International Journal of Health Policy and Management

International Journal of Health Policy and Management

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
Yinkai Zhang 1
Yu-Chih Chen 1, 2
Julia Shu-Huah Wang 3
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
10.34172/ijhpm.2023.7938
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
Long-Term Supports and Services
Self-Rated Health
Depression
Satisfaction
China Health and Retirement Longitudinal Study (CHARLS) 
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International Journal of Health Policy and Management
Volume 12, Issue 1
2023
Pages 1-13

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  • Received Date 17 January 2023
  • Revised Date 10 September 2023
  • Accepted Date 21 November 2023
  • First Published Date 22 November 2023
  • Published Date 01 December 2023