Social Long-term Care Insurance Research Articles

Zur Beitragssatzentwicklung in der Sozialen Pflegeversicherung – Wie wirkt ein Einfriermodell mit degressiver Leistungsdynamisierung?

Abstract An increasing contribution rate in social long-term care insurance is likely to be unavoidable in the future. To achieve the possibility of contribution rate stability, we consider the idea of a freezing model with partial degressive benefit dynamization. Using a projection model to calculate the potential future development of the contribution rate, we analyze the dampening effects of this proposal. In terms of contribution rate stability and sustainable financing in social long-term care insurance, the considered approach is able to make a significant contribution. Conclusively, it represents a compromise between subsidiarity and solidarity by transferring more responsibility to younger generations and continuing to guarantee social support to older generations.

From the Perspective of Internal Control, Research on the Government Responsibility for the Construction of Long Term Care Insurance System in China

Under the pressure of aging, aging of the aged, disability, empty nesting and so on, the demand for long-term care services for the elderly in China has risen sharply. To explore and establish a social long-term care insurance system is conducive to meeting the needs of the elderly for long-term care services. This paper demonstrates the necessity of government responsibility in the social long-term care insurance system, discusses the advantages and disadvantages of different government responsibility modes and the choice of government responsibility modes, and analyzes in depth the implementation of government responsibility. Specific contents.

CHANGES IN PATTERNS OF FORMAL AND INFORMAL HELP AND UNMET NEEDS AMONG KOREAN OLDER ADULTS

Abstract Despite the consistent expansion of social long-term care insurance (LTCI), informal care by family members is still dominant in Korea. This study aims to examine how older adults in need utilized formal and informal sources of help and how patterns of help and unmet needs changed over time, since LTCI has been introduced in 2008. Community-dwelling older adults (65+) from the Korean Longitudinal Study of Ageing (N = 2,501) reported their I/ADL limitations and who helped them—if they are in need in 2010 and 2018. We grouped older adults’ sources of care into (a) no help, (b) informal help only, and (c) any formal help, and examined the patterns by wave and gender. Among older adults with I/ADL limitations, formal help use increased between waves (1% to 12%), suggesting the impact of LTCI expansion. Changes in the patterns of help and unmet need differed by gender. The proportion of older men with no help dramatically decreased (41% to 27%); more men received informal or formal help in 2018. In contrast, the proportion of older women who did not receive any help remained similar (33% to 34%); thus, although more women received formal help, less women relied on informal help in 2018. Within the context of LTCI expansion, older men may mobilize support from their family further, which contributes to lowered unmet needs. However, older women’s unmet need did not decrease, while reduced use of informal help. These findings highlight the importance of considering gendered long-term care resources in Korea.

The social long-term care insurance model: comparing actor configurations across countries and time

AbstractTo date, social long-term care insurance (SLTCI) systems have been introduced in six countries globally: the Netherlands, Israel, Germany, Japan, Luxembourg and South Korea. Applying an actor-centred, multi-dimensional framework and fuzzy-set analysis, the present article investigates the typical characteristics and variations of these SLTCI schemes at introduction and today. In short, we find that the SLTCI model features dominant social contribution financing, a mix of for- and non-profit providers, and state regulation. In light of the relevance of corporate self-regulation often associated with social insurance systems, the dominance of state regulation is unexpected. The analysis also reveals considerable variance between cases, most notably concerning the extent of private individual actors’ involvement. While geographical proximity of countries does not explain differences between SLTCI systems, “temporal clusters” seem to partly drive the variation of SLTCI actor configurations.

Asymmetric information, strategic transfers, and the design of long-term care policies

Abstract We study the optimal design of social long-term care (LTC) insurance when the utility of informal caregivers is taken into account. Informal care is exchange-based. Children’s cost of providing care is continuously distributed over some interval and is not observable. Parents choose a rule specifying transfers conditional on the level of informal care. We study first uniform provision of LTC and then a nonlinear policy depending on family transfers. In both cases, informal care increases with the children’s welfare weight. Our theoretical analysis is completed by calibrated numerical solutions. Uniform public care should represent up to 40% of total care but its share decreases to about 30% as the weight of children increases. In the nonlinear case, public care increases with the children’s cost of providing care at a faster rate when children’s weight in social welfare is higher. It represents 100% of total care for families with high-cost children.

Well-being losses by providing informal care to elderly people: Evidence from 310 caregivers in Shanghai, China.

A series of policies aimed toward rational resource allocation of long‐term care have being actively discussed since the launch of the social long‐term care insurance in Shanghai, and it is important to take a societal perspective for informed decision‐making. This study aims to explore factors that are associated with well‐being of informal caregivers in Shanghai, and to provide empirical evidence of application of an established well‐being valuation method to monetise informal caregivers' well‐being losses in a developing country. 310 informal caregivers of applicants for social long‐term care insurance in Shanghai were interviewed. Univariate and multivariate analyses were conducted to explore the associated factors with life satisfaction of the caregivers. The monetary values of an additional hour of caregiving with and without specification of care tasks were estimated by the well‐being valuation method. Life satisfaction was consistently associated with monthly income, health status, and caring hours of the caregivers. The money needed to compensate one additional hour of caring per week was 12.58 CNY (0.3% of the monthly income), and 96.95 CNY (2.0% of the monthly income) for activities of daily living (ADL) tasks. Income, health status, and caregiving are significantly associated with well‐being of informal caregivers. Caregivers in relatively poor health condition and/or involved in more ADL tasks should be particularly considered in supporting policies in Shanghai.

Willingness-to-pay and willingness-to-accept of informal caregivers of dependent elderly people in Shanghai, China

BackgroundIn order to make optimal long-term care-related decisions, it is important to take a societal perspective. Shanghai is one of the pilot cities of social long-term care insurance in China. However, little knowledge exists about the economic value of the informal care provided to dependent elderly people in China. This paper aims to evaluate the economic value of informal caregiving in Shanghai using the contingent valuation method by their least-preferred care tasks, and identify the associated factors of willingness-to-pay (WTP) and willingness-to-accept (WTA) of the informal caregivers.MethodsThis study employed the contingent valuation method to elicit 371 informal caregivers’ WTP and WTA for 1 hour of reduction or increase of least-preferred caring tasks in Shanghai. Univariate and multivariate analyses were conducted to explore the associated factors with the WTP and WTA values.ResultsThe average WTP and WTA were 25.31 CNY and 38.66 CNY, respectively. The associated factors with WTP include caregiver’s income and caregiver’s relationship to the recipient. Care recipient’s age, income, least-preferred task by the caregiver, and subscales of Caregiver Reaction Assessment were found to be associated with WTA. The non-responsiveness rates were 26.1 and 33.2% for WTP and WTA questions, respectively.ConclusionsThe findings of the current study demonstrated that decision-makers and researchers should take the economic valuation results of informal care into account to make more informed and effective long-term care-related policies and analyses.

Financing Mechanism for Social Long-Term Care Insurance: A Theoretical Analysis Framework

The financing mechanism is an important component of social long-term care insurance, its stability and sustainability have a vital significance in keeping the healthy and efficient operation of social long-term care insurance. In order to carry out an in-depth study on the financing mechanism of social long-term care insurance, this article makes an analysis of each of the links and key points involved in the financing in accordance with the whole process of the social long-term care insurance financing and on the basis of summarizing the existing literature regarding the definition and connotation of the financing mechanism of social long-term care insurance. On such basis, it establishes the financing mechanism element framework of social long-term care insurance, by which it then explores the practices and experiences of the typical countries with social long-term care insurance and the advanced areas of China. Finally, in view of the common points and reform tendency of the construction of foreign countries’ social long-term care insurance financing mechanism, this paper puts forward some policy suggestions for the construction of China’s social long-term care insurance financing mechanism.

Asymmetric Information, Strategic Transfers, and the Design of Long-Term Care Policies

We study the design of social long-term care (LTC) insurance when informal care is exchange-based. Parents do not observe their children's cost of providing care, which is continuously distributed over some interval. They choose a rule specifying transfers that are conditional on the level of informal care. Social LTC insurance is designed to maximize a weighted sum of parents' and children's utility. The optimal uniform public LTC insurance can fully cover the risk of dependence but parents continue to bear the risk of having children with a high cost of providing care. A nonlinear policy conditioning LTC benefits on transfers provides full insurance even for this risk. Informal care increases with the children's welfare weight. Our theoretical analysis is completed by numerical solutions based on a calibrated example. In the uniform case, public care should represent up to 40% of total care but its share decreases to about 30% as the weight of children increases. In the nonlinear case, public care increases with the children's cost of providing care at a faster rate when children's weight in social welfare is higher. It represents 100% of total care for the families with high-cost children.

Aiming Higher: Advancing Public Social Insurance for Longterm Care to Meet the Global Aging Challenge Comment on "Financing Long-term Care: Lessons From Japan".

Globally, aging populations are driving the demand for long-term care (LTC) services for a growing number of older people with disabilities or chronic illnesses. A key challenge for policy-makers in all countries is to find a comprehensive solution to financing LTC services to make them widely accessible, affordable, and equitable for all in need. In this commentary, we make a case for LTC policy-makers and reformers across countries to take a long-term vision toward establishing a public, mandatory social insurance model of LTC financing. We first take a hard look at the LTC financing problems and the limitations of existing financing options. We then argue for a public social insurance approach to LTC financing and offer insights into several top-level insurance design features that are key to successful implementation of a public social insurance model, building on the experiences and lessons learned from Japan and other countries that have already "gotten there." We conclude with additional thoughts on the future of public LTC insurance in a global context, including the prospect of spreading this model to middle-income countries.

ASSESSING THE EFFECTS OF LONG-TERM CARE INSURANCE ON EQUITY AND EFFICIENCY: A CASE STUDY OF QINGDAO CITY IN CHINA

The demand for equitable and efficient long-term care (LTC) has risen rapidly, and finding a suitable mechanism to finance LTC has become a pressing policy concern for many countries. A number of high income countries have chosen to use a social LTC insurance to fund the LTC system, but empirical assessments on such an insurance in low-and middle-income countries are limited. Using China as an example, this paper empirically assesses the performance of newly-piloted LTCNI by evaluating its impact on equity and efficiency in financing. We draw data from 47 in-depth interviews conducted with local government, care providers and family members of the LTCNI participants in Qingdao in 2016. We found that there remain sizable disparities in financial burden among LTCNI participants, despite of its emphasis on ensuring access to care based on people’s needs; care providers are incentivised to provide care at the least cost even this care is deemed as insufficient or inadequate due to fixed payment for their services. Our paper offers critical insights into the potential and challenges in applying LTC insurance model to a LMIC, where critical lessons can be drawn for public LTC insurance in other LMICs.

Long-term care policy with nonlinear strategic bequests

We study the design of long-term care (LTC) policies when children differ in their cost of providing informal care. Parents do not observe this cost, but they can commit to a “bequest rule” specifying a transfer (gift or bequest) conditional on the level of informal care. Care provided by high-cost children is distorted downwards in order to reduce the rent of low-cost ones. Social LTC insurance is designed to maximize a weighted sum of parents’ and children’s utility. When the LTC benefit is uniform and children have no weight in social welfare, the risk of becoming dependent is fully insured. Otherwise the insurance coverage of parents is adjusted to enhance the utility of the caregivers. Parents are never fully insured against the risk of having a high-cost child. A general policy conditioning LTC benefits on transfers provides full insurance even against the risk of having high-cost children. Quite surprisingly the level of informal care induced by the optimal (uniform or nonuniform) policy always increases in the children’s welfare weight.

Social Insurance for Long-Term Care with Deductible and Linear Contributions

With the rapid increase in long-term care (LTC) needs, the negligible role of the market, and the declining role of informal family care, one might expect that the government would take a more proactive role in the support of dependent elderly, particularly those who cannot, whatever the reason, count on assistance from their family. The purpose of this paper is to analyze the possibility of designing a sustainable public LTC scheme that would meet a widespread concern, that about going bankrupt and being unable to bequeath any saving to one's children.

Discrimination Risks of Alzheimer's as Support for Social Insurance for Long-Term Care.

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Social long-term care insurance with two-sided altruism

This paper studies the design of a social long-term care (LTC) insurance when altruism is two-sided. The laissez-faire solution is not efficient, unless there is perfect altruism. Under full information, the first-best can be decentralized by a linear subsidy on informal aid, a linear tax on bequests when the parent is dependent and state specific lump-sum transfers which provide insurance. We also study a second-best scheme comprising a LTC benefit, a payroll tax on children׳s earnings and an inheritance tax. This scheme redistributes resources across individuals and between the states of nature and the tax on children׳s labor enhances informal care to compensate for the children׳s possible less than full altruism.

A systematic review of intervention programs for frail elderly people enrolled in the Japanese social long-term care insurance system

The aim of this study was to systematically review intervention programs for frail elderly people enrolled in the Japanese social long-term care insurance system to clarify the effects and identify any problems. We reviewed 61 articles (7 in English and 54 in Japanese) from four databases: MEDLINE, CINAHL, PsycInfo, and "Igaku Chuo Zasshi Web" (the Japana Centra Revuo Medicina) version 5. We focused on the following three areas: age and male/female ratio of participants, study design, and intervention program. The results showed that (1) participants tended to be ≥75 years of age and female, (2) more than half of the programs were of a before and after design, and (3) most interventions took place in local community centers and were group programs for muscle training and/or physical exercise that improved physical function. Future studies focusing on the following intervention programs are necessary: individual programs such as home visits for those who do not want to participate in group programs and programs that improve instrumental activities of daily living, nutrition, oral function, cognitive function, and depression. Additionally, while there are many studies reporting the effect of muscle training and exercise, randomized controlled studies are necessary to more accurately evaluate the effects.

Social long-term care insurance and redistribution

We study the role of social long-term care (LTC) insurance when income taxation and private insurance markets are imperfect. Policy instruments include public provision of LTC as well as a subsidy on private insurance. The subsidy scheme may be linear or nonlinear. For the linear part we consider an arbitrary number of types, characterized by earnings and survival probabilities. In the nonlinear part, society consists of three types: poor, middle class and rich. The first type is too poor to provide for dependence; the middle class type purchases private insurance and the high income type is self-insured. The main questions are at what level LTC should be provided to the poor and whether it is desirable to subsidize private LTC for the middle class. Interestingly, the results are not totally similar under both linear and nonlinear schemes. First, whereas in the linear case a subsidy of private LTC insurance is desirable, it is not in the nonlinear case (at least at the margin). Second, the desirability of public provision of LTC services depends on the way the income tax is restricted. In the linear case, it may be desirable only if no demogrant (uniform lump-sum transfer) is available. In the nonlinear case, public provision is desirable when the income tax is sufficiently restricted. Specifically, this is the case when the income is subject only to a proportional payroll tax while the LTC reimbursement policy can be nonlinear.

Behavioral Biases and Long-Term Care Insurance: A Political Economy Approach

Abstract We develop a model where individuals all have the same probability of becoming dependent and vote over the social long-term care insurance contribution rate before buying additional private insurance and saving. We study three types of behavioral biases, all having in common that agents under-weight their dependency probability when taking private decisions. Sophisticated procrastinators anticipate their mistake when voting, while optimistic and myopic agents have preferences that are consistent across choices. Optimists under-estimate their own probability of becoming dependent but know the average probability, while myopics underestimate both. Sophisticated procrastinators attain the first-best allocation, while myopics and optimists insure too little and save too much. Myopics and optimists more (resp., less) biased than the median are worse off (resp., better off), at the majority-voting equilibrium, when private insurance is available than when it is not.

The Formal and Informal Long-Term Caregiving for the Elderly: The Malaysian Experience

This paper examines the formal and informal caregiving for elderly in the Malaysian society under the absence of a structured long-term care environment. We surveyed 31 health care providers and 56 informal caregivers for elderly. The private for-profit care providers offer better facilities and services than non-profit centres. Females especially daughters were usually the informal caregivers to the elderly. Caregivers spent below USD$330 on long-term care expenses and relying heavily on public health care services. The results suggest government to implement a comprehensive social insurance for long-term care to ensure protection and equal treatment to be received by elderly.

A Qualitative Exploratory Study on the Service Delivery System for the New Long-Term Care Insurance System in Korea

ABSTRACT To cope with the rapid growth in its aging population, the Korean government introduced a new social long-term care insurance (LTCI) system for elderly people beginning in July 2008. This study aims to understand how National Health Insurance Corporation (NHIC) staff and home-visiting service providers experienced and evaluated the new service delivery system. A total of 26 semistructured in-depth interviews were conducted with NHIC staff primarily responsible for the functional assessment of the elderly and the home-visiting service providers responsible for providing direct services to elderly clients. In summary, interviewees had negative experiences with the new service delivery system such as difficulties in carrying out their roles. The findings suggest that Korea's new LTCI service delivery system faces challenges and that a more active role for the Korean government, especially regarding the introduction of a proper care management system, is needed to address the issues. Future research with larger sample sizes is needed to examine and understand the issues in detail.