Implementation Of Long-term Care Insurance Research Articles

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.

Long-term care needs and hospitalization costs with long-term care insurance: a mixed-sectional study.

With the rapid aging of the population, the health needs of the older adult have increased significantly, resulting in the frequent occurrence of the "social hospitalization" problem, which has led to a rapid increase in hospitalization costs. This study investigates whether the "social hospitalization problem" arising from the long-term care needs can be solved through the implementation of long-term care insurance, thereby improving the overall health of the older adults and controlling the unreasonable increase in hospitalization costs. The entropy theory was used as a conceptual model, based on data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. The least-squares method was used to examine the relationship between long-term care needs and hospitalization costs, and the role that long-term care insurance implementation plays in its path of influence. The results of this study indicated that long-term care needs would increase hospitalization cost, which remained stable after a series of tests, such as replacing the core explanatory variables and introducing fixed effects. Through the intermediary effect test and mediated adjustment effect test, we found the action path of long-term care needs on hospitalization costs. Long-term care needs increases hospitalization costs through more hospitalizations. Long-term care insurance reduces hospitalization costs. Its specific action path makes long-term care insurance reduce hospitalization costs through a negative adjustment of the number of hospitalizations. To achieve fair and sustainable development of long-term care insurance, the following points should be achieved: First, long-term care insurance should consider the prevention in advance and expand the scope of participation and coverage; Second, long-term care insurance should consider the control in the event and set moderate levels of treatment payments; Third, long-term care insurance should consider post-supervision and explore appropriate payment methods.

Health effects of long-term care insurance on spouses of disabled people: a quasi-experimental study

BackgroundIt is still uncertain whether and how formal long-term care (LTC) systems affect the health status of family members. This paper examines the health effects of long-term care insurance (LTCI) on spouses of disabled people in China.MethodsThe data is from China Health and Retirement Longitudinal Survey (CHARLS), a longitudinal survey of a nationally representative sample of Chinese residents aged 45 or older and their spouses, and China City Statistical Yearbook. Exploiting the regional variation in the implementation of LTCI in the first round of pilot cities in China, a difference-in-difference (DID) strategy is applied to identify the causal effects of LTCI on the health status of spouses of disabled people. We carefully identify the causal effects by controlling for city-level covariates, testing common trends between the treatment and control groups, combining propensity score matching (PSM) with DID, selecting the second round of pilot cities as the control group, controlling for city fixed effects (FE) instead of individual FE, and evaluating selection bias from omitted observable and unobservable factors.ResultsThe introduction of LTCI in China reduces the number of painful body parts and the self-reported health score significantly, indicating that spouses of disabled people get physical health benefits from LTCI coverage. However, the impact of LTCI on the depression index remains ambiguous and needs to be analyzed further. LTCI improves the physical health status of spouses of disabled individuals mainly through the time reallocation channel, while the impact of the consumption promotion channel has not been verified. Furthermore, the beneficial effects of LTCI on physical health are stronger for spouse caregivers and spouses with lower-level education and lower household income.ConclusionThese findings demonstrate that LTCI not only improves the health status of family caregivers by reducing their caregiving burden but also has beneficial health effects on non-caregiver family members. Policy designs of LTCI should emphasize the orientation of home and community-based care services (HCBS), which can not only satisfy the care preferences of disabled individuals, reduce the care burden on family caregivers, promote the health of all family members, but also prevent a large number of disabled individuals from choosing high-cost institutional care and reduce the financial burden of the LTCI Fund.

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.

Effects of the Long-term Care Insurance on Health Among Older Adults: A Panel Data From China.

China's long-term care insurance (LTCI) has been launched since 2016 to ensure that older disabled people obtain affordable care services. However, rigorous evaluations of the health effects of China's LTCI pilots have been limited. This paper aimed to examine the effects of LTCI on health among older adults aged 60 years and above. Drawing from panel data of the China Health and Retirement Longitudinal Study (CHARLS), we used a propensity score matching (PSM) and difference-in-difference (DID) approach to identify the health effects of the LTCI program and reduce the selection bias. Further, heterogeneity of the effects was examined by physical and intellectual function to evaluate whether the effects differed among subgroups of older population. The implementation of LTCI significantly improved self-rated health (β = 0.15, P<.05) and cognitive function (β = 0.59, P<.01) for older adults. The results were robust when keeping only those living in pilot cities (β = 0.31, P<.05 for self-rated health status; β = 0.98, P<.001 for cognitive function) or non-pilot cities (β = 0.14, P<.05 for self-rated health status; β = 0.60, P<.01 for cognitive function) as the control group. The effects of LTCI were especially manifested in older adults with physical disability (β = 0.13, P<.01 for self-rated health; β = 0.76, P<.001 for cognitive function) or intellectual disability (β = 0.16, P<.01 for self-rated health). From a policy perspective, these findings suggested that LTCI in China could benefit the health outcomes of older adults, especially those with physical or cognitive disabilities. Policy-makers can target resources more effectively to improve health outcomes for the most vulnerable populations.

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.

Study on Health Effect and Health Equity of Long-term Care Insurance Pilot Policy in China

Long-term care insurance (LTCI) is an important measure to actively cope with the aging population in China. In this paper, CHARLS data is used to study the health effects of pilot policies of LTCI through DID model and PSM-DID model, and Dagum Gini coefficient is used to analyze the sources of differences in health equity between urban and rural areas. Results show that the implementation of LTCI has an improvement effect on self-reported health status, but the results after propensity score does not significantly support the conclusion of the improvement effect. In addition, the health inequality mainly comes from the internal differences respectively existed in urban and rural areas, and the difference in self-reported health status of the elderly in the treatment group is more obvious. Therefore, future institutional design should focus on policy coverage of the population and improving services.

Impact of long-term care insurance on health inequality in older adults in China based on the concentration index approach.

Several studies have shown that social security would reduce health inequalities. However, little was known about the relationship between long-term care insurance and health inequality. We aimed to evaluate the impact of long-term care insurance on health status and health inequality in older adults using a nationally representative cohort. Based on four waves of data from the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, 2015 and 2018), we used the staggered difference in difference (DID) design with the order probit regression models and the concentration index approach as well as decomposition analysis to assess the contribution of long-term care insurance towards residents' health status and health inequality in older adults aged ≥65y. We further used the semi-parametric DID model for robustness testing. Long-term care insurance demonstrated its role, improving self-assessed health in the study population (βcoefficient: 0.090, 95% CI 0.087 to 0.092, p<0.001). The estimation results of the semi-parametric DID were consistent with those of the staggered DID. The income-related health concentration index was 0.0005, having a contribution rate of 1.639% to health inequality in older adults. Decomposition analysis revealed that different policies and residential areas were more influential on the observed health inequalities. The findings implied that long-term care insurance has widened the health inequality while improving health status in older adults. Additional investment in more comprehensive insurance coverage and increased accessibility to enhance implementation of long-term care insurance is warranted to close the gap.

Long-term care insurance and multidimensional poverty of middle-aged and elderly: Evidence from China.

This paper examined the impact of public long-term care insurance (LTCI) pilots in China on the multidimensional poverty status of middle-aged and older adults. Using panel data from the China Health and Retirement Longitudinal Survey, we utilized LTCI pilots conducted in different cities from 2012 to 2018 and assessed the impact of LTCI using a difference-in-differences strategy. We found that the implementation of LTCI reduces the multidimensional poverty of middle-aged and older adults and their likelihood of future multidimensional poverty. LTCI coverage was also associated with a reduction in the likelihood that middle-aged and older adults in need of care fall into income poverty, living consumption poverty, health poverty, and social participation poverty. From a policy perspective, the findings of this paper suggest that the establishment of an LTCI system can improve the poverty of middle-aged and older adults in several ways, which has important implications for the development of LTCI systems in China and other developing countries.

Different impact on health outcomes of long-term care insurance between urban and rural older residents in China

Long-term care insurance (LTCI) is garnering attention internationally and is being considered a public policy in a growing number of countries. Previous research has focused on the effects of LTCI in developed countries, ignoring the health outcomes of developing countries, especially in rural regions. Therefore, this study investigates whether different impact on health outcomes is present in the effects of LTCI between urban and rural residents in China. We employed a quasi-experimental design with data from the China Health and Retirement Longitudinal Survey. The specific implementation time of each pilot city was sorted according to the LTCI policy texts, dividing these pilot cities into the treatment group and control group. Finally, difference-in-differences analyses were utilized to evaluate the health effects of LTCI between urban and rural residents, and the health effect in urban areas was further tested. The implementation of LTCI has effectively enhanced the self-rating health (SRH) of the entire group of residents; however, this effect may only be significant for the urban group. In particular, LTCI can increase the SRH of urban residents by 0.377 units compared to the urban residents without LTCI (P < 0.01). The result of the placebo effect test further verifies that LTCI could improve the health of residents to some extent. In China, LTCI may have triggered different impacts on health outcomes between urban and rural residents, and may not improve the SRH of rural residents and only prove efficacious for urban residents. Government and policy-makers should give more attention to the rural group as it needs long-term care the most.

The Impact of the Long-Term Care Insurance on the Medical Expenses and Health Status in China.

Based on the panel data of China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2015, and 2018, this paper used the difference-in-difference (DID) method to evaluate the implementation effect how the Long-Term Care Insurance (LTCI) policy impacted on the medical expenses and the health status of the middle-aged and elder population. The empirical results show that LTCI has reduced the outpatient and inpatient quantity by 0.1689 and 0.1093 per year, and cut the outpatient and inpatient expenses by 23.9% and 19.8% per year. Moreover, the implementation of LTCI has improved the self-rated health, the activity of daily living (ADL), as well as the mental health. These conclusions verify the implementation value of LTCI system and provide policy implications for the medical reform and the further LTCI implementation in a larger scale.

Long-term care insurance and the well-being of older adults and their families: Evidence from China

This paper examines the impact of China's public long-term care insurance (LTCI) pilots on the well-being of older adults and their families. Using panel data from the Chinese Longitudinal Healthy Longevity Survey, we exploit the rollout of the LTCI pilots across different cities during 2015–2017 and identify the effect of LTCI using a difference-in-differences approach. We find that the implementation of LTCI has reduced the likelihood of older adults reporting unmet activity of daily living (ADL)–related need for care, the intensity of informal care, and the amounts of ADL-related care expenditures and out-of-pocket medical expenditures. LTCI coverage was also associated with an improvement in self-reported health and a reduction in one-year mortality risk of older adults with baseline need for care. From a policy perspective, these findings suggest that the introduction of LTCI may benefit all members of the household, both care recipient and caregivers, which has important implications for the development of LTCI in China and other middle-income and developing countries.

„Aber vielfach scheitert man dann an Besonderheiten“ – Pflegeberater über Gesetzesänderungen und die Herausforderungen ihrer Arbeit: Eine qualitative Untersuchung

IntroductionSince the implementation of long-term care insurance in 1995, various reforms have contributed to the development of the German nursing care system in order to meet the structural and financial needs of the growing number of people in need of care. The aim of this paper is to present an assessment of care consultants on past legislation, challenges encountered during their work and suggestions to improve the current care system. Methods14 semi-structured, face-to-face interviews were conducted with care consultants. All interviews were transcribed verbatim and a qualitative content analysis was performed. ResultsCare consultants perceived tangible improvements with regard to the scope of benefits as a direct result of recent legislation changes. The use of these benefits, however, is limited due to an insufficient growth of care infrastructure. Particularly frequent legislation changes, unclear responsibilities and dissimilar regulations between federal states were seen as challenges. Discussion and conclusionComplex dependencies within the German nursing care system were identified and the necessity for a public discourse on themes such as self-responsibility, equity and a comprehensive (nationwide) care supply was underlined. A central information platform was proposed in order to concretely improve information about services available locally.

LONG-TERM CARE IV A REVIEW OF THE LONG-TERM CARE INSURANCE PROGRAMS IN 15 PILOT CITIES IN CHINA

China is now making all the efforts to solve the problem of who pays the bill for the rapidly increasing long-term care services. Since 2016, 15 cities in China have begun their pilot programs in long-term care insurance. Each city designed its own program. Some cities finance their long-term care services from medical insurance funding solely. Others supplement it with individual and/or employer contributions. This study documents the nature and extent of implementation of long-term care insurance across the 15 pilot cities to draw lessons for subsequent implementation nationally. This study used qualitative methods, including document review and key informant interviews with long-term care insurance administrators, medical insurance administrators, service providers in different settings and families and individuals who use long-term care services. Results reveal considerable variation in the specific attributes of the long-term care insurance programs implemented across the 15 participating cities, with respect to such characteristics as the target population, policy coverage, and payment methods, etc. Results also shed light on the achievements and challenges in implementing the long-term care insurance program. This study’s examination of long-term care insurance adoption in 15 Chinese cities serves as an important base with which to inform future national long-term care insurance design and implementation. It suggests that successful adoption of long-term care insurance across China will require administering jurisdictions to anticipate and address policy bottlenecks and implementation barriers that might otherwise inhibit program impact and effectiveness in addressing the growing long-term care needs of China’s aging population.

Is China facing the social risks associated with reliance on hospitalization for the care of the elderly with chronic diseases?

This study aims to investigate if China is facing the social risks associated with reliance on hospitalization for the care of the elderly with chronic diseases. Textual studies and big data analysis indicate the following outcomes: (1) The elderly population suffering from chronic diseases is expanding rapidly, while the prevalence rate also shows a growing trend; (2) the reliance on hospitalization for the care of the elderly patients exists and has caused three new social risks; and (3) these social risks are wasted health resources, poverty between individuals and families, and relative increase in the disability rate of the elderly after hospital admission. We conclude that effectively defusing the risks entails strengthening the management of chronic diseases related to communal public health, initiating the concept of "continuity of care" to pursue an active combination of medical and health care, hastening the implementation of long-term care insurance (LTCI) and other policy measures.

The Struggle for Recognition: The Politics of Migrant Care Worker Policies in Taiwan

This article investigates how local political context—including civil society and political parties—influences the development of migrant care worker policies in Taiwan. This is particularly important in a national context where the government has actively utilized migrant care worker policies to solve the crisis in the social welfare sector. This article draws upon documentary analysis of policy debates on the proposed implementation of Long-Term Care Insurance and in-depth interviews with government officials, public service providers and non-governmental organizations to explore how the political alliances of political parties, social organizations, and interest groups affect policy outcomes. While current research focuses on the relationship between social welfare policies and the employment of migrant care workers, this article highlights the local political context and explores how political alliances have influenced the development of migrant care worker policies. This article argues that institutional path dependency and the strong policy alliance between the progressive party and social welfare organizations have stymied changes in migrant care worker policies and prevented Taiwan from further socializing the eldercare sector.

介護保険制度の受容に伴う高齢者ケアと相互扶助の変容―上甑島旧里村を事例として―

In the late 1990s, the problem of care for the elderly was a growing concern in Japan. Under these circumstances, care services for the elderly in the former village of Sato attracted the attention of many specialists who regarded it as having the most developed community-care system. In general, it is believed that the provision of medical welfare services on remote islands is mediocre in comparison with the standards of the mainland. This paper discusses the process of the provision of high-level care for the elderly in the former village of Sato, which is located on an island handicapped by socioeconomic problems. In addition, the paper also clarifies the impact that the provision of care for the elderly has had on the local system of provision of services for the elderly, after the implementation of long-term care insurance in 2000.

Outcomes Research of Home-Visit Nursing Care in Japan

Since the implementation of long-term care insurance (LTCI) in Japan, home care services have received more national attention. Because the utilization of home-visit nursing is increasing, evaluation of the effectiveness of home-visit nursing care will be needed. Although there are a few outcome research studies of home-visit nursing care in Japan, outcomes research, especially related to the LTCI, will be needed much more in the future. This article shows a framework to easily identify variables that are important to evaluate the effectiveness of home-visit nursing care in Japan.

Changes in Stroke Rehabilitation Outcomes After the Implementation of Japan’s Long-Term Care Insurance System:

To explore the changes in stroke rehabilitation outcomes after the introduction of Japan's long-term care insurance (LTCI) system. Stroke patients discharged during a 3-yr period before and after the implementation of LTCI were compared (before-LTCI vs. after-LTCI). Outcome measures included onset to admission interval, length of stay, and correlation between discharge site and functional level at discharge. A total of 201 patients in the before-LTCI group and 252 patients in the after-LTCI group were eligible for the study. Shorter mean length of stay (P < 0.01) and higher rates of discharge to a rehabilitation facility (P < 0.01) were found in the after-LTCI group. Logistic regression analysis revealed that the patients with higher activities of daily living scores or ambulatory status at discharge were more likely to be discharged to home after inpatient rehabilitation in both groups (P < 0.01). The rate of discharge to home was similar in both groups. Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.

Differences in Facilities' Acceptance of Patients Under Long-Term Care Insurance in Japan

Objectives. In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI. Methods. We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions. Results. We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor. Discussion. In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.