Care Insurance Research Articles

Forecasting Financial Expenditures for Long Term Care Insurance Evidence from the Typical Pilot Cities in C

Purpose: This study aims to provide decision-makers with a reference by predicting the financial expenditures and trends of long-term care insurance in China over the next thirty years. Approach/Methodology/Design: This study employs Markov chains and overall simulation model to forecast the extent of financial expenditures on long-term care for employees and residents. It examines the financial outlay levels under various entitlement payment scenarios and estimates the discrepancies in financial expenditures between employees and residents from 2021 to 2050. Findings: The results show that (1) The number of disabled elderly employees aged 60 and above will be about 14,288 thousand, and the number of disabled elderly residents will be about 68,176 thousand in 2050. (2) Under the low scenario, the financial expenditures of elderly employees and residents in 2050 will reach 29,636.87 million yuan and 17,597.92 million yuan respectively, which are 2.86 and 10.24 times as much as those in 2021. The total financial expenditures under the medium and high scenarios will be 2.38 and 5.51 times as much as those under the low scenario respectively. (3) The scale of financial expenditure on long-term care insurance for residents far exceeds that of employees, and the trend is expanding. Practical Implications: This study may provide theoretical support for the full implementation of long-term care insurance policies. Originality/value: This study uses Markov models and overall simulation models, along with typical representative plans from pilot areas in China, to differentiate the insurance identity of elderly employees and residents and to estimate the scale and trend of financial expenditures for long-term care insurance in China from 2021 to 2050.

Preference of urban and rural older people in Shandong Province for long-term care insurance: based on discrete choice experiment.

Severe population ageing and weak long-term care support systems has spurred China's pilot program for long-term care insurance (LTCI). This study aimed to provide references for optimizing long-term care insurance policies in Shandong Province by measuring the preferences of urban and rural older people for LTCI. Based on the discrete choice experiment, a questionnaire survey was conducted on urban and rural older people from Shandong Province. A mixed logit model was used for data analysis and the relative importance of attributes, willingness to pay, and preference heterogeneity based on residence type, number of children, chronic conditions, gender, education level and financial situation were further estimated. The results showed that individual premium, reimbursement rate and whose provision of home-based care can be reimbursed had a significant effect on the LTCI preference of urban and rural older people in Shandong Province. Benefit package and government subsidy lost statistical significance in full sample but played a role in certain subgroups. There were also differences in preferences for individual premium among different groups of older people. Optimizing the policy design of long-term care insurance based on the actual needs of the older adults can help increase the utility of them and promote the smooth implementation of long-term care insurance.

Research on the evaluation and optimization path of long-term care insurance policy in Chengdu and Chongqing--Based on the PMC index model

This paper applies the quantitative method of policy text to construct an evaluation index system based on the PMC index model to quantitatively evaluate the long-term care insurance policies introduced in Chengdu and Chongqing since 2017. The study finds that long-term care insurance policies have dilemmas in terms of policy subjects, policy areas, and policy tool combinations. The direction of future policy optimization should strengthen collaboration between departments; focus on the development of weak policy areas; and optimize the combination of policy tools.

간병보험 약관의 ‘보험기간 중 보험사고 발생’ 조항에 대한 해석론 - 대법원 2023. 10. 12. 선고 2020다232709, 232716 판결의 평석

The Supreme Court recently rendered a decision on the interpretation of the “occurrence of an insured event during the insurance period” clause in the terms and conditions of long-term care insurance. In this decision, the Supreme Court applied various rules of standard form contract interpretation to lay out a detailed theory of interpretation. As the insurer's liability to pay insurance benefits arises only if the insured event specified in the insurance contract occurs during the insurance period, the determination of whether the insurer’s liability has arisen must be preceded by the interpretation of the “occurrence of an insured event during the insurance period” clause in the insurance terms and conditions that constitute part of the insurance contract. If one finds the grounds for which insurance terms and conditions are binding on the contracting parties in the parties’ mutual agreement, the general principles of legal acts, i.e., contracts, interpretation are applicable to the interpretation of insurance terms and conditions. Additionally, the various rules of standard form contract interpretation specifically provided for in the Act on the Regulation of Terms and Conditions are also applicable. In the case addressed by this article, the Supreme Court’s interpretation of the disputed clause in the long-term care insurance terms and conditions differed from that of the lower and appellate courts. The Supreme Court, adhering to principles of contract interpretation, focused on the wording of the clause in question while also considering the context, including the purpose and intent of long-term care insurance, trade practices and other relevant factors. The Supreme Court further applied the principle of objective interpretation, rooted in the principle of good faith as stipulated in the Act on the Regulation of Terms and Conditions. Consequently, the Supreme Court interpreted the clause stating insurance benefits are payable “if the insured is recognized as eligible for long-term care insurance benefits during the insurance period” to mean that insurance benefits are payable “if the insured receives a long-term care rating from the assessment committee during the insurance period,” in accordance with the wording of the clause. Furthermore, the Supreme Court determined that this interpretation did not violate the principle of good faith beyond the limits of private autonomy, thus ruling out the complete nullification or partial nullification, i.e., validity-preserving interpretative reduction, of the clause. Based on this interpretation, the Supreme Court ruled that if the insured was assessed with a long-term care rating after the insurance period terminated due to the insured’s death, the insured event could not be considered to have occurred during the insurance period, even if it was confirmed that the insured was in a state requiring long-term care during the insurance period, and therefore, the insurer's liability to pay insurance benefits did not arise. This court decision is significant as it is the first to establish a specific interpretation theory for the “occurrence of an insured event during the insurance period” clause in long-term care insurance policies. Given that many long-term care insurance products currently on the market have clauses with similar structures and content, the standards and interpretation methods from this decision are expected to apply to future disputes relating to the insurer's liability to pay insurance benefits under such contracts. Moreover, the court decision is meaningful in that it clearly delineates the limits of validity-preserving interpretative reduction or modifying interpretation.

Cost analysis review of a patient navigator and fecal immunochemical testing on colorectal cancer screening in an underserved population

BackgroundColorectal cancer screening is a critical preventative service and part of routine patient care, yet a substantial portion of the population fails to undergo recommended screening.AimsTo investigate the impact and cost-effectiveness of a patient navigator on colorectal cancer screening via fecal immunochemical testing.MethodsDesign: retrospective analysis investigating structured outreach via a dedicated patient navigator. Location: Center for Primary Care, Rhode Island Hospital’s primary safety-net clinic for adult patients in Providence, Rhode Island. Timing: the study ran between 01/2017 and 12/2021, with the intervention introduced 01/2021.ResultsThis study included 3542 patients. The intervention improved completion rates from 64.7 to 74.5% at 1 month (HR 1.12, 95%CI [1.003–1.243]), 73.7% to 90.1% at 3 months (1.28[1.156–1.410]), and 87.8 to 98.8% at 1 year (1.36 [1.239–1.498]). Overall, completion rates were improved by 38.5% (1.39[1.260–1.522]). Total cost of colorectal cancer screening per patient was decreased by $874.18 in the post-intervention group ($72.0 ± 383.3 vs. $946.1 ± 1873.5, p < 0.0001).ConclusionsIn this retrospective analysis, our targeted intervention improved fecal immunochemical testing kit return rates and significantly reduced screening costs. The addition of a dedicated patient navigator is critical to ensuring compliance with screening guidelines, particularly for deprived and/or medically underserved populations. Health care systems, insurance companies and payers, and state health departments should actively and consistently support this role, as it will allow fecal immunochemical testing to reach and risk-stratify more patients, increasing the yield of colonoscopy for detecting advanced neoplasia and cancer and subsequently reducing pressure on endoscopy centers.

Consumer behavior and healthy food consumption: quasi-natural experimental evidence from Chinese household participation in long-term care insurance

IntroductionThere is a strong link between consumer behavior and healthy food consumption. However, how to narrow the gap between consumption intentions and actual healthy food consumption is still under discussion.MethodsThis study takes Chinese families as the research object, based on the family participation in long-term care insurance (LTCI) policy, and constructs an analytical framework including healthy eating behavior, food consumption, and insurance system to discuss how to narrow the gap between consumption intention and actual healthy food consumption. In addition, the intermediary role played by the risk prevention mechanism is also analyzed. Based on data from the China Health and Nutrition Survey (CHNS), this study uses a difference-in-differences analysis framework to empirically examine the impact of changes in consumption behavior on healthy food consumption after households participate in the LTCI pilot.Results and discussionThe research results show that implementing LTCI can increase the frequency of healthy meal preparation methods by 0.045 units and the frequency of not including processed foods in the meals of households participating in the policy by 0.033 units compared with households that do not participate. The daily meal quantity is increased by 0.198 (converted to 1.219 grams), and 0.198 units increase the healthy food consumption structure. This conclusion holds under a series of robustness tests. Mechanism test shows that LTCI affects healthy food consumption through risk prevention mechanisms. The impact of the LTCI policy will also not be affected by similar competitive policies. The heterogeneity test further proves that LTCI policies are more likely to increase healthy food consumption among urban households, larger households, and households employed in private enterprises. Based on these findings, it is recommended that families participate in LTCI to reduce the financial stress faced by families due to illness and care needs while increasing the demand for and consumption of healthy foods. The findings also provide a valuable reference for current policy formulation on improving family dietary quality in China.

Long‐term care and myopia: Optimal linear subsidies for private insurance

AbstractThis paper studies optimal linear policy directed at private long‐term care insurance in the context where individuals are myopic, that is, underestimate their dependency risk. Without government intervention, myopic individuals underinsure, while the first‐best optimum requires full insurance. To decentralize the first‐best, one needs personalized linear subsidies on private insurance premiums combined with personalized lump‐sum taxes to finance these subsidies and redistribute resources among individuals. In the second‐best setting where only uniform instruments can be used, the determination of the optimal insurance subsidy rate includes three main considerations: standard efficiency concern, correction for myopia, and redistributive concerns. While the correction for myopia pushes for a higher subsidy rate, the analysis of the redistributive concerns is far less straightforward. Overall, the redistributive concerns depend on three main factors: whether wealthier individuals are less myopic, how the probability of dependency varies with wealth and what is the type of absolute risk aversion exhibited by individual preferences.

Long-run consequences of informal elderly care and implications of public long-term care insurance

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany’s public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

Difficulties and Solutions in Caring for Cognitive Disorders in Elderly People with Dementia from the Perspective of Social-ecological System Theory

With the deepening of population aging, the increasing population of cognitively impaired older adults in China has put forward an urgent demand for professional cognitive care. In the context of long-term care insurance policy, this paper will take R agency as an example and construct an analysis framework based on the social-ecological system theory at three levels: micro-system, meso-system, and macro-system. It will analyze the physiology and psychology of dementia elderly from inside to outside, how the sentinel care agency collaborates with the sentinel assessment agency, family, and community, how the LTCI policy support and financial support affect the cognitive intervention for cognitively impaired elderly, to promote the healthy operation of the care ecosystem, analyze the dilemma, summarise and put forward the optimization strategy, and provide the experience of providing care services for other aged care service agencies.

Effect of long-term care insurance policy on depression in non-disabled people: evidence from China

BackgroundPolicy effect might be multidimensional and spill over to non-recipients. It is unclear how the implementation of Long-Term Care Insurance (LTCI) policy affects depression in non-disabled people and how this effect differs in different non-disabled groups.MethodsUsing time-varying differences-in-differences method and nationally representative health survey data in wave 2011, wave 2013, wave 2015 and wave 2018 from the China Health and Retirement Longitudinal Study, we assessed the effect of LTCI policy on depression in non-disabled people aged 45 years and older, and discussed the heterogeneity of effect across different population characteristics: retirement, financial support and social participation status.ResultsWe found LTCI policy statistically significant reduced depression by 0.76 units in non-disabled people compared to non-pilot cities. Depression in non-disabled people who unretired, with financial support and without social participation was reduced by 0.8267, 0.7079 and 1.2161 units, respectively.ConclusionsDepression in non-disabled people was statistically significant reduced because of LTCI policy in China, and non-disabled people who unretired, with financial support and without social participation benefited more from LTCI policy. Our findings highlight the depression-reducing effect of LTCI policy in non-recipients and suggest that non-disabled people who unretired, with financial support and without social participation should be concerned during LTCI policy progress.

Evaluation of China's long-term care insurance policies.

In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.

Value of Knowing following Amyloid PET Results Disclosure in Mild Cognitive Impairment

AbstractBackgroundPersonal utility is commonly cited as a rationale for Alzheimer’s disease (AD) biomarker testing. Yet, limited reports document how the value of knowing one’s AD biomarker status manifests in cognitively symptomatic patients. Emerging literature suggests two potential dimensions to the construct: a) inherent value, or “knowledge for the sake of knowledge,” and b) value of knowing as a basis for action. We describe actions taken by patients following amyloid PET results disclosure with the goal of elucidating the value of knowing AD biomarker status in cognitively symptomatic populations.MethodWe analyzed longitudinal health behavior assessments completed by patients with mild cognitive impairment who learned of being amyloid positive (n = 12), negative (n = 22), or assigned to a comparison group (n = 37). Patients were 92% non‐Hispanic white, 59% male, 73±8.61 years old with 16.25±2.49 years of education. Qualitative interviews supplemented scan group participants’ data. Both questionnaires and qualitative interviews focused on activities newly adopted to promote cognitive health or plan ahead.ResultOver 12 months of follow‐up, all participants reported at least one behavior change from baseline. Amyloid positive patients reported the most behavior changes (mean = 4.67/14±1.83) while amyloid negative patients reported the fewest (mean = 3.72±1.58). Across groups, no significant differences were observed in changes to: lifestyle, vitamin/supplement use, stress reduction activities, cognitive stimulation, and advance directive completion. Amyloid negative participants were significantly less likely than controls to consider long‐term care insurance (63.6% vs. 89.2%; P = .025), and to endorse changes classified as “other” (36.4% vs. 64.9%; P = 0.037). After adjusting for education level, gender, and MMSE, logistic regression showed that amyloid negative patients were 74% less likely than controls to report “other” changes (OR = 0.26, 95% CI [0.08, 0.85], P = 0.025), and 78% less likely to consider long‐term care insurance (OR = 0.22, 95% CI [0.06, 0.86], P = 0.03). Qualitative analysis yielded insight into “other” activities, including changes in employment, driving, and residential status, and engagement in other non‐medical activities (pursuing bucket list activities and mending strained relationships), particularly among amyloid positive patients.ConclusionValue of knowing one’s amyloid status may differ by scan result and encompass a wide range of actions to enhance not only cognition but quality of life.

Pelaksanaan Perjanjian Kerjasama Antara Rumah Sakit Umum Daerah Palembang Bari dengan PT. Asuransi Inhealth Kesehatan

The purpose of this paper This research focuses on the implementation of cooperation between Palembang BARI Regional General Hospital (RSUD) and PT. Health Inhealth Insurance in the context of health services and the provision of drugs for insurance participants. Normative legal research methods with e-explanatory approach are used, with a legal approach and a concept approach to investigate how cooperation agreements are implemented and what obstacles are faced. Secondary data are taken as sources of information and analyzed using qualitative data analysis techniques. The results show that the cooperation agreement has fulfilled the provisions in Article 1320 of the Civil Code, but there are several obstacles in its implementation. These obstacles include the difficulty of changing the standard clauses of the agreement, the lack of specific regulations on the implementation of cooperation agreements, and the lack of online integration between the hospital system and PT. Health Inhealth Insurance. This research hopes to help improve the quality of cooperation between health care facilities and insurance companies.

Influences of long-term care insurance on pulmonary and urinary tract infections among older people with disability.

Pulmonary infection (PI) and urinary tract infection (UTI) have been the most common cause of hospitalization and most frequent infection respectively in older people with disability (OPWD). Long-term care insurance (LTCI) policy, intending to provide services to reduce the disease burden of OPWD, it remains unclear whether LTCI could reduce PI-, and UTI-related hospitalizations. This quasi-experimental study aimed to assess the influences of LTCI on all-cause, especially PI- and UTI-related hospitalizations among OPWD and the variation across sociodemographic characteristics. 32,120 participants in the Chengdu Long-term Care Insurance cohort were considered the intervention group, and 2,704 not covered by the LTCI were in the control group. A total of 3,134,160 hospitalization records were collected between January 2014 and June 2021. A doubly robust difference-in-differences (DID) method was used to estimate the average treatment effect on the treated (ATT), indicating the average effect of LTCI on intervention group. The average monthly all-cause, PI-, and UTI-related hospitalization rates were 16.3%, 4.0% and 0.5% in the intervention group, respectively, and were 19.3%, 3.9% and 0.5% in the control group, respectively. Under LTCI, all-cause (ATT [95% CI]: 7.15% [6.41%, 7.88%]), PI- (3.25% [2.76%, 3.74%]), and UTI-related hospitalizations (0.46% [0.28%, 0.64%]) were decreased. The influences of LTCI became significant after 5 months since the LTCI implementation and remained stable over time. The impact was more pronounced among those with longer coverage. The overall reduction was stronger in those who were not married, lived alone, and resided in institutions. LTCI may reduce the occurrence of all-cause, PI-, and UTI-related hospitalizations in OPWD, with stronger influences observed over an extended period of implementation. The implementation of LTCI can play a role in reducing the burden of infectious diseases in OPWD and the care burden of families and society.

노인 돌봄의 전문성 향상을 위한 인력정책 비교연구: 독일, 일본, 한국을 중심으로

labor policy among the long-term care insurance policies for the elderly in Germany, Japan, and Korea. To this end, previous studies examined changes in the policy environment and the framework of policy calculation in the global historical trend of elderly care policies in countries that first experienced an aging society. As a result, various policies appeared from country to country between tax-based care and social insurance-based care. Germany and Japan, which first chose the same route as Korea, advanced the professionalism of care workers, while dualizing them into auxiliary workers at the level of daily care. Strengthening the professionalism of elderly care workers is a must-achieve goal in the long run, but it can be seen that various real conditions have also been linked to an important part of the elderly care labor policy. Based on this study, suggestions were included at the level of policy, education, and medical care institutions. First, at the policy level, the minimum line should be maintained in the professionalism of caregivers. Second, at the educational level, it is necessary not only to deliver knowledge and skills, but also to build the pride of care workers. Third, even if it is not a salary, at the medical care institution level, if expertise is developed and awareness is raised through self-education and the possibility of promotion, the effect of long-term tenure can be seen.

Building a welfare system through bounded learning: A case of Korean long‐term care insurance

AbstractThis article verifies three conditions in its aim to confirm the influence of Japan's experience on the introduction timing and policy model of South Korean long‐term care insurance (LTCI). First, the LTCI systems in Korea and Japan agree in terms of their core principles. Both are based on a separate social insurance system and ensure financial sustainability at the expense of service quality in response to the need to elevate expenditure. Second, the policymaking process reveals the reference relationship between the two systems. The advocacy coalition for LTCI suggested introducing an LTCI based on Japan's experience. However, their rationale was constrained due to the bounded rationality of policy learning. Finally, this article demonstrates that the rival arguments cannot completely explain the introduction of the Korean LTCI without considering the bounded learning argument. Consequently, the results of this study indicate that policy learning is critical to welfare development in latecomer welfare states.

Should Medical Insurance Review Serve the Patient's Best Interests? Examples and Considerations Illustrated by Behavioral Health Cases.

Physician medical directors working for health care insurance companies conduct utilization reviews, participate in quality-of-care reviews, and adjudicate appeals. As a result, they have access to substantial and important clinical information. The medical director may have both current and historical information that can assist the treatment team in providing care. Sharing this information with a patient's current health care provider(s) is problematic due to concerns about patient privacy and the insurer's goal of not assuming legal liability for patient care. While this paper considers legal issues, it predominantly addresses the ethical responsibilities of medical directors who have valuable information unavailable to or unrecognized by the treatment team. Although it is important to consider sharing general medical information, this paper emphasizes the sharing of behavioral health information, which can be highly sensitive but also pertinent to psychiatric and other medical treatment choices. We suggest that clinical information should flow from insurer to provider when the insurer has information that will benefit the patient or prove crucial to optimal care rather than just flow from provider to insurer for the purposes of claims payments. To support and secure that flow, the paper outlines procedures for determining the need to share information, the means of providing that information, ways to separate liability, and processes for protecting privacy.

Lapses in Long-Term Care Insurance.

About a quarter of long-term care insurance (LTCI) policy holders aged 65 let their policies lapse prior to death, forfeiting all benefits. We find that lapse rates are substantially higher among the cognitively impaired in the Health and Retirement Study. This generates a pernicious form of dynamic advantageous selection, as the cognitively impaired are more likely to use care. Simulations show that an inappropriately optimistic asset drawdown path further increases the individual welfare cost of unanticipated lapses. Meanwhile, we find evidence of a significant but very small role for either strategic or financial motives for lapsing.

Does long-term care insurance reduce the disability among middle-aged and older adults? Evidence from China

This study aimed to examine whether the implementation of Long-Term Care Insurance (LTCI) policy could reduce the disability among middle-aged and older adults in China, and to test the heterogeneity of the effects. Data came from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). The Difference-In-Differences (DID) method and the panel data fixed effect model were used to estimate the effect of implementation of LTCI policy on disability among individuals aged 45 years and above. The LTCI policy had a positive impact on reducing disability among middle-aged and older people. Females, younger adults, city dwellers, and individuals living alone benefited the most from LTCI policy. The results provided empirical evidence for the implementation of LTCI policy in China and other similar countries as China. The implementation of LTCI policy should also pay more attention to inequity of the effects on reducing disability among different demographic groups.

Integrating familial care and extra‐familial care into a new long‐term care policy for China: Examples from Germany's long‐term care insurance

AbstractRapid demographic ageing constitutes a significant challenge for the Chinese social system. As China has only recently begun developing a long‐term care (LTC) policy, care provision is currently based on family care. However, the prevalence of such care is declining due to low social recognition and conflicts between family members' care and work responsibilities. Thus, a comprehensive LTC policy should expand extra‐familial care services and make family care attractive. Germany's LTC insurance is an example of a policy that integrates extra‐familial and family care. This study analyses whether China's LTC policy can gain insights from Germany's LTC policy in view of the findings from Chinese LTC pilot projects. We argue that a policy that supports extra‐familial and family care would facilitate the LTC provision preferred by older people, while also supporting relatives who wish to provide care according to their values of intergenerational solidarity.