Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality

Document Type : Original Article

Authors

1 Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China

2 Social Policy Institute, Washington University in St. Louis, St. Louis, MO, USA

3 Department of Social Work, National Taiwan University, Taipei, Taiwan

Abstract

Background 
Evidence of the impact of long-term care insurance (LTCI) on health and well-being has predominantly come from developed countries. China officially launched its city-level LTCI policy in 2016. Recent evidence in China has shown that having an LTCI program contributes to positive health. However, it is unclear whether such positive policy effects were attributed to policy announcement or implementation effects, and whether the policy effects vary by locality, chronic conditions, and their intersectionality. This study examines whether there are longitudinal health benefits for older Chinese who are participating in LTCI, particularly considering their city location (urban/rural), whether they have chronic conditions, and the intersectionality.
 
Methods 
Following the Andersen Behavioral Model, health and satisfaction outcomes of 9253 adults aged 60+ years were extracted from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). Individual data were linked to census socioeconomic data with city-level characteristics and LTCI policy variable. Multilevel lagged regression models investigated the impact of LTCI policy on health and satisfaction with health services, after controlling for baseline individual- and city-level covariates.
 
Results 
Of 125 cities in the dataset, 21 (16.8%) had adopted LTCI. These city inhabitants had significantly better selfrated health and higher satisfaction relative to cities without LTCI policies when environmental- and personal-level characteristics were modeled. Health benefits of LTCI were stronger after policy announcement and were particularly observed among rural older adults and those with chronic conditions. Results also suggest that LTCI’s positive effects on satisfaction spill over to middle-aged adults.
 
Conclusion 
Expanding coverage and eligibility to LTCI for all older Chinese could improve health and well-being.

Keywords

References

  1. United Nations. World Population Prospects 2019 Highlights. 2019. https://www.un.org/development/desa/publications/world-population-prospects-2019-highlights.html. Accessed June 17, 2019.
  2. Choi JK, Joung E. The association between the utilization of long-term care services and mortality in elderly Koreans. Arch Gerontol Geriatr. 2016;65:122-127. doi:1016/j.archger.2016.03.013
  3. Wu B, Cohen MA, Cong Z, Kim K, Peng C. Improving care for older adults in China: development of long-term care policy and system. Res Aging. 2021;43(3-4):123-126. doi:1177/0164027521990829
  4. Lee TW, Yim ES, Choi HS, Chung J. Day care vs home care: effects on functional health outcomes among long-term care beneficiaries with dementia in Korea. Int J Geriatr Psychiatry. 2019;34(1):97-105. doi:1002/gps.4992
  5. Li Y, Jensen GA. Why do people let their long-term care insurance lapse? Evidence from the health and retirement study. Appl Econ Perspect Policy. 2012;34(2):220-237. doi:1093/aepp/pps017
  6. Kim H, Kwon S. A decade of public long-term care insurance in South Korea: policy lessons for aging countries. Health Policy. 2021;125(1):22-26. doi:1016/j.healthpol.2020.11.003
  7. Yang W, Jingwei He A, Fang L, Mossialos E. Financing institutional long-term care for the elderly in China: a policy evaluation of new models. Health Policy Plan. 2016;31(10):1391-1401. doi:1093/heapol/czw081
  8. Chen L, Xu X. Effect evaluation of the long-term care insurance (LTCI) system on the health care of the elderly: a review. J Multidiscip Healthc. 2020;13:863-875. doi:2147/jmdh.s270454
  9. Lei X, Bai C, Hong J, Liu H. Long-term care insurance and the well-being of older adults and their families: evidence from China. Soc Sci Med. 2022;296:114745. doi:1016/j.socscimed.2022.114745
  10. Feng J, Wang Z, Yu Y. Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China. Soc Sci Med. 2020;258:113081. doi:1016/j.socscimed.2020.113081
  11. Wu J, Chen S, Wen H, Yi Y, Liao X. Health status, care needs, and assessment for beneficiaries with or without dementia in a public long-term care insurance pilot in Guangzhou, China. BMC Health Serv Res. 2020;20(1):1127. doi:1186/s12913-020-05965-1
  12. Du P, Dong T, Ji J. Current status of the long-term care security system for older adults in China. Res Aging. 2021;43(3-4):136-146. doi:1177/0164027520949117
  13. Chui EW-T. Caring for our seniors – private issue or public? The Asian scene. J Asian Public Policy. 2012;5(1):51-70. doi:1080/17516234.2012.662355
  14. Zhu Y, Österle A. China's policy experimentation on long-term care insurance: implications for access. Int J Health Plann Manage. 2019;34(4):e1661-e1674. doi:1002/hpm.2879
  15. Zhang Y, Yu X. Evaluation of long-term care insurance policy in Chinese pilot cities. Int J Environ Res Public Health. 2019;16(20):3826. doi:3390/ijerph16203826
  16. National Healthcare Security Administration. Guidance on the Expansion of the Long-Term Care Insurance System Pilot [Chinese]. 2020. http://www.nhsa.gov.cn/module/download/downfile.jsp?classid=0&filename=b9f5c190706640ef8b452b3cf959e5bc.pdf. Accessed September 16, 2020.
  17. Cai F. Hukou system reform and unification of rural–urban social welfare. China World Econ. 2011;19(3):33-48. doi:1111/j.1749-124X.2011.01241.x
  18. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1-10. doi:2307/2137284
  19. von Lengerke T, Gohl D, Babitsch B. Re-revisiting the Behavioral Model of Health Care Utilization by Andersen: a review on theoretical advances and perspectives. In: Janssen C, Swart E, von Lengerke T, eds. Health Care Utilization in Germany. New York, NY: Springer; 2014:11-28. doi:1007/978-1-4614-9191-0_2
  20. Ladino JF, Saavedra S, Wiesner D. One step ahead of the law: the net effect of anticipation and implementation of Colombia’s illegal crops substitution program. J Public Econ. 2021;202:104498. doi:1016/j.jpubeco.2021.104498
  21. Wang JSH, Kaushal N. Health and mental health effects of local immigration enforcement. Int Migr Rev. 2019;53(4):970-1001. doi:1177/0197918318791978
  22. Salgado M, Madureira J, Mendes AS, Torres A, Teixeira JP, Oliveira MD. Environmental determinants of population health in urban settings. A systematic review. BMC Public Health. 2020;20(1):853. doi:1186/s12889-020-08905-0
  23. Sun R, Gu D. Air pollution, economic development of communities, and health status among the elderly in urban China. Am J Epidemiol. 2008;168(11):1311-1318. doi:1093/aje/kwn260
  24. Hsu HC, Bai CH. Social and built environments related to cognitive function of older adults: a multi-level analysis study in Taiwan. Int J Environ Res Public Health. 2021;18(6):2820. doi:3390/ijerph18062820
  25. Park S, Cho J, Chen YC. Subsidized housing and geographic accessibility to neighborhood resources for low-income older people: from later year social exclusion perspective. Geoforum. 2019;106:297-304. doi:1016/j.geoforum.2019.09.002
  26. Chiavegatto Filho ADP, Sampson L, Martins SS, et al. Neighbourhood characteristics and mental disorders in three Chinese cities: multilevel models from the World Mental Health Surveys. BMJ Open. 2017;7(10):e017679. doi:1136/bmjopen-2017-017679
  27. Zeng Y, Chen YC, Lum TYS. Longitudinal impacts of grandparent caregiving on cognitive, mental, and physical health in China. Aging Ment Health. 2021;25(11):2053-2060. doi:1080/13607863.2020.1856779
  28. Shu Z, Han Y, Xiao J, Li J. Effect of medical insurance and family financial risk on healthcare utilisation by patients with chronic diseases in China: a cross-sectional study. BMJ Open. 2019;9(11):e030799. doi:1136/bmjopen-2019-030799
  29. Chao SF, Chen YC. Environment patterns and mental health of older adults in long-term care facilities: the role of activity profiles. Aging Ment Health. 2019;23(10):1307-1316. doi:1080/13607863.2018.1484889
  30. Wang Y, Gonzales E, Morrow-Howell N. Applying WHO's age-friendly communities framework to a national survey in China. J Gerontol Soc Work. 2017;60(3):215-231. doi:1080/01634372.2017.1292980
  31. Holman D, Walker A. Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses. Eur J Ageing. 2021;18(2):239-255. doi:1007/s10433-020-00582-7
  32. Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol. 2014;43(1):61-68. doi:1093/ije/dys203
  33. Reijneveld SA. Neighbourhood socioeconomic context and self reported health and smoking: a secondary analysis of data on seven cities. J Epidemiol Community Health. 2002;56(12):935-942. doi:1136/jech.56.12.935
  34. Cao L, Gao J, Xia Y. The effects of household solid fuel use on self-reported and performance-based physical functioning in middle-aged and older Chinese populations: a cross-sectional study. Ecotoxicol Environ Saf. 2021;213:112053. doi:1016/j.ecoenv.2021.112053
  35. Nakamura JS, Hong JH, Smith J, et al. Associations between satisfaction with aging and health and well-being outcomes among older US adults. JAMA Netw Open. 2022;5(2):e2147797. doi:1001/jamanetworkopen.2021.47797
  36. Chen H, Mui AC. Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China. Int Psychogeriatr. 2014;26(1):49-57. doi:1017/s1041610213001701
  37. Luke DA. Multilevel Modeling. Thousand Oaks, CA: SAGE Publications; 2004. doi:4135/9781412985147
  38. Martinussen PE, Rydland HT. Is a decentralised health policy associated with better self-rated health and health services evaluation? A comparative study of European countries. Int J Health Policy Manag. 2021;10(2):55-66. doi:34172/ijhpm.2020.13
  39. Gruneir A, Miller SC, Intrator O, Mor V. Hospitalization of nursing home residents with cognitive impairments: the influence of organizational features and state policies. Gerontologist. 2007;47(4):447-456. doi:1093/geront/47.4.447
  40. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377-399. doi:1002/sim.4067
  41. Chen Y, Yin Z, Xie Q. Suggestions to ameliorate the inequity in urban/rural allocation of healthcare resources in China. Int J Equity Health. 2014;13:34. doi:1186/1475-9276-13-34
  42. Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595-602. doi:1016/j.jclinepi.2004.10.018
  43. Zhao Y, Atun R, Oldenburg B, et al. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health. 2020;8(6):e840-e849. doi:1016/s2214-109x(20)30127-3
  44. Alpert A. The anticipatory effects of Medicare Part D on drug utilization. J Health Econ. 2016;49:28-45. doi:1016/j.jhealeco.2016.06.004
  45. Goss KA. Civil society and civic engagement: towards a multi-level theory of policy feedbacks. J Civ Soc. 2010;6(2):119-143. doi:1080/17448689.2010.506370
  46. Chao SF, Chen YC. Environment patterns and mental health of older adults in long-term care facilities: the role of activity profiles. Aging Ment Health. 2019;23(10):1307-1316. doi:1080/13607863.2018.1484889

Files

History

  • Receive Date: 17 January 2023
  • Revise Date: 10 September 2023
  • Accept Date: 21 November 2023
  • First Publish Date: 22 November 2023

Share

How to cite

Statistics