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Abstract

Objective

Since 2016, the Chinese government has been piloting a public long-term care insurance (LTCI) scheme. This study examined whether the LTCI scheme reduced the use of informal care and how this has varied across income groups.

Method

We used data from the 2011, 2014, and 2018 waves of Chinese Longitudinal Healthy Longevity Survey, focusing on community-dwelling older adults aged 65 years and older. We used staggered difference-in-differences analyses with propensity score matching to examine the effects of the policy.

Results

The LTCI scheme reduced the probability and intensity of informal care use by 5.7% (p < .05) and 17.4% (p < .05), respectively. The policy impact was limited to older people in the middle-income group, reducing the probability and intensity of informal care use by 15.6% (p < .001) and 43.1% (p < .05), respectively. We did not find a statistically significant policy effect for older adults with high or low incomes.

Conclusions

The LTCI scheme had different effects on reducing the informal care burden for family caregivers by income level. We suggest that the scheme should entitle people with low incomes to a preferential co-payment rate, thereby enhancing their access to formal care.

Keywords

long-term care insurance informal care use income

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References

Gong

Wang

, et al. Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China health and retirement longitudinal study (CHARLS). Lancet Public Health 2022; 7: e1005–e1013.

. Receipt of informal care in the Chinese older population. Ageing Soc 2018; 38: 766–793.

Feng

. Filial piety and old-age support in China: tradition, continuity, and change. In: Zang

Zhao

(eds) Handbook on the family and marriage in China. Northampton, MA: Edward Elgar Publishing, 2017, pp. 266–285.

Chen

Ning

. The impacts of long-term care insurance on health care utilization and expenditure: evidence from China. Health Policy Plan. 2022; 37: 717–727.

Zhu

Österle

. China’s policy experimentation on long-term care insurance: implications for access. Int J Health Plann Manage. 2019; 34: e1661–e1674.

National Healthcare Security Administration . Statistical bulletin on the development of national healthcare security in 2021. China: National Healthcare Security Administration, https://www.nhsa.gov.cn/art/2022/6/8/art_7_8276.html (2022, accessed 18 October 2022).

Lei

Bai

Hong

, et al. Long-term care insurance and the well-being of older adults and their families: evidence from China. Soc Sci Med 2022; 296: 114745.

Zhang

Zhao

, et al. Impact of formal care use on informal care from children after the launch of long-term care insurance in Shanghai, China. Int J Environ Res Public Health. 2020; 17: 2938.

Chen

Ning

. Public long-term care insurance scheme and informal care use among community-dwelling older adults in China. Health Soc Care Community 2022; 30: e6386–e6395.

10.

Sohn

O’Campo

Muntaner

, et al. Has the long-term care insurance resolved disparities in mortality for older Koreans? Examination of service type and income level. Soc Sci Med 2020; 247: 112812.

11.

Mudge

Denaro

O’Rourke

. Improving hospital outcomes in patients admitted from residential aged care: results from a controlled trial. Age Ageing 2012; 41: 670–673.

12.

Stabile

Laporte

Coyte

. Household responses to public home care programs. J Health Econ 2006; 25: 674–701.

13.

Izuhara

. Social inequality under a new social contract: long-term care in Japan. Soc Pol Adm 2003; 37: 395–410.

14.

Bakx

de Meijer

Schut

, et al. Going formal or informal, who cares? The influence of public long-term care insurance. Health Econ 2015; 24: 631–643.

15.

Yang

Chang

Zhang

, et al. An initial analysis of the effects of a long-term care insurance on equity and efficiency: a case study of Qingdao city in China. Res Aging 2021; 43: 156–165.

16.

Zeng

Vaupel

Xiao

, et al. Sociodemographic and health profiles of the oldest old in China. Popul Dev Rev 2002; 28: 251–273.

17.

Zeng

. Towards deeper research and better policy for healthy aging -using the unique data of Chinese longitudinal healthy longevity survey. China Econ J 2012; 5: 131–149.

18.

Wang

Yang

Avendano

. Income-related inequalities in informal care: evidence from the longitudinal Healthy longevity survey in China. J Gerontol 2021; 76: 1691–1696.

19.

Liu

Yang

. Long-term care insurance’s impact on medicual expenditure-based on synthetic control research on Qingdao case. Insurance Studies 2019; 2: 114–127 (in Chinese)

20.

Citro

Michael

. Measuring poverty, a new approach. Washington, DC: National Academy of Sciences, 2013.

21.

Andridge

Little

RJA

. A review of hot deck imputation for survey non-response. Int Stat Rev 2010; 78: 40–64.

22.

Griffith

Jones

Bor

, et al. Changes in health insurance coverage, access to care, and income-based disparities among US adults, 2011–17. Health Aff 2020; 39: 319–326.

23.

Wang

Lee

. Socioeconomic gradients of cardiovascular risk factors in China and India: results from the China health and retirement longitudinal study and longitudinal aging study in India. Int J Publ Health 2017; 62: 763–773.

24.

Andersen

Newman

. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973; 51: 95–124.

25.

Abadie

Imbens

. Large sample properties of matching estimators for average treatment effects. Econometrica 2006; 74: 235–267.

26.

Rosenbaum

Rubin

. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Statistician 1985; 39: 33–38.

27.

Hollingsworth

Ohinata

Picchio

, et al. The impacts of free universal elderly care on the supply of informal care and labour supply. Oxf Bull Econ Stat 2022; 84: 933–960.

28.

Wang

Kong

, et al. A study on care homes in China. Gerontological Studies 2015; 3: 13–24 (in Chinese).

29.

Zhao

Qian

Shan

. Filial piety, pension policy and changing perceptions of elderly care responsibility: evidence from China. China: An International Journal. 2021; 19: 112–131.

30.

Kim

Kwon

. A decade of public long-term care insurance in South Korea: policy lessons for aging countries. Health Policy. 2021; 125: 22–26.

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Does income matter for the policy effect of public long-term care insurance on informal care use in China? A quasi-experimental study

Abstract

Objective

Method

Results

Conclusions

Keywords

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References

Supplementary Material