Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China

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Abstract

Background

Since the national long-term care (LTCI) policy pilot in 2016 of China, the LTCI policy has had significant impact on the residents in the pilot area.

Methods

From the perspective of medical expenses and health security equity, this study selects tracking survey data from the CHARLS database in 2013, 2015, and 2018 and empirically investigates the effect of LTCI policy pilot by using differences-in-differences method (DID). Moreover, this study measures the economic distribution and health equity of the treated and untreated groups using the concentration and Theil indices.

Results

The results showed that group heterogeneity of medical expenses and health level of elderly in the treatment group were narrowing. Moreover, the policy results showed that the LTCI policy pilot significantly affects the outpatient, hospital expenses, and length of stay of elders. Residence registration, income level, and basic medical insurance play a significant regulatory role. Additionally, LTCI policy pilot significantly improved the overall health of the elderly.

Conclusions

The measurement results of inequality show that the policy increases the income of low-income people, lowers the inequality level of outpatient and inpatient reimbursement, and reduces the concentration index of ADL disability and serious diseases. However, the inequality of serious diseases is becoming higher. Based on this, this paper provides several suggestions on optimizing the pilot policy of LTCI.

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Most cited references 34

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A research agenda for aging in China in the 21st century

Evandro Fei Fang, Morten Scheibye-Knudsen, Heiko J Jahn … (2015)

Highlights • The elderly population in China is growing exponentially and this growth will last for decades. • The aging problem in China is expected to lead to a significant socioeconomic burden which will require a combined effort among gerontologists, healthcare professionals, policymakers, and social forces. • A research agenda on the collection of public health data, diet and food safety, physical exercise, pharmacological interventions in age associated diseases, the elderly and geriatric care, and policy dialogues are potential ways to relieve the aging problem. • Increased political and financial commitments from the Chinese government are critical for achieving a research agenda on aging in China for the 21st century.

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A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

Evandro F Fang, Chenglong Xie, Joseph A. Schenkel … (2020)

Highlights • Covered broad fields of ageing in China: In addition to an update of the statistics of ageing and disease burden, we include basic and translational research, long-term care, policy and social networks; • Provided more detailed numerical updates of the ageing challenges in China (4 Figures, plus one summary figure of Fig. 5). • Some new features of the aging-related challenges which were not mentioned in the 1st edition, are included, e.g., oral ageing and STDs in the elderly in China; and • A new and independent section on immune ageing, covering viral hepatitis, tuberculosis, AIDS, Influenza and Pneumonia in the Chinese elderly. We also mentioned the COVID-19-induced death in the Chinese elderly.

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Long-term care system for older adults in China: policy landscape, challenges, and future prospects

Zhanlian Feng, Elena Glinskaya, Hongtu Chen … (2020)

In China, the population is rapidly ageing and the capacity of the system that cares for older people is increasingly a concern. In this Review, we provide a profile of the long-term care system and policy landscape in China. The long-term care system is characterised by rapid growth of the residential care sector, slow development of home and community-based services, and increasing involvement of the private sector. The long-term care workforce shortage and weak quality assurance are concerning. Public long-term care financing is minimal and largely limited to supporting welfare recipients and subsidising the construction of residential care beds and operating costs. China is piloting social insurance long-term care financing models and, concurrently, programmes for integrating health care and long-term care services in selected settings across the country; the effectiveness and sustainability of these pilots remain to be seen. Informed by international long-term care experiences, we offer policy recommendations to strengthen the evolving care system for older people in China.

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Author and article information

Contributors

Huan Liu:

ORCID: http://orcid.org/0000-0001-8772-1545

liuhuan@zufe.edu.cn

Journal

Journal ID (nlm-ta): Arch Public Health

Journal ID (iso-abbrev): Arch Public Health

Title: Archives of Public Health

Publisher: BioMed Central (London )

ISSN (Print): 0778-7367

ISSN (Electronic): 2049-3258

Publication date (Electronic): 4 January 2022

Publication date PMC-release: 4 January 2022

Publication date Collection: 2022

Volume: 80

Electronic Location Identifier: 3

Affiliations

[1 ]GRID grid.463102.2, ISNI 0000 0004 1761 3129, Zhejiang University of Finance & Economics, ; Hang Zhou, China

[2 ]GRID grid.49470.3e, ISNI 0000 0001 2331 6153, Wuhan University, ; Wuhan, China

Author information

Huan Liu http://orcid.org/0000-0001-8772-1545

Article

Publisher ID: 761

DOI: 10.1186/s13690-021-00761-7

PMC ID: 8725500

PubMed ID: 34983634

SO-VID: efdf7ad1-d804-4dac-876d-9c63f6c6cc4a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 21 October 2021

Date accepted : 11 December 2021

Funding

Funded by: Zhejiang Philosophy and Social Science Planning Project

Award ID: 20NDQN302YB

Award Recipient : Huan Liu

Funded by: National Natural Science Fund of China

Award ID: 71904167

Award Recipient : Huan Liu

Funded by: FundRef http://dx.doi.org/10.13039/501100004731, Natural Science Foundation of Zhejiang Province;

Award ID: LQ20G030018

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ScienceOpen disciplines: Public health

Keywords: long-term care insurance,disability,medical expenses,health level,did

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ScienceOpen disciplines: Public health

Keywords: long-term care insurance, disability, medical expenses, health level, did

Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China

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Most cited references 34

A research agenda for aging in China in the 21st century

A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

Long-term care system for older adults in China: policy landscape, challenges, and future prospects

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