Long-term Care Insurance Research Articles

The impact of long-term care insurance system on family care: Evidence from China.

The inconsistent findings on the impact of the long-term care insurance (LTCI) system on family care require us to extend our study horizon to more countries with LTCI system designs or market practices. China has explored the LTCI system through pilot programs, which provide a quasi-natural experimental environment. This paper aims to examine how the LTCI system affects family care in China. We primarily employ the time-varying difference-in-differences method to perform regression analyses based on the panel data from the China Health and Retirement Longitudinal Study. We discover a 7.2% rise in family care under the LTCI system. Specifically, the LTCI system is more likely to promote family care as the relatively primary care for disabled women, disabled people aged 60-74, and those who cannot fully take care of themselves. In addition, the formal care support policy of LTCI will crowd in both formal care and family care, and the crowding-in-effect on formal care may even obscure the crowding-in-effect on family care. The family care support policy of LTCI may encourage the policy-covered groups to take family care as their relatively primary care. It may also lengthen family care for those groups. The LTCI system has a crowding-in effect on family care. It can increase family care through cash payments or linking formal and informal care resources by providing formal community and home care.

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 the Dilemma of Implementing Rural LTC Insurance and the Implementation Path

Against the backdrop of China's ageing situation and the rising number of disabled persons, the Ministry of Human Resources and Social Security started to promote the construction of long-term care insurance in 2016. Compared to the mature LTC insurance models in developed Western countries, there are still many problems in the process of promoting LTC insurance in China due to the short duration of the pilot. This paper presents a synthesis of the dilemmas observed by different scholars in the process of promoting LTC insurance, and summarises the solutions and concrete implementation paths proposed by other scholars in response to these dilemmas. It can be found through the study that the lack of policies and laws, backward physical conditions and the difficulty in changing attitudes are the main reasons why it is difficult to promote LTC insurance in rural areas. Different scholars have accordingly put forward suggestions such as extending funding channels, strengthening the training of talents and creating a perfect care model.

Family spillovers and long-term care insurance

We examine how long-term care insurance (LTCI) affects informal care use and expectations among the insured individuals and co-residence and labor market outcomes of their adult children. We address the endogeneity of LTCI coverage by instrumenting for LTCI with changes in state tax treatment of LTCI insurance policies. We do not find evidence of reductions in informal care use over a horizon of approximately eight years. However, we find that LTCI coverage reduces parents’ perceptions of the willingness of their children to care for them in the future and that the behavior of adult children changes, with LTCI resulting in lower likelihoods of adult children co-residing and stronger labor market attachment. These findings provide empirical support for the presence of spillovers of LTCI on the economic behaviors of family members.

PREMIUMS CALCULATION OF TERMINAL ILLNESS INSURANCE

One related type of critical illness insurance is Long Term Care (LTC) Insurance. This study discusses the calculation of LTC insurance premiums with an annuity as a rider benefit. The benefit is included the cost of insurance care when diagnosed with a critical illness with a terminal condition or death because of any reason. The types of critical illnesses used in this study are cancer, heart disease, stroke, and diabetes mellitus. The data used are in the form of Indonesia's mortality table, and data on the prevalence of critical illness patients with terminal illness conditions. The net annual premium value in this study was obtained through the results of the multiple-state model determination of the transition probabilities of 10 states. The transition probability of an insured candidate is obtained from the prevalence of critical illness patients and the prevalence of mortality. Based on the case study, the amount of net annual premium that must be paid by an insured female aged years in good health is for the protection period and the payment period is years. The cost of insurance premiums for the male insured is greater than for the female insured. The higher the interest rate used, the smaller the net single premium that must be paid. The younger the age when registering the policy, the smaller the premium that must be paid. The longer the coverage period, the greater the premium that must be paid. This result is expected to be a recommendation for the prospective insured to adjust the suitable premium.

Home care aides' perspectives of occupational tobacco smoke exposure: A Q methodology study.

The increased growth of older adults has generated demand for home care aides (HCAs). Occupational tobacco smoke exposure (OTSE) may risk their health that should be paid attention to. This study explored the HCAs' perspectives of OTSE to inform health promotion programs catering to individual needs. A two-stage Q methodology was employed for data collection and analysis. 39 Q statements were extracted in the first stage and then 51 HCAs with OTSE were recruited to complete Q sorting in the second stage. PQ Method software was used for data analysis. Principal component analysis was performed to determine the most appropriate number of factors. The five factors identified from HCAs' perspective of OTSE explained 51% of the variance. The HCAs agreed that OTSE could increase cancer risk. The HCAs with Factor I did not care about OTSE, tending to complete their work. The HCAs with Factor II agreed the health hazards of OTSE, but did not know how to help their clients stop smoking. The HCAs with Factor III cared about OTSE but were afraid of disrupting the client-provider relationship. The HCAs with Factor IV regarded OTSE as a priority for occupational interventions whereas the HCAs with Factor V did not think OTSE was an issue and believed that they could balance work and OTSE health hazards. Our findings will inform the design of home care pre-service and on-the-job training courses. Long-term care policies should be developed to promote smoke-free workplaces. There are five types of home care aides' perspective on occupational tobacco smoke exposure (OTSE). The tailor interventions can be developed to help them avoid the OTSE (e.g., opening windows for ventilation or using air purification equipment) and have an OTSE-free spaces.

Serum folate and risk of disabling dementia: a community-based nested case–control study

ABSTRACT Purpose The aim of this study was to examine associations between serum folate levels and risk of disabling dementia that required care under the national insurance (disabling dementia). Methods We performed a nested case–control study in a community-based cohort, the Circulatory Risk in Communities Study, involving 13,934 Japanese individuals aged 40–84 years at the baseline period of 1984–2005. Serum folate was measured in 578 cases of incident disabling dementia, and in 1,156 controls whose age (±1 years), sex, area of residence, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. Results After a 20.8-year follow-up, serum folate was inversely associated with risk of disabling dementia. The respective multivariable odds ratios (95% CIs) were 0.71 (0.51–0.99), 0.76 (0.54–1.06), 0.70 (0.49–1.00), and 0.62 (0.43–0.90) for persons with the second, third, fourth, and highest quintiles of serum folate as compared with the lowest quintile (P for trend = 0.03). A similar association was observed for dementia with or without stroke. Conclusion In this nested case–control study with a long follow-up, low serum folate levels were associated with an increased risk of disabling dementia among Japanese individuals.

Associations between long-term care-service use and service- or care-need level progression: a nationwide cohort study using the Japanese Long-Term Care Insurance Claims database

BackgroundThe effectiveness of the long-term care service in Japan has been unclear, and most of the relevant studies of this service have been limited to a single region and relatively small samples, necessitating large-scale studies. We examined the associations between long-term care service use and the service/care-need level progression at the national scale in Japan.MethodsWe conducted a nationwide retrospective cohort study using data from the Japanese Long-Term Care Insurance Claims database. Individuals aged ≥ 65 years and newly certified as being at the support-need level 1 or 2 or the care-need level 1 between April 2012 and March 2013 were included. We first conducted 1:1 propensity score matching and then examined the associations between service use and the progression in support-need or care-need levels by using Kaplan–Meier survival curves and log-rank tests.ResultsThe final sample consisted of 332,766 individuals. We observed that service use was associated with a faster decline in the support/care-need level, although the differences in the subjects' survival rate diminished; the log-rank test showed significance (p < 0.001). When stratified for urban–rural classifications or regions of Japan, the results were similar to the primary analysis in all of the stratified groups, and no clear regional variations were observed.ConclusionWe did not observe a clear beneficial effect of receiving long-term care in Japan. Our results suggest that Japan's current long-term care service may not be effective for the recipients of these services. Considering that the system is becoming a financial burden, a re-examination of the service to provide more cost-effective care may be advisable.

Acceptance of preventive home visits by nurses - The user perspective.

The aim of this study was to investigate acceptance of preventive home visits (PHVs) for older adults in rural Germany. Qualitative descriptive approach. We investigated the personal, individual perspective of adults aged 65 to 85, who were not yet eligible for benefits from the long-term care insurance, were able to understand and speak German, and who lived in the municipality under study. Fifteen semi-structured interviews were conducted between 02/2019 and 08/2020. They were transcribed, coded using MAXQDA, and content analyzed. Ethical approval was obtained. The acceptance of PHVs was extremely high and characterized by five main effects: very close relationship with the nurse, well-being, empowerment, satisfaction, ambivalence. Participants wish to receive PHVs in the future and would recommend it to others. Even those with a healthy or health-promoting lifestyle are thankful to be able to refer to the counselling sessions if life circumstances should deteriorate. Those who became care-dependent wish to continue and perceive it as a valuable addition to their care. From the participants' point of view, this low-threshold counselling-and-support approach should be maintained in the future. PHVs can support health and independence in older adults and therefore prevent them from becoming care-dependent.

Controlling Spending For Health Care And Long-Term Care: Japan's Experience With A Rapidly Aging Society.

As the Japanese population has aged rapidly, Japan's experience has implications for other high-income countries, including the United States. The aging of Japan's population, coupled with the government's decision to implement a public long-term care insurance program in 2000, has increased the nation's expenditures. In acute care, costs have been relatively contained by biennially revising the fee schedule for all physician and hospital services and by lowering pharmaceutical prices. The fee schedule not only sets prices but also controls volume by setting the conditions of billing for each item. This fee schedule is applied to all social health insurance plans (which enroll all permanent residents of Japan) and to virtually all providers. In contrast, despite the use of a similar fee schedule, spending in long-term care insurance has increased more than spending in health care. This is both because long-term care became an entitlement and because aging has had a greater impact on long-term care insurance spending than on health insurance spending. In this article we analyze Japanese expenditure data to provide essential information to the US as the percentage of its population ages sixty-five and older continues to rise. A key lesson that the US can learn from Japan's experience is that as its population ages, the need for long-term care will increase, necessitating better control of acute care spending.

Analyzing and comparing healthy aging in France and OECD countries based on a new physiological age measure

We introduce a new individual measure of healthy aging on a sample of more than 39,000individuals and compare the results for France with 11other European countries and the United States. Our healthy aging measure is based on the discrepancy between the calendar age of populations with their estimated physiological age, which corresponds to a measure of age adjusted for the effects of comorbidities and functional health. France is ranked in the lower middle of our healthy aging scale, with the Nordic countries (Denmark, Sweden, Netherlands), Switzerland and Greece being ahead. Economic capital has a strong impact on the estimated physiological age and on healthy aging trajectories. Socioeconomic inequalities are particularly marked in France as well as in Italy and the United States. The generosity of long-term care policies seems to be positively associated with the level of healthy aging of the populations. More work is required to identify the drivers of healthy aging among individuals living in OECD countries.

텍스트 마이닝 기법을 활용한 노인장기요양기관 부당청구 판례 분석 연구

The increasing number of unfair claims in long-term care facilities has emerged as a risk factor for threatening the finances of the Korean national health insurance and increasing medical expenses, considering the imminent danger to super-aged society, since the implementation of the Long-term Care Insurance Act for the Elderly. Therefore, we aim to provide alternatives for unfair claim prevention and recidivism. The court's precedents and text-mining analysis were used to identify issues and factors in unfair claims to meet our research goals. Ninety-one cases (i.e., eighty-five elderly care facilities and six elderly care communal homes) were collected from January 1, 2013, to December 31, 2020. Our results revealed that fourty-four were fined, seventy-two received probation, and eighteen were sentenced to imprisonment, of the first verdicts by trial courts for senior medical welfare facilities. Among the defendants (n = 146), ninety-nine were top managers; thirteen were care workers; and five were social workers. The indictments consisted of seven violations, and of three most representative contents were violations of the Long-Term Care Insurance Act for the Elderly, of the Act on the Aggravated Punishment of Specific Economic Crimes (fraud), fraud, violations of the Elderly Welfare Act, business embezzlement and forgery of private documents. In the first trial, TF-IDF analysis indicated four keywords, 'regulations and announcements,' 'working hours,' 'additions,' 'competition,' and mandatory personnel, such as physical therapists, social workers, and nursing assistants. In the second trial, 'field investigation,' 'sanitation,' and 'resident' were the main words. Topic Modeling of the first trial showed that 'nursing care workers &amp; sanitation center,' 'nursing care staff assignment standards,' 'social worker &amp; physical therapist,' 'notifications and laws,' 'working hours &amp; exploitation,' 'defendants &amp; victim.' In the second trial, 'accused &amp; supreme unjust (heavy),' 'placement criteria &amp; deception (acts),' 'long-term care benefit &amp; breach of working hours,' 'victim's claim &amp; crime of fraud,' 'false service,' 'staff assignment standards &amp; deceiving (acting),' and 'defendant's working rules &amp; field investigation.' Thus, we explored causes and issues with unfair claims. Finally, we proposed several preventative solutions: ①. change in the perception of operators and works of long-term care institutions, ②. transparent management, ③. a thorough understanding of relevant regulations, such as laws and public announcements, and prevention of errors in interpretation, and lastly ④. active countermeasures focused on improving unfair claims instead of punishment.

A Review of the Implementation of the Long-term Care Insurance System in China - A Case Study of City T

A Review of the Implementation of the Long-term Care Insurance System in China - A Case Study of City T

Regional disparities in Dementia-free Life Expectancy in Japan: An ecological study, using the Japanese long-term care insurance claims database.

The number of people with dementia increases in an aging society; therefore, promoting policies for dementia throughout the community is crucial to creating a dementia-friendly society. Understanding the status of older adults with dementia in each region of Japan will be a helpful indicator. We calculated Dementia-free Life Expectancy and aimed to examine regional disparities and their associated factors. We calculated Dementia-free Life Expectancy and Life Expectancy with Dementia for each secondary medical area in Japan based on the Degree of Independence in Daily Living for the Demented Elderly, using data extracted from the Japanese long-term care insurance claims database. We then conducted a partial least squares regression analysis, the objective variables being Dementia-free Life Expectancy and Life Expectancy with Dementia for both sexes at age 65, and explanatory regional-level variables included demographic, socioeconomic, and healthcare resources variables. The mean estimated regional-level Dementia-free Life Expectancy at age 65 was 17.33 years (95% confidence interval [CI] 17.27-17.38) for males and 20.05 years (95% CI 19.99-20.11) for females. Three latent components identified by partial least squares regression analysis represented urbanicity, socioeconomic conditions, and health services-related factors of the secondary medical areas. The second component explained the most variation in Dementia-free Life Expectancy of the three, indicating that higher socioeconomic status was associated with longer Dementia-free Life Expectancy. There were regional disparities in secondary medical area level Dementia-free Life Expectancy. Our results suggest that socioeconomic conditions are more related to Dementia-free Life Expectancy than urbanicity and health services-related factors.

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.

The limits of social investment and the resilience of long-term care

This article investigates the extent to which a social investment paradigm has guided policy reforms in long-term care for the elderly in France and the Netherlands and how this relates to the resilience of the sector during the Covid-19 pandemic. It conceptualizes the theoretical impact of social investment on long-term care policy and analyzes its use to justify reforms since the early 2000s. It concludes that social investment has not played any role in Dutch long-term care reforms and a moderate role in France. Meanwhile, in both countries a neoliberal emphasis on the efficiency of the market has contributed to a rise in for-profit service provision and fragmentation of the long-term care sector. While long-term care provision in both countries proved relatively resilient in the first phase of the pandemic, at a later stage its resilience was undermined by fragmentation and marketization, limiting the government's ability to respond adequately to new challenges and, crucially, to improve working conditions in the sector. The article concludes that a social investment approach cannot resolve these problems and that there is a need for a new paradigm that acknowledges the inherent value of care work and prioritizes the long-term sustainability of care provision.

The Effect of informal caregiving on caregivers’ healthcare utilization in China

ABSTRACT A fast-ageing population implies an upsurge in demand for caregiving. We examine the causal effect of informal caregiving on caregivers’ realized and forgone healthcare utilization based on data from China. Accounting for the potential endogeneity in caregiving, we find that caregivers not only use more outpatient care and self-treatment, but are also more likely to forgo necessary inpatient care. Caregiving also increases the out-of-pocket expenditures of all types of healthcare. Further mechanism analysis shows that caregiving worsens caregivers’ health and takes up time and economic resources for healthcare utilization, which causes the coexistence of increased realized and forgone healthcare use. Heterogeneity analysis reveals that those with tighter budgets and higher marginal costs for healthcare (e.g. rural or less educated caregivers) tend to bear larger increases in caregiving-driven health costs. Our results shed light on the overlooked benefit of long-term care policies if accounting for the spillover effects of informal care provision on caregivers’ healthcare use, particularly for disadvantaged groups.

Application of Markov Model in Long-Term Care Insurance

The Markov process is not only the actuarial basis of pricing of long term care (LTC) insurance but also the fundamental for predicting the future elder population and disabled population. This article aims to summarize how the Markov processes or Semi-Markov processes are used in the Long-term care risk and Long-term care insurance. We also discuss the models based on the time-homogeneous and time-inhomogeneous. Moreover, under the GLM framework, some studies show Tweedie-GLM would give more accurate predictions compared with other GLM models and additive models. However, these models, whether based on the Markov process or Semi-Markov process or GLM, have theoretical advantages due to the natural features, the researchers would quickly build the multi-state models, there are still exits many challenges, and they provoke the researchers into some tries of how to deal with the limitations of data, the development of medical technology, and the longer expectancy of life.

Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model

BackgroundOlder adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults.ObjectiveThe purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home.MethodsThis was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance.ResultsEducation and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support).ConclusionsThe present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.

Pricing of Joint Life Long-Term Care Insurance Based on a Multistate Markov Model

This study considers elderly couples as the research object and proposes a new mode of joint life long-term care insurance. Based on the data from the China Health and Retirement Longitudinal, the study is used to define six health states and to establish an ordered logistic model to derive a health-state transition probability matrix for elderly couples in China. On the basis of the estimated annual transfer probability matrix, a Markov model is selected for the calculation of premiums of joint life long-term care insurance. In addition, the study analyzes the impacts of initial health status, age, residential area, and care status on state transition probabilities and joint life long-term care insurance (LTCI) premiums.