, the staff of the Banan District Joint Office have actively assisted the Banan District Medical Insurance Bureau to strictly supervise the use of long-term care insurance funds, establish and improve comprehensive supervision mechanisms such as online supervision, offline investigation, and industry supervision, and eliminate fraud , service discounts and other phenomena to prevent long-term care insurance funds from “running and leaking”. Only by continuously optimizing and upgrading the whole chain system of long-term care insurance can the disabled people truly realize “prepared aging”.

(The names of the disabled elderly people and their family members in this article are pseudonyms)

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