Long-term Care Insurance Research Articles

Can Long-Term Care Insurance Change Eldercare Patterns? Evidence from China

ABSTRACT Long-term Care Insurance (LTCI), providing care services and economic compensation to older adults with activity limitations, plays a crucial role in addressing the care needs of older adults and easing the burden on family caregivers. This article is based on the 2011–2018 China Health and Retirement Longitudinal Study (CHARLS) and uses China’s LTCI pilot program as a quasi-experiment to examine the impact of LTCI on older adults’ care patterns in China. It employs a staggered difference-in-differences (staggered DID) methodology to model the economic support, living arrangements and care, and spiritual comfort provided to older adults. Results indicate that LTCI significantly enhances the economic and emotional independence of older adults. On the one hand, LTCI effectively decreases the economic and emotional dependence of older adults on their children. On the other hand, LTCI raises the likelihood that older adults rely on social institutions and personnel for care. Additionally, LTCI is associated with achieving higher life satisfaction. Interestingly, the impact of LTCI varies significantly across sub-samples of different types of older adults and different policy regulations. Overall, findings indicate that LTCI shifts older adults’ care patterns from family to socialized care, thereby reducing children’s caregiving burden.

Radiographic Knee Osteoarthritis Is a Risk Factor for the Development of Dementia: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study.

Osteoarthritis is linked to dementia, but no longitudinal studies have established this connection. This prospective cohort study from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) aimed to determine if knee osteoarthritis (KOA) independently predicts dementia in adults aged 65 and above. Participants were classified by the Kellgren-Laurence scale into no/minimal KOA (grades 0 and I) and definitive KOA (grade II or higher). We analyzed dementia incidence from 2009 to 2015 using long-term care insurance data, adjusting for age, sex, vascular risks, depressive symptoms, and activity levels. Out of 1089 participants (58.9% female, average age 72.5), 72.0% had definitive KOA. Dementia occurrence was significantly higher in the definitive group (8.4%) compared to the no/minimal group (3.0%) (p < 0.001). A log-rank test and Cox regression analysis confirmed these findings, showing an adjusted hazard ratio of 2.29 (confidence interval: 1.12-4.68) for dementia in those with definitive KOA. These results suggest that KOA is a significant risk factor for dementia, highlighting the importance of addressing contributing factors in KOA patients to potentially slow the progression of dementia.

Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study

BackgroundOlder adults requiring care often have multiple morbidities that lead to polypharmacy, including the use of potentially inappropriate medications (PIMs), leading to increased medical costs and adverse drug effects. We conducted a cross-sectional study to clarify the actual state of drug prescriptions and the background of polypharmacy and PIMs.MethodsUsing long-term care (LTC) and medical insurance claims data in the Ibaraki Prefecture from April 2018 to March 2019, we included individuals aged ≥ 65 who used LTC services. The number of drugs prescribed for ≥ 14 days and the number of PIMs were counted. A generalized linear model was used to analyze the association between the backgrounds of individuals and the number of drugs; logistic regression analysis was used for the presence of PIMs. PIMs were defined by STOPP-J and Beers Criteria.ResultsHerein, 67,531 older adults who received LTC services were included. The median number of total prescribed medications and PIMs was 7(IQR 5–9) and 1(IQR 0–1), respectively. The main PIMs were loop diuretics/aldosterone antagonists (STOPP-J), long-term use of proton pump inhibitors (Beers Criteria), benzodiazepines/similar hypnotics (STOPP-J and Beers Criteria), and nonsteroidal anti-inflammatory drugs (STOPP-J and Beers Criteria). Multivariate analysis revealed that the number of medications and presence of PIMs were significantly higher in patients with comorbidities and in those visiting multiple medical institutions. However, patients requiring care level ≥1, nursing home residents, users of short-stay service, and senior daycare were negatively associated with polypharmacy and PIMs.ConclusionsPolypharmacy and PIMs are frequently observed in older adults who require LTC. This was prominent among individuals with comorbidities and at multiple consulting institutions. Utilization of nursing care facilities may contribute to reducing polypharmacy and PIMs.Graphical

The effect of long-term care insurance on women’s health outcomes in China: evidence from a disability inclusion action

BackgroundLong-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers.MethodsUsing the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women’s health outcomes.ResultsLTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village.ConclusionsAfter the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI’ improvement on women’s health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women’s health inequalities in geography and society.

Multidimensional Care Poverty Among East Asian and Nordic Older Adults.

This study uses the care poverty framework, focusing on both individuals and structures. In this context, structures are represented by 2 welfare states: Taiwan, an East Asian welfare system and Finland, a Nordic welfare state. This study explores multidimensional care poverty rates and examines 3 realms of individual factors (health status, sociodemographic factors, and care support availability) among older adults in these long-term care (LTC) models. We analyzed data from the 2019 Taiwan Longitudinal Study on Ageing Survey and the 2020 Daily Life and Care in Old Age Survey in Finland to compare the rates and factors of care poverty in these 2 culturally and structurally different countries. Our analysis revealed different rates of care poverty in personal, practical, and socioemotional care needs in the 2 countries. Under a familistic welfare regime, Taiwanese older adults had higher personal care poverty rates than their Finnish counterparts. Those living alone faced more personal and practical care poverty. Conversely, Finnish older adults, under the Nordic welfare model, experienced more practical and socioemotional care poverty. Those with high care needs and disadvantaged social status and support were more likely to experience personal and practical care poverty. Socioemotional care poverty varied with the availability of support and health status in both countries. The study highlights the impact of 2 LTC policies and cultures on older adults' multidimensional care poverty, identifying disadvantaged older adults under different welfare-transforming LTC models. Taiwan's budget-constrained LTC policies and high family reliance contrast with Finland's inadequate attention to the practical and socioemotional needs of its aging population. This study suggests that holistic LTC policies are needed in both countries to improve the well-being of older adults with limited support and health issues.

Premium Calculations with Long Term Care Insurance using Markov Chain Method for Human Immunodeficiency Virus Inpatients

&lt;strong&gt; &lt;/strong&gt;Indonesia has a high prevalence of HIV, which is inversely proportional to its insurance product propolis. Life insurance offers economic protection by providing payment upon the death of the policyholder. Long Term Care (LTC) insurance, a type of health insurance, guarantees care and health insurance for the elderly. This study calculates LTC insurance premiums with annuities as rider benefits using a multi-status model that includes health status, HIV, and death. Using Markov Chain modeling and data from Malang city in 2022, we determine the premium based on transition probabilities. This case study involves a 20-year-old man with 5 years of LTC coverage, a benefit value of IDR100,000,000, and an interest rate of 5%. The premium varies by age and gender: at age 20, male pay Rp 2,719,241 and female Rp 2,701,893, at age 21, male pay Rp. 5,762,095 and female pay Rp.5,746,178. At age 22, male pay at Rp. 6,203,680 and females pay Rp.6,189,454 while at age 23, male pay Rp. 6,640,674 and females pay 6,628,146. And male at 24, pay Rp. 7,066,949 while females pay Rp. 7,012,138 and at age 25, male pay Rp 7,068,616 and females Rp 7,029,781. The results of this calculation show that the more age increases, the greater the net premium and also the male net premium is greater than the female net premium

'Successfully' Aging 'Alone'?: Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally.

For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family tie. Such unprecedented shifts require a reevaluation of existing models of "successful aging", particularly in terms of long-term care policies. This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries. Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of "successful aging" opportunities in high income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated in higher income countries with lower within-country inequality. Aging "alone" is a risk factor in some contexts, yet a marker of privilege in others. Models of "successful aging" are largely unobtainable in lower income countries or high inequality countries, and therefore require a thorough incorporation of global realities, or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.

2244 Effect of long-term care insurance in a pilot city of China: health benefits among 12,930 disabled older adults

Abstract Introduction The surge of disabled older people has brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. Methods This was a prospective observational study based on data from the government led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyse the impact of LTCI on mortality. Results: A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. Results LTCI implementation significantly reduced mortality by 5.10% (95% CI, −9.30% to −0.90%) and extended the survival time by 33.74 days (95% CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participate in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. Conclusions LTCI implementation had a favourable impact on the mortality and physical ability of participants. This research marks the first comprehensive exploration of the potential health benefits associated with the implementation of LTCI, providing valuable perspectives that can inform policy making and enhance the development of robust long-term care systems in developing countries.

2245 Disease trajectories and medical expenditures of older long-term care residents in China: prospective observational study

Abstract Introduction Global ageing and an increasing disability population impose huge health and economic burdens on societies, and understanding the impact of disability on mortality and medical expenditures among the elderly is vital. Methods This study was based on the government-led long-term care insurance program initiated in July 2017 and followed up to June 2021. Diagnosis and hospitalisation costs were extracted from electronic medical records and medical insurance system. The networks of the disease trajectories were established by combining disease pairs with overlapping diseases. Medical expenditures relating to exact disease were calculated and compared between age groups. Results The 30,003 participants had a mean age of 79.6 ± 11.1 years, with 57.0% females. After a mean follow-up time of 21 ± 16 months, 17,428 (58.1%) death were observed. Diseases with the highest HRs included septic shock (HR 3.59, 95% CI, 3.36–3.84), respiratory failure (HR 3.19, 95% CI, 3.05–3.34), sepsis (HR 2.98, 95% CI, 2.80–3.18), malnutrition (HR 2.38, 95% CI, 2.27–2.48), and decubitus ulcer (HR 2.27, 95% CI, 2.14–2.41). The disease trajectories were initially related to hypertension and diabetes mellitus, while mortality was associated with malnutrition, infectious diseases, and organic failure. In subgroup analysis, participants with older age, those living in nursing institutions, and males had more complex disease trajectories. The medical costs gradually decreased with increasing age, and there was a rapid increasing trend before death for the decedents. Among the diseases of top 30 frequent hospitalisation visits, intracerebral haemorrhage, sepsis, and respiratory failure ranked as the top three total medical costs. Conclusions The study shows that malnutrition and infection-related diseases contribute to death in older disabled and the latter account for part of the highest medical cost, calling for comprehensive strategies for infection prevention and treatment.

On the Motivations for Purchasing Long-Term Care Insurance: Protecting Bequest and Unreliability of Family Care

Family considerations are known to influence the decision to buy long-term care (LTC) insurance. This paper uses a Swiss survey to identify the characteristics of individuals willing to purchase LTC insurance, either to protect their children’s bequest or because they cannot rely on family for care. First, it shows that the presence or absence of children plays an important role in the two motivations for buying LTC insurance. Second, it shows that individuals from the French-speaking part of Switzerland and those with lower self-perceived health are more likely to buy LTC insurance because of the unreliability of family care. On the other hand, individuals with higher self-perceived health and those with a right and center political orientation are more likely to buy LTC insurance for reasons of bequest protection. The results provide insights into designing more targeted strategies to promote LTC insurance.

Differences in Cumulative Long-Term Care Costs by Dental Visit Pattern Among Japanese Older Adults: The JAGES Cohort Study.

Long-term care (LTC) costs create burdens on aging societies. Maintaining oral health through dental visits may result in shorter LTC periods, thereby decreasing LTC costs; however, this remains unverified. We examined whether dental visits in the past 6 months were associated with cumulative LTC insurance (LTCI) costs. This cohort study of the Japan Gerontological Evaluation Study targeted independent adults aged≥65 years in 2010 over an 8-year follow-up. We used data from a self-reported questionnaire and LTCI records from the municipalities. The outcome was cumulative LTCI costs, and exposure was dental visits within 6 months for prevention, treatment, and prevention or treatment. A 2-part model was used to estimate the differences in the predicted cumulative LTCI costs and 95% confidence intervals (CIs) for each dental visit. The mean age of the 8 429 participants was 73.7 years (standard deviation [SD] = 6.0), and 46.1% were men. During the follow-up period, 17.6% started using LTCI services. The mean cumulative LTCI cost was USD 4 877.0 (SD = 19 082.1). The predicted cumulative LTCI costs were lower among those had dental visits than among those who did not. The differences in predicted cumulative LTCI cost were -USD 1 089.9 (95% CI = -1 888.5 to -291.2) for dental preventive visits, -USD 806.7 (95% CI = -1 647.4 to 34.0) for treatment visits, and -USD 980.6 (95% CI = -1 835.7 to -125.5) for preventive or treatment visits. Dental visits, particularly preventive visits, were associated with lower cumulative LTCI costs. Maintaining oral health through dental visits may effectively reduce LTCI costs.

Exploring confidence in financial planning topics among care partners of persons living with dementia.

Care partners of persons living with dementia perform significant financial planning in partnership with the person for whom they care. However, research is scarce on care partners' confidence and experiences with financial planning. The purpose of this study was, first, to quantify care partners' confidence across different financial planning topics. We sought to understand whether income, education, relationship type, and years of experience are related to care partners' level of confidence in financial planning. Second, we sought to better understand the reasons for these confidence ratings by examining care partners' experiences of financial planning. We conducted an online survey that asked a combination of quantitative and qualitative questions to understand care partners' confidence and experiences with financial planning. Participants were nationally recruited care partners of persons living with dementia. Multivariate linear regression was used to understand different subgroups' levels of confidence in each financial planning topic. Inductive thematic analysis was used to understand qualitative data. The financial planning topics in which participants (N = 318) felt the least confident were: options when there is not enough money to provide care; tax deductions available to cut care costs; and sources of money from government programs for which the care recipient is eligible. Differences in confidence were observed among care partners with lower incomes, less experience, and caring for a parent. Qualitatively, participants described the challenges of care budgeting and protecting personal finances; confusion about long-term care insurance and accessing resources; and, among confident care partners, reasons for this sense of preparedness. These results underscore the need for tailored interventions and technologies that increase care partners' confidence in specific aspects of financial planning, including long-term care insurance, available financial support, and what to do when money runs out.

Health-economic evaluation of orthogeriatric co-management for patients with pelvic or vertebral fragility fractures

BackgroundOrthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures.MethodsIn this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014–2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.ResultsWe included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5–5.9% of the pelvic and 31.8–33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained.ConclusionWe did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM.

On the effects of public subsidies for severe and mild dependency on long-term care insurance

Extant theoretical work on long-term care (LTC) and its insurance has neglected an important fact: Benefits of LTC insurance as well as the amount of public subsidization of LTC can differ between severe and mild dependency. The objective of this paper is to revisit the study of optimal purchase of LTC insurance and its crowding out by public subsidies dissociating coverage for the risk of dependency in nursing home and of dependency at home. This study examines three prevalent models of LTC insurance indemnities commonly encountered in various LTC insurance markets. It also studies the presence of potential intergenerational moral hazard and shows how it drives the crowding out or crowding in of LTC insurance by public subsidization according to the insurance models and risk aversion behaviours.

Long-Term Care Insurance: A Possibility but Not a Panacea

Long-Term Care Insurance: A Possibility but Not a Panacea

Effectiveness of Japan’s Health Insurance System in Meeting Complex Long-Term Care Needs

Japan’s Long-Term Care Insurance (LTCI) system, introduced in 2000, was designed to address the growing needs of the country’s aging population. This study evaluates the effectiveness of the LTCI system in meeting complex long-term care needs, focusing on four key dimensions: access, quality, financial sustainability, and user satisfaction. Using quantitative analysis of data from national databases and surveys, the study reveals significant improvements in access to services and positive care outcomes, with approximately 80% of beneficiaries expressing satisfaction with the services received. However, geographic disparities persist, with rural areas facing limited service availability compared to urban centers. Financial sustainability remains a critical concern, as expenditures have risen by 20% over the past five years, highlighting the need for innovative funding models. The study recommends policy interventions to address regional disparities, ensure financial viability, and expand specialized services for individuals with complex care needs. By examining these challenges and opportunities, the study provides insights into the strengths and limitations of the LTCI system and offers guidance for future policy development. The findings underscore the importance of targeted reforms to enhance the system’s capacity to deliver high-quality, equitable care to Japan’s elderly population.

Last year of life care transitions between long-term care insurance services in Japan: Analysis of long-term care insurance claims data.

We determined the number of care transitions in the year before death among older adults requiring long-term care (LTC) and those receiving public LTC insurance (LTCI) services in Japan, along with care transition pathways and factors associated with the number of care transitions. This study used data from the Japanese LTCI claims, which store national information on certification of needed LTC and LTCI claims data. Services received in the year before death were classified as in-home, facility, mixture of in-home and facility, and not using LTCI services. The transition count is presented, and Sankey diagrams are produced to visualize care transition pathways. We used a multivariable analysis to identify factors associated with the number of care transitions. Of the participants, 276 896 (65.2%) experienced at least one transition in LTCI care settings in the year before death. Further, 72.0% of those requiring mild LTC underwent one or more transitions. Participants who were 75-84 years old (vs. 65-74 years old), male, without medical care needs, with symptoms of dementia, and with changes in LTC needs in the year before death were more likely to require care transitions. Moreover, participants with higher baseline LTC needs were less likely to require transitions. Over half the participants requiring LTC underwent one or more care transitions in the year before death. Policy deliberations regarding enhancing care under the LTCI system at the end of life and optimizing care transitions are necessary. Geriatr Gerontol Int 2024; ••: ••-••.

Professional dental care and survival rates in long-term care recipients: A cohort study of 1 459 163 individuals in South Korea.

To determine the dental care pattern and survival rates of participants who received long-term care (LTC) and a matched control cohort in South Korea. Global ageing trends and the development of superaged societies pose healthcare challenges. South Korea's LTC system aids those with chronic illnesses and disabilities. Despite the link between oral health and systemic diseases, providing dental care in LTC facilities often reflects social neglect. We identified 1 459 163 individuals eligible for LTC insurance in the Korean National Health Insurance Service database from July 2008 to 2015 (LTC cohort) and 1 459 544 individuals matched through propensity-score matching (matched cohort). The LTC recipients were further categorised into subgroups based on their care type (institutional, home or mixed care). Population of utilising dental services and the average number of dental visits were counted in each cohort, and the survival rate of the LTC cohort was determined according to dental utilisation. Population of utilising dental services increased steadily in all cohorts except for institutional care, with the highest utilisation (around 30%) observed in the matched cohort. Lower independence in LTC cohorts was associated with lower dental utilisation: 18-27% for home care, 12-18% for mixed care, and 10% for institutional care. The survival rates in the LTC cohort were significantly lower than in the matched cohort (P < .0001), with 28.1% survival in LTC vs 59.3% in the matched cohort. Long-term care recipients experience social neglect for oral care, while higher survival rates were observed in those utilised dental services.

Payment Methods for Palliative Care in China: Current Status, Challenges, and Countermeasures

With the accelerated aging of the population and the subsequent increase in cancer incidence, the development of palliative care services has gradually become a societal hotspot. By analyzing the existing issues in payment methods for palliative care in China, such as unreasonable division of payment standards, incomplete coverage of beneficiaries and services, and difficulties in ensuring equity in palliative care benefits, this paper further proposes that the government should expedite the legislative process, improve top-level design, promote the inclusion of palliative care within the scope of long-term care insurance, enhance the cross-regional settlement system, and increase auxiliary services and social support.

Estimation of private-use prices of at-home care services in Japan: Data from a survey of housekeeper employment agencies

ABSTRACT This study examined housekeeper referral agencies’ operations in Japan, their services, and fee standards. This promoted an estimation of the standard price of housekeeping services in Japan if insurance coverage was excluded. Questionnaires were distributed to 399 housekeeping agencies whose addresses were available on the website of the Japan Association of Nursing and Welfare Placement Agencies as of October 2022, and 101 agencies responded (response rate: 25.3%). Surveys were completed in February–March 2023. Two-thirds (65%) of the housekeeper placement agencies had a long-term care (LTC) insurance office. Housekeeper referrals were mostly for 1–4 h; the fee varied according to city size and service provider type, which tended to be higher in larger cities. The fees were lower for attached LTC providers than for stand-alone providers. Most managers (60%) of housekeeper referral agencies rated their fees as ‘somewhat low’ or ‘very low’, requesting an increase in users’ burden and housekeepers’ compensation. LTC insurance keeps the prices of services provided by housekeeper referral agencies low. In the future, daily living support services for the lightly insured may be excluded from LTC insurance coverage in Japan, and the demand for housekeeper agencies’ services is expected to increase.