Abstract
BackgroundChina’s long-term care insurance (LTCI) policy has been minimally evaluated. This systematic review aimed to assess the impact of China’s LTCI pilot on beneficiaries and their caregivers.MethodsThis review is based on a search of peer-reviewed studies in English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases from January 2016 through July 2020, with all studies published in English or Chinese included. We included quantitative analyses of beneficiary-level data that assessed the impact of LTCI on beneficiaries and their caregivers, with no restriction placed on the outcomes studied.ResultsNine studies met our inclusion criteria. One study was a randomised trial and two used quasi-experimental approaches. Four studies examined LTCI’s effect on beneficiaries’ quality of life, physical pain, and health service utilisation; one study reported the effect on beneficiaries’ healthcare expenditures; and one study evaluated the impact on caregivers’ care tasks. These studies generally found LTCI to be associated with an improvement in patients’ quality of life (including decreased physical pain), a reduction in the number of outpatient visits and hospitalisations, decreased patient-level health expenditures (e.g. one study reported a reduction in the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively), and reduced informal care tasks for caregivers. In addition, four out of four studies that evaluated this outcome found that beneficiaries’ overall satisfaction with LTCI was high.ConclusionThe current evidence base for the effects of LTCI in China on beneficiaries and their caregivers is sparse. Nonetheless, the existing studies suggest that LTCI has positive effects on beneficiaries and their caregivers. Further rigorous research on the impacts of LTCI in China is needed to inform the future expansion of the program.
Highlights
China is facing a rapidly ageing population, which poses challenges for its healthcare system and society at large
The existing studies suggest that long-term care insurance (LTCI) has positive effects on beneficiaries and their caregivers
Further rigorous research on the impacts of LTCI in China is needed to inform the future expansion of the program
Summary
China is facing a rapidly ageing population, which poses challenges for its healthcare system and society at large. In 2015, there were 143.86 million people aged 65 years or older in China, representing 10.5% of the population. Alongside the rapid growth of the older adult population in China, the number of people with debilitating comorbidities is increasing, from 15.63 million in 2015 to 40 million by 2060.4,5 Non-communicable diseases (NCDs) represent the majority of these comorbidities, including stroke, cardiovascular disease, diabetes, hypertension, Alzheimer’s disease or related dementias and multiple comorbidities,[6,7,8,9,10,11] which result in limitations in their daily activities. The need for long-term care in China is expected to increase rapidly and substantially.[4]. China’s long-term care insurance (LTCI) policy has been minimally evaluated. This systematic review aimed to assess the impact of China’s LTCI pilot on beneficiaries and their caregivers
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