Long-term Care Insurance Research Articles

Research on the Aging of Global Workforce and Solutions

The twenty-first century has seen significant shifts in fertility attitudes and demographics, leading to an aging global workforce. This paper explores how different regions - the United States, Western Europe, Japan, and China - address the challenges and opportunities posed by their aging populations in terms of healthcare, social security, and employment. The main findings reveal diverse strategies. The United States combines public and private healthcare components through Medicare and private insurance. Western Europe emphasizes publicly funded healthcare, exemplified by the UKs NHS and Germanys multi-layered pension system. Japans universal coverage and pioneering Long-Term Care Insurance stand out, while China adapts healthcare for both urban and rural elderly residents. Social security systems range from Germanys multi-faceted pensions to Japans comprehensive structure, and China is working to bridge urban-rural disparities. Employment trends vary, with the United States witnessing older adults extending work lives, the Netherlands introducing innovative retirement schemes, Japan promoting active aging, and China focusing on skill enhancement. The study suggests cross-country learning and adaptation. Each nation can benefit from the best practices of others to enhance its own strategies. Collaborative approaches can drive innovative solutions for aging populations, fostering resilient healthcare systems, inclusive social security, and age-friendly employment environments. This comparative analysis offers insights for creating a harmonious and sustainable future for aging populations globally.

노인장기요양서비스 평가체계의 변화에 관한 연구

The evaluation system for South Korea's long-term care services for the elderly was reorganized with a focus on services quality management through the long-term care facility evaluation system following quasi-marketizing reform in the late 2000s. However, unlike the old evaluation system, service quality is managed through the evaluation of providers who voluntarily entered the market, and this provider evaluation is conducted in connection with the benefit provision process by the insurer (National Health Insurance Services) as a characteristic of South Korea. With regard to the evaluation system, there is dissatisfaction with provider evaluation, and it is argued that a separate independent dedicated evaluation organization should be established together with the strengthening of the role of local governments.
 Therefore, taking notice of cases in Japan, which is introducing an evaluation system that is different from the one in South Korea, this study is intended to examine how the evaluation system for long-term care services for the elderly in Japan has been reorganized and changed in comparison with South Korea and find implications for South Korea. To that end, this study will analyze how the institutional devices for various evaluations such as the third-party evaluation system, the policy evaluation system, and the evaluation system for long-term care insurance business plans for the elderly have been reorganized to be pluralistic and multilayered in the institutional reform following quasi-marketization reform in Japan. Second, it will derive the fact that objective-based policy evaluation (=performance management) and participatory evaluation are being strengthened amid changes in policies regarding the evaluation system for long-term care services for the elderly in Japan. Third, it will capture the governance structure of the evaluation system by revealing the intergovernmental and inter-institutional linkage structure of Japan's evaluation system. Fourth, by identifying the functions carried out by the evaluation system through cases in Japan, this study will present policy implications that will enable the problems of South Korea's evaluation system to be overcome.

The impact of cardiac rehabilitation for older adults with heart failure who underwent invasive cardiac treatment eligible for long-term care needs certification: A retrospective cohort study.

This study aimed to assess the usefulness of cardiac rehabilitation (CR) for older adults with heart failure (HF) who need nursing care and investigate the effect of CR on cognitive function (CF) and basic activities of daily living (BADL). This was a retrospective cohort study. The study included older adults with HF eligible for long-term care insurance in fiscal year 2014 (FY2014) as the baseline and followed them up until March 2018. Patients were divided into two groups, CR (+) and CR (-), and the changes in their CF and BADL scores over time for 3 years were investigated. Of the 765 patients included in the study, 36.5% performed CR. BADL scores in the CR (+) and CR (-) groups (mean (SE)) were 5.81 (0.26) vs. 5.87 (0.20) in FY2014, 5.6 (0.28) vs. 5.92 (0.21) in FY2015, 5.72 (0.31) vs. 6.15 (0.22) in FY2016, and 5.64 (0.33) vs. 6.40 (0.25) in FY2017, respectively. BADL scores worsened over time in the CR (-) group but had a trend to inhibit decline in the CR (+) group, and a significant difference was observed between both groups (p = 0.04). Multivariate analysis showed a significant difference in CR as a factor suppressing ADL decline after 1 year (adjusted odds ratios: 0.54, 95% confidence intervals: 0.36-0.82; p = 0.004). However, no significant difference in the CF scores was observed. CR for older adults with HF eligible for long-term care needs certification does not affect CF and may suppress ADL decline.

Outcomes of the Pilot Project for Community Care Among Older Adults in South Korea

ABSTRACT The Korean government implemented the pilot project for community care for older adults in June 2019. This study investigated the outcomes of the pilot project among Korean older adults by linking survey data from the pilot project with data of Korean National Health Insurance Service. The final sample included 17,801 pilot project participants and 68,145 in a matched comparison group. Pilot program participants experienced an increase of 4.8 days for length of home stay and a reduction of $956 (US) per participant relative to the matched comparison group. Pilot program participants with long-term care insurance who used home care services experienced an increase of 8.9 days for length of home stay and a reduction in $1,177 (US) in total costs, along with a reduction in the admission to long-term care facilities, compared to the matched comparison group. Patients discharged from hospitals indicated an increase of 35.2 days for length of home stay and a reduction of $6,947 (US) in total costs, but a 3.53 times increase in hospital readmissions relative to the matched comparison group. The pilot project for community care resulted in increased length of home stay and reduced total costs among older adults in Korea.

Are ageing Nordic welfare states sustainable? An analysis of pension and care policies in Finland and Sweden

Introduction: The article discusses the aging population in Nordic countries, focusing on Sweden and Finland, where the median age has steadily increased since 1950. The text emphasizes the impact of demographic changes on the old-age dependency ratio and the subsequent implications for the welfare stateObjective: It is examination and comparison of the aging policies of Nordic countries, with a specific focus on Finland and Sweden. The author aims to shed light on the differences in pension and long-term care systems between these two nations, challenging the perception of a common "Nordic pension model."Materials and methods: The article employs a theoretical background based on the "intergenerational reciprocity trichotomy" developed by André Masson. The methodological approach utilized in the research is that of a "comparative case study." The author analyzes the pension and long-term care systems of Finland and Sweden, reviewing key indicators, policy documents, and relevant research literature.Results: While the Swedish system is financially robust, it encounters political challenges due to low public pension levels, prompting discussions about potential reforms, such as increasing contribution rates for higher benefits. Finland's public pension system, characterized by stable political support, raises concerns about long-term financial sustainability. The decision-making model, led by social partners, may shift to a more parliamentary approach as trade union density decreases and aging-related issues become more significant for the electorate. Both countries have successfully promoted high employment rates among older workers, but long-term care policies pose a greater challenge to the sustainability of their welfare models. The growing importance of family and informal care, coupled with a reliance on migrant workers for healthcare, highlights the strain on the welfare systems. Demographic changes increase pressure on pro-old welfare policies, particularly in long-term care, with Sweden better positioned than Finland to sustain elevated spending towards the elderly.

Analyzing the demographic coherence of selected US, Australian and Chinese biometric data sets used to price long-term care insurance and life care annuities

This paper examines the implicit healthy life expectancy used for actuarial calculations in some selected biometric data sets from the US, Australia and China. We are interested in checking the demographic/epidemiological coherence of these data sets because this health indicator is rarely presented when authors build their biometric data sets, nor when they are used to calculate long-term care insurance (LTCI) and life care annuity (LCAs) premiums, nor when they are employed in research articles to estimate the future demand for LTC services. We follow a methodology based on multistate life table methods that enables us to obtain a life expectancy matrix for individuals on the basis of their initial health state. We also present some additional indicators of longevity, mortality and morbidity, these being the median age at death, the interquartile range, the weighted modal age at death, the mortality ratio and the implicit LTC prevalence rates broken down by health state. We find several weaknesses that highlight the difficulty involved in building the biometric data sets needed to make an actuarially fair valuation of the premiums for LTCI and LCAs. We also verify the existence of the so-called “male–female health-survival paradox”. From the perspective of a potential purchaser of this type of insurance products, disclosing and explaining the summary measures of health and longevity would make it easier for them to understand the need to protect themselves against the cost of possible LTC services and also make the computation of the premiums more transparent.

Effect of dietary diversity on incident of disability in community-dwelling older adults with sarcopenia: A 40-month follow-up longitudinal study

BackgroundSarcopenia is a clinical issue in older adults that leads to serious adverse health outcomes, including disability. The present study investigated whether dietary diversity affects the incidence of disability in older adults with sarcopenia. MethodParticipants were 759 Japanese older adults with sarcopenia (mean age 77.2 ± 6.0 years; 44.4 % men) who were aged ≥65 years at the time of the examination. Sarcopenia was diagnosed according to the recommendations of the European Working Group on Sarcopenia in Older People 2. Dietary diversity was assessed using a diet variety score. This diet variety score assessed the one-week consumption frequency of ten food groups, according to the following responses: “eat almost every day” (1 point), or “not eaten almost daily” (0 points). Older adults with a diet variety score of 3 or more points were defined as having high dietary diversity. Incident disability was certified by long-term care insurance (mean follow-up duration 32 months). ResultsThe cumulative disability incidence rates in the older adults with low dietary diversity and high dietary diversity were 23.3 % and 16.9 %, respectively. Cox proportional hazards regression analysis revealed high dietary diversity was associated with a lower risk of incident disability in older adults with sarcopenia (hazard ratio 0.66, 95 % confidence interval 0.47–0.92; p = 0.015), after adjusting for covariates. ConclusionsThis longitudinal study revealed that high dietary diversity is associated with a lower risk of incident disability among sarcopenic Japanese older adults.

Typologies of dependency, household characteristics, and disparity in formal and informal care use: analysis of community-dwelling long-term care insurance claimants in an urban municipality of China

BackgroundA comprehensive understanding of subgroups of community-dwelling older adults and their long-term care (LTC) utilization can help to promote equality in the long-term services and support system. Dependency and household characteristics were found to affect the LTC utilization of homebound older adults. However, few studies considered the typologies of dependency of older populations according to co-occurring limitations, and little is known about differences in LTC use among elderly of typologies of dependency under distinct household conditions.MethodsWe aimed to identify typologies of dependency of older adults living at home and explore the disparities in formal care and informal care use among typologies of dependency by income and living situation. In this cross-sectional study, we used the public long-term care insurance (LTCI) database of Yiwu, Zhejiang Province, China, and included 1675 individuals aged ≥ 60 years living at home. Cluster analysis was conducted to determine typologies of dependency among older adults. A two-step multilevel analysis was used to examine disparities in formal and informal care use related to household income and living status among typologies of dependency.ResultsSeven dependency clusters were identified. Pro-wealthy inequalities in both formal and informal care use were found in the least dependent cluster and the limited-locomotion cluster. Pro-poor inequalities in formal care use were found in the fully dependent cluster without impaired vision and the cluster with intact continence and vision. Living with family members was positively associated with receiving formal care for the fully dependent cluster. Older adults in most clusters were more likely to use informal care when living with family members, except for the least dependent cluster and the limited-locomotion cluster.ConclusionsOur findings suggest that household inequalities in LTC use varied among typologies of dependency of older adults, which may provide insights for researchers and policymakers to develop tailored LTC and targeted LTCI programs for older adults living at home and their family caregivers, considering both typologies of dependency and household characteristics.

Evaluation of costs, osteoporosis treatment, and re-fractures in German collaborative orthogeriatric care after fragility fractures.

Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence for other fractures is rare. The aim of our study was to conduct an evaluation of economic and health outcomes after the German OGCM for geriatric fragility fracture patients. This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a fragility fracture in 2014-2018, and were treated in hospitals certified for OGCM (ATZ group), providing OGCM without certification (OGCM group) or usual care (control group). Healthcare costs from payer perspective, prescribed medications, and re-fractures were investigated within 6 and 12 months. We used weighted gamma and two-part models and applied entropy balancing to account for the lack of randomization. All analyses were stratified per fracture site. We observed 206,273 patients within 12-month follow-up, of whom 14,100 were treated in ATZ, 133,353 in OGCM, and 58,820 in other hospitals. Total average inpatient costs per patient were significantly higher in the OGCM and particularly ATZ group for all fracture sites, compared to control group. We did not find significant differences in costs for re-fractures or antiosteoporotic medication for most fracture sites, although antiosteoporotic medication was significantly more often observed in the OGCM and particularly ATZ group for hip, pelvic, and humerus fractures. The observed healthcare costs were higher in ATZ and OGCM hospitals within 12 months. Antiosteoporotic medication was prescribed more often in both groups for most fracture sites, although the corresponding medication costs did not increase.

Atrial fibrillation and mortality after ischemic stroke: An observational study using an insurance claim database

ObjectivesIn this study, we aimed to examine the association between atrial fibrillation and mortality after ischemic stroke and evaluate the use of anticoagulation therapy for atrial fibrillation before stroke onset in patients who experienced stroke. MethodsIn this retrospective observational study, we used a combined database of medical and long-term care insurance claims data from one prefecture in Japan. The data of 25,352 patients aged ≥ 65 years who were hospitalized in acute care hospitals with a diagnosis of ischemic stroke between April 2012 and March 2015 were extracted. Cox proportional hazard modeling, with adjustment for age, sex, comorbidities, and long-term care dependency level (based on the activities of daily living), was performed to evaluate the relationship between mortality and atrial fibrillation. ResultsThe prevalence of atrial fibrillation was 21.8% in the study population. A significant association was noted between mortality and atrial fibrillation (adjusted hazard ratio: 1.28, 95% confidence interval: 1.16–1.41, p < 0.001). Anticoagulant drugs were used in 32.2% of the patients with atrial fibrillation. ConclusionsThese results indicate that atrial fibrillation is associated with mortality after stroke; however, the use of anticoagulation therapy for atrial fibrillation is unsatisfactory. Efforts to improve the use of atrial fibrillation therapy are required in Japan.

District-level Collaboration for Improving Quality of Life of Older People in Thailand

Thailand established district-level collaborations to improve citizens' quality of life and promote self-governance. Despite successful district-level collaborations to improve the quality of life (QoL) of older people through long-term care (LTC) policies, a lack of analysis of the collaborative process across the country persisted. To address this gap in knowledge, this study aimed to analyze the collaborative process at the district level in implementing LTC activities in Thailand. In this study, qualitative research was employed to collect data through in-depth interviews and non-participating observations during collaborative meetings in four regions of Thailand. The findings of this study indicate that in Thailand, district-level collaboration was overseen by the Committee for the Improvement of the Quality of Life at the District Level (CIQ), which comprised representatives from the public, private, and civil sectors. The CIQ was responsible for improving the QoL of older people and its activities included member selection, appointment, problem identification, problem prioritization, problem-solving planning, task delegation, joint operation, and monitoring. This collaboration was implemented in accordance with legal preferences for decentralization and has contributed to the effective and appropriate implementation of LTC operations. Furthermore, the collaborative approach utilized in this study may also be applicable to other collaborative operations.

The Genetic Information Privacy Act

This Viewpoint discusses proposed and enacted state legislation to protect genetic privacy for those participating in direct-to-consumer genetic testing and ensuring genetic antidiscrimination for life, health, long-term care, and disability insurance.

The effect of long-term care insurance on healthcare utilization of middle-aged and older adults: evidence from China health and retirement longitudinal study

BackgroundAs global ageing continues to increase and many countries face challenges from the growing demand for long-term care. Drawing on the experiences of developed countries, developing countries have explored their own suitable long-term care insurance and have shown strong potential for development and research prospects. However, due to their late start, relevant research is underrepresented in the global research network and still needs to be supplemented. The present study hopes to examine the effect of long-term care insurance on healthcare utilization among the middle-aged and elderly from an empirical perspective, using China as an example.MethodsPanel data from wave 3 (2015) and wave 4 (2018) of the nationally-representative China health and retirement longitudinal study were selected to obtain a sample of 661 processing participants and 16,065 control participants after matching the policy implementation time in the first pilot cities, and quantitative analysis was conducted using difference-in-differences propensity score matching estimator method to assess the net effect of long-term care insurance on health care utilization among the middle-aged and elderly adults.ResultsIn the matched frequency-weighted regression difference-in-differences estimator results, long-term care insurance had a negative effect on the number and costs of annual hospitalizations at the 5% significance level (key variable values of − 0.0568101 and − 1236.309, respectively) and a non-significant effect on outpatient service utilization (P > 0.05). Further exploration of the heterogeneous effect of it revealed that implementation had a more significant negative effect on hospitalization utilization for middle-aged and older people in the East and for those with higher levels of education or attended care.ConclusionLong-term care insurance has played a role in controlling hospitalization costs but has not yet achieved the expected effect in controlling outpatient costs. The policy effects in terms of regional distribution and education level and care situation have been variable. The treatment plan of long-term care insurance needs to be improved, the supply of resources for long-term care services should be increased, and the promotion of long-term care insurance and health science should be given attention.

Dignity in the care of older adults living in nursing homesand long-term care facilities.

Depending on the fields and actors involved, dignity may involve, signify, and encompass different meanings. This fundamental right can be subjectively experienced and rooted in a person's perception of being treated and cared for. Care refers to a set of specific activities combined in a complex life-sustaining network, including long-term Care, which involves various services designed to meet a person's health or personal care needs. However, older residents' human rights have been disrespected and widened the gaps between theory and practice regarding the precarious protection of their rights and dignity inside long-term facilities and nursing homes. This paper aims to discuss threats to dignity and elucidate some strategies to promote and conserve dignity in care, including the person-centered practice in long-term care. Some barriers to the dignity of older residents involve the organizational culture, restraints of time, heavy workload, burnout, and lack of partnership between the residents, their families, and the long-term care homes' staff. Person-centered integrated care quality frameworks are core components of a good quality of care in these spaces in high-income countries. Unfortunately, the COVID-19 pandemic highlighted how weak long-term care policies were and demonstrated that much progress in the dignity of care in long-term care facilities and nursing homes is needed. In low- and middle-income countries, long-term care policies do not accompany the accelerated and intense aging process, and there are other threats, like their invisibility to the public sector and the prejudices about this service model. It's urgent to create strategies for designing and implementing sustainable and equitable long- term care systems based on a person-centered service with dignity to everyone who needs it.

The Significance of Independence in Japan’s Long-term Care Insurance Act

The Significance of Independence in Japan’s Long-term Care Insurance Act

Can long-term care partnership programmes increase insurance coverage and reduce Medicaid costs?

ABSTRACT Although long-term care is a substantial financial risk for elderly Americans, only about 10% purchase insurance, with many of the remainder relying on Medicaid. Faced with rising Medicaid expenditure on long-term care, states introduced long-term care partnership programmes in the hope of reducing Medicaid spending by encouraging the purchase of private insurance. Using numerical optimization techniques, we show theoretically that partnership programmes will only modestly increase long-term care insurance coverage. Most of the benefits will go to those who would have purchased non-partnership policies. Thus, the potential costs to Medicaid will exceed the savings.

Effective service coverage of long-term care among older persons in South Korea.

Global population aging, and the accelerated increase in the number of oldest-old adults, over 80years, has implied a heightened need for long-term care (LTC). We aimed to provide a theoretical care cascade of LTC services to assess publicly funded LTC (Analysis 1) and to investigate the association between the use of LTC insurance (LTCI) and unmet care needs among older people (Analysis 2) in South Korea. Analysis 1 used data from the eighth wave (2020) of the Korean Longitudinal Study of Aging (KLoSA), the 2020 National Health Insurance Service LTCI Statistical YearBook and the 2020 National Awareness Survey of LTCI. The care cascade consisted of the target population, service contacts, coverage and outcomes. Analysis 2 used the fifth to eighth waves of KLoSA, and LTCI analysis was based on three groups: not aware, aware but do not use and aware and use. Unmet care needs were defined as the absence of help among older people with care needs. Among 8,489,208 people aged 65 or older in 2020, 1,368,148 (16.1%) were estimated to want care. Of these, 62.7% (N = 857,984) had LTCI service contact and 807,067 (94.1%) of those had used LTCI services in the past year (Analysis 1). Older people who were aware and used LTCI were less likely to report unmet activities of daily living (ADL) (prevalence ratio (PR): 0.34, 95% confidence interval (CI): 0.18-0.66) or unmet instrumental ADL (IADL) needs (PR: 0.27, 95% CI: 0.17-0.43) than those who were not aware (Analysis 2). This article provides a theoretical cascade to assess LTC provision in South Korea and a preliminary model for other countries. Korea's LTCI is associated with reduced unmet ADL and IADL needs.

Variation in Utilization of Postoperative Rehabilitation After Total Hip Arthroplasty in Japan

ObjectiveThe use of rehabilitation after arthroplasty in Japan is unknown. We aimed to identify utilization of postoperative rehabilitation after total hip arthroplasty (THA) and to explore the factors associated with rehabilitation usage. DesignA retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). SettingHospitals nationwide. ParticipantsPatients aged >40 years who underwent primary THA between 2017 and 2018 (N=51,332). InterventionsNot applicable. Main Outcome MeasuresThe proportion of patients who underwent postoperative rehabilitation and the number of rehabilitation days were also calculated. Patient demographic characteristics, hospital case volumes, and regions associated with continuing postoperative rehabilitation were analyzed using a Cox proportional hazards model. ResultsEligible patients were selected from 3033 hospitals, of whom 41,192 (80%) were women. Of these, 94% used inpatient rehabilitation, and 20% received outpatient rehabilitation. The mean durations of rehabilitation were 47±72 days for inpatient and 195±109 days for outpatient, respectively. Large-scale hospitals performing more than 200 procedures annually had the shortest duration of inpatient rehabilitation (36-65 days) and the longest duration of outpatient rehabilitation (220-109 days) compared with smaller hospitals. The regression model consistently showed that rehabilitation continued longer at hospitals with over 200 patients per year (HR 0.96, 95% CI 0.93-0.99, P<.007). ConclusionThe Japanese health care system provided higher access to inpatient rehabilitation after THA than other countries. One limitation of this study is that long-term care insurance data were not analyzed. However, outpatient rehabilitation vary according to hospital case volume. Further research is needed to determine the causes of variation in rehabilitation use and the effect of variation on patient outcomes.

Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care.

Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care. The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs. Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001). Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumferenceis suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.

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.