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Zhang Y, Chen YC, Wang JSH. Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality. Int J Health Policy Manag 2023; 12:7938. [PMID: 38618772 PMCID: PMC10843175 DOI: 10.34172/ijhpm.2023.7938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/21/2023] [Indexed: 04/16/2024] Open
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 self-rated 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.
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Affiliation(s)
- Yinkai Zhang
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Chih Chen
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Social Policy Institute, Washington University in St. Louis, St. Louis, MO, USA
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Ye X, Hu M, Lin H. Effects of the Long-term Care Insurance on Health Among Older Adults: A Panel Data From China. Int J Health Policy Manag 2023; 12:7664. [PMID: 38618818 PMCID: PMC10590242 DOI: 10.34172/ijhpm.2023.7664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 08/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND China's long-term care insurance (LTCI) has been launched since 2016 to ensure that older disabled people obtain affordable care services. However, rigorous evaluations of the health effects of China's LTCI pilots have been limited. This paper aimed to examine the effects of LTCI on health among older adults aged 60 years and above. METHODS Drawing from panel data of the China Health and Retirement Longitudinal Study (CHARLS), we used a propensity score matching (PSM) and difference-in-difference (DID) approach to identify the health effects of the LTCI program and reduce the selection bias. Further, heterogeneity of the effects was examined by physical and intellectual function to evaluate whether the effects differed among subgroups of older population. RESULTS The implementation of LTCI significantly improved self-rated health (β = 0.15, P<.05) and cognitive function (β = 0.59, P<.01) for older adults. The results were robust when keeping only those living in pilot cities (β = 0.31, P<.05 for self-rated health status; β = 0.98, P<.001 for cognitive function) or non-pilot cities (β = 0.14, P<.05 for self-rated health status; β = 0.60, P<.01 for cognitive function) as the control group. The effects of LTCI were especially manifested in older adults with physical disability (β = 0.13, P<.01 for self-rated health; β = 0.76, P<.001 for cognitive function) or intellectual disability (β = 0.16, P<.01 for self-rated health). CONCLUSION From a policy perspective, these findings suggested that LTCI in China could benefit the health outcomes of older adults, especially those with physical or cognitive disabilities. Policy-makers can target resources more effectively to improve health outcomes for the most vulnerable populations.
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Affiliation(s)
- Xin Ye
- Institute for Global Public Policy, Fudan University, Shanghai, China
- LSE-Fudan Research Centre for Global Public Policy, Fudan University, Shanghai, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hugo Lin
- CentraleSupélec, Paris-Saclay University, Paris, France
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Chen TC, Wu SC, Zhong ZT, Chen YM, Wu SC. Effect of different patterns of home- and community-based services in Taiwan on the changes in physical function. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6532-e6542. [PMID: 36371633 DOI: 10.1111/hsc.14100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
Our study aimed to explore the impact of different home- and community-based service (HCBS) use patterns on older adults' physical function. The cohort data were drawn from two national datasets, the National Ten-Year Long-Term Care Plan 1.0 database and the National Health Insurance Program claims data. Participants were care recipients ages 65 and over, first evaluated and prescribed HCBS from 2010 through 2013 and evaluated again after 6 months (n = 32,392). Latent class analysis was used to identify subgroups with different HCBS use patterns. Multiple regression was used to examine the impact of different HCBS use patterns on change over time in disability related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The analysis was stratified by respondents' levels of disability. Four subgroups of HCBS recipients were identified, with patterns of home-based personal care, home-based personal care and medical care, home-based medical care and community care services. Older adults in the Home-based MpC had significantly more improvement in both ADL (p < 0.05) and IADL (p < 0.001) scores compared with adults in the other three groups, while the community care group regressed the most. In the stratified analysis of the severely disabled, the IADL outcome of the Home-based MC group was better than the home-based PC group (p < 0.001). Study findings shed light on the benefits of promoting the use of integrated HCBS that combines personal and medical care, especially for community care services.
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Affiliation(s)
- Tsai-Chun Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Shih-Cyaun Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Zi-Ting Zhong
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Suwu-Chong Wu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
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Li Y, Leng F, Xiong Q, Zhou J, Du A, Zhu F, Kou X, Sun W, Chen L, Wang H, Xie H, Gao F, Jin H, Sun Y. Factors Associated With Alzheimer's Disease Patients' Caregiving Status and Family Caregiving Burden in China. Front Aging Neurosci 2022; 14:865933. [PMID: 35370609 PMCID: PMC8970011 DOI: 10.3389/fnagi.2022.865933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
Background The increasing prevalence of Alzheimer's disease (AD) has emerged as a major challenge worldwide. China as the most populous country in the globe is amid rapid aging of its population, highlighting the need for appropriate social and medical policies to meet the challenge. The current multicenter cross-sectional observational study aims to provide understanding of the current status of caring given to AD patients in China and investigate the factors that influence the family burden as well as the choice of care given to AD patients. Methods A total of 1,675 patients with probable AD from 30 provincial regions of mainland China were enrolled in the current study from August 2019 to December 2019. We analyzed the caregiving status and its relationship with family burden and various socio-economical and medical factors. Results In the current study, 90.87% of the AD patients enrolled adopted family care. The choice of caregiving method was influenced by factors including age (>80 years old, OR 0.648; 95% CI, 0.427-0.983), overall family burden (high, OR 0.574; 95% CI, 0.0.373-0.884), patients' income (OR 0.511; 95% CI, 0.330-0.789) and self-care ability (OR 0.329; 95% CI, 0.183-0.588). Conclusion Family care is the primary method of care for AD patients in China and the institutional care system for AD patients is still underprepared in China.
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Affiliation(s)
- Yuxian Li
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangda Leng
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Qi Xiong
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Jiong Zhou
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Ailian Du
- Department of Neurology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feiqi Zhu
- Department of Neurology, Shenzhen Luohu People’s Hospital, Shenzhen, China
| | - Xiaowen Kou
- Health Times, The People’s Daily, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Luzeng Chen
- Department of Ultrasonography, Peking University First Hospital, Peking University, Beijing, China
| | - Huali Wang
- Department of Psychiatry, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Hengge Xie
- Department of Neurology, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Feng Gao
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
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Yamamoto T, Goda A, Maki Y, Tone A, Kousaka T, Arita K, Ogawa Y, Katsura J, Yanagibashi K. Factors related to suspension of day-care services: an effective program for older users with declined ambulation to reduce care burden. Eur Geriatr Med 2022; 13:951-957. [PMID: 35217981 DOI: 10.1007/s41999-022-00621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Day-care services contribute to maintaining the daily living ability of older people cared for at home. This study aimed to detect factors that could impede the continuation of day-care services. METHODS We collected clinical data of 132 older users (age = 82.8 ± 7.5 years; male:female = 49:83) utilizing our day-care center from April 2019 to March 2020. We evaluated age, sex, underlying disease, medication, family background, care level, food texture, physical ability, reasons for frequenting day-care centers, and combined medical/nursing care plans. Participants were divided into two groups: continuation (n = 51) and suspension (n = 81). The collected items were evaluated statistically using the chi-square test, Mann-Whitney test, and unpaired t test. Multivariate logistic analysis (forward-backward stepwise selection method) was added to the statistically significant items. Statistical significance was defined as p < 0.05. RESULTS The comparison test detected statistical significance in Parkinson disease/Parkinsonism, pain complaints, day-service use, short-stay service use, day-care center use to reduce care burden, physical ability including ambulation, and availability of the major caregiver (p < 0.05). Day-care service use to reduce care burden (odds ratio 5.646, p < 0.05), use of short-stay and day-care services (odds ratio 4.798, p < 0.05), and low independent ambulation (odds ratio 0.585, p < 0.05) were the likely factors for suspended use (percentage of correct classification = 68.5%). CONCLUSION An unreplaceable and effective program for day-service and short-stay services to improve the activities of daily living of older users and reduce care burden is required in day-care centers.
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Affiliation(s)
- Tomoe Yamamoto
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan.
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | - Akira Tone
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | | | - Kouyou Arita
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | - Youhei Ogawa
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
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Chen S, Li L, Yang J, Jiao L, Golden T, Wang Z, Liu H, Wu P, Bärnighausen T, Geldsetzer P, Wang C. The impact of long-term care insurance in China on beneficiaries and caregivers: A systematic review. JOURNAL OF GLOBAL HEALTH ECONOMICS AND POLICY 2021; 1:e2021014. [PMID: 35083471 PMCID: PMC8788994 DOI: 10.52872/001c.29559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND China's long-term care insurance (LTCI) policy has been minimally evaluated. This systematic review aimed to assess the impact of China's LTCI pilot on beneficiaries and their caregivers. METHODS This review is based on a search of peer-reviewed studies in English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases from January 2016 through July 2020, with all studies published in English or Chinese included. We included quantitative analyses of beneficiary-level data that assessed the impact of LTCI on beneficiaries and their caregivers, with no restriction placed on the outcomes studied. RESULTS Nine studies met our inclusion criteria. One study was a randomised trial and two used quasi-experimental approaches. Four studies examined LTCI's effect on beneficiaries' quality of life, physical pain, and health service utilisation; one study reported the effect on beneficiaries' healthcare expenditures; and one study evaluated the impact on caregivers' care tasks. These studies generally found LTCI to be associated with an improvement in patients' quality of life (including decreased physical pain), a reduction in the number of outpatient visits and hospitalisations, decreased patient-level health expenditures (e.g. one study reported a reduction in the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively), and reduced informal care tasks for caregivers. In addition, four out of four studies that evaluated this outcome found that beneficiaries' overall satisfaction with LTCI was high. CONCLUSION The current evidence base for the effects of LTCI in China on beneficiaries and their caregivers is sparse. Nonetheless, the existing studies suggest that LTCI has positive effects on beneficiaries and their caregivers. Further rigorous research on the impacts of LTCI in China is needed to inform the future expansion of the program.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University; Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Linye Li
- Chinese Academy of Social Sciences
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College
| | | | - Todd Golden
- Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Zhuoran Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Haitao Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Peixin Wu
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University; Chinese Academy of Medical Sciences and Peking Union Medical College; Department of Global Health and Population, Harvard School of Public Health
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University; Division of Primary Care and Population Health, Department of Medicine, Stanford University
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital
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Lunt C, Dowrick C, Lloyd-Williams M. What is the impact of day care on older people with long-term conditions: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1201-1221. [PMID: 33332714 DOI: 10.1111/hsc.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
There is a lack of robust evidence regarding outcomes for day care use among older people living with long-term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty-five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field.
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Affiliation(s)
- Catherine Lunt
- Academic Palliative and Supportive Care Studies Group (APSCSG), Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Christopher Dowrick
- Academic Palliative and Supportive Care Studies Group (APSCSG), Institute of Psychology Health and Society Block B Waterhouse Building, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), University of Liverpool / Honorary Consultant Liverpool CCG (Liverpool Health Partners), Liverpool, UK
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Chin YR, Lee HY, Lee MJ. Development and Validation of a Person-Centered Care Assessment Questionnaire for Daycare Centers for Older Adults. Gerontol Geriatr Med 2021; 7:23337214211036274. [PMID: 34409129 PMCID: PMC8366116 DOI: 10.1177/23337214211036274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022] Open
Abstract
Daycare services serve to prolong aging at home. This decreases both families' care burden and the government's financial burden. We identified key factors in the person-centered approach of South Korean daycare center workers to develop and validate a Korean person-centered care questionnaire. Twenty-one items were developed, and 10 expert interviews were conducted. The items were applied to 271 daycare center staff (19.2% male vs. 80.0% female, mean age = 50.68 ± 11.37 years) to evaluate their reliability and validity. Twenty items concerning intimate relationships and the environment, consumers' self-determination, and home-likeness domains were derived, explaining 40.28%, 10.44%, and 6.97% of the total variance, respectively. The overall tool's Cronbach's alpha was 0.905, demonstrating internal consistency. Inter-rater agreement ranged from 0.221 (fair) to 0.765 (good). This tool will be useful for individual staff members as well as for the National Health Insurance Service's evaluations of service quality at daycare centers.
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Affiliation(s)
- Young Ran Chin
- Department of Nursing, Chungwoon University, Chungnam, Republic of Korea
| | - Hyo Young Lee
- Department of Health Administration, Dongseo University, Busan, Republic of Korea
- Hyo Young Lee, Department of Health Administration, Dongseo University, 47 Jurye-ro, Sasang-Gu, Pusan 617-716, Republic of Korea. ; ;
| | - Mi-Joung Lee
- Faculty of Medicne and Health, University of Sydney, Sydney, Australia
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Park I, Lee K, Yim E, Noh K. Differences in Function and Healthcare Cost of Older Adults with Dementia by Long-Term Care Service Type: A National Dataset Analysis. Healthcare (Basel) 2021; 9:healthcare9030307. [PMID: 33802027 PMCID: PMC8000297 DOI: 10.3390/healthcare9030307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/18/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022] Open
Abstract
This study aims to analyze the function and cost changes among long-term care insurance (LTCI) beneficiaries with low-severity dementia according to their LTCI service type. Data were collected from the Korean LTCI and national health insurance (NHI) datasets. Participants were 4414 beneficiaries with dementia aged 65 or older who received LTC services continuously for 4 years (2008–2011). LTCI service types were classified into home care (HC), institutional care (IC), and combined care (CC). Activities of daily living (ADL), cognitive function, medical cost, and benefit-cost were assessed. Linear mixed models and multiple regression models were used to analyze the changes in function and costs of the beneficiaries. ADL, cognitive function, medical cost, and benefit-cost differed significantly depending on the service type and time (p < 0.001). LTCI service types affected the degree of changes in ADL, cognitive function, medical cost, and benefit-cost over four years and showed negative changes in IC and CC beneficiaries than HC beneficiaries. HC is a cost-effective way to maintain the function of beneficiaries with low-severity dementia. Thus, efforts are needed to actively promote HC services.
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Affiliation(s)
- Ilsu Park
- Department of Healthcare Management, Dong-eui University, 176 Eomgwangno, Busanjin-gu, Busan 47340, Korea;
| | - Kyounga Lee
- Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Correspondence:
| | - Eunshil Yim
- Department of Nursing, Daegu Health College, 15 Yeongsong-ro, Buk-gu, Daegu 41453, Korea;
| | - Kyunghee Noh
- Mokpo National Quarantine Station, 20 Haean-ro, 177 Beon-gil, Mokpo-si 58754, Korea;
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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. [PMID: 32922026 PMCID: PMC7457853 DOI: 10.2147/jmdh.s270454] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background How to cope with the rapid growth of LTC (long-term care) needs for the old people without activities of daily living (ADL), which is also a serious hazard caused by public health emergencies such as COVID-2019 and SARS (2003), has become an urgent task in China, Germany, Japan, and other aging countries. As a response, the LTCI (long-term care insurance) system has been executed among European countries and piloted in 15 cities of China in 2016. Subsequently, the influence and dilemma of LTCI system have become a hot academic topic in the past 20 years. Methods The review was carried out to reveal the effects of the LTCI system on different economic entities by reviewing relevant literature published from January 2008 to September 2019. The quality of 25 quantitative and 24 qualitative articles was evaluated using the JBI and CASP critical evaluation checklist, respectively. Results The review systematically examines the effects of the LTCI system on different microeconomic entities such as caretakers or their families and macroeconomic entities such as government spending. The results show that the LTCI system has a great impact on social welfare. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. Conclusion Implementation of LTCI system not only in reducing the physical and mental health problems of health care recipients and providers, and the economic burden of their families, but also promote the development of health care service industry and further improvement of the health care system. However, the dilemma and sustainable development of the LTCI system is the government needs to focus on in the future due to the sustainability of its funding sources.
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Affiliation(s)
- Linhong Chen
- School of Mathematics and Statistics, Chongqing Technology and Business University, Chongqing 400067, People's Republic of China.,School of Public Administration, Sichuan University, Chengdu 610065, People's Republic of China
| | - Xiaocang Xu
- School of Economics, Chongqing Technology and Business University, Chongqing 400067, People's Republic of China.,Department of Actuarial Studies & Business Analytics, Macquarie University, Sydney 2109, Australia
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Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: "If You Can't Stand the Heat, Get Out of the Kitchen". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124442. [PMID: 32575765 PMCID: PMC7345032 DOI: 10.3390/ijerph17124442] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
Ethical conflicts among nurses can undermine nurses’ psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.
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Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082649. [PMID: 32294909 PMCID: PMC7216140 DOI: 10.3390/ijerph17082649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 11/17/2022]
Abstract
In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.
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Impact of Outpatient Rehabilitation Service in Preventing the Deterioration of the Care-Needs Level Among Japanese Older Adults Availing Long-Term Care Insurance: A Propensity Score Matched Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071292. [PMID: 30974921 PMCID: PMC6480242 DOI: 10.3390/ijerph16071292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 12/02/2022]
Abstract
Outpatient rehabilitation (OR) and outpatient day long-term care (ODLC) services are frequently used by older adult patients in Japan. However, there is a need to clarify that OR service, which has more rehabilitation professionals than ODLC, has the role of providing rehabilitation. This retrospective study examined the impact of OR services by comparing the two services based on City A data from the care-needs certification survey conducted between 2015 to 2017. We performed a propensity score matched analysis to compare the changes in the care level and function of OR and ODLC users after two years. The results showed that OR users showed a lower deterioration in care levels and less decline in the activities of daily living (ADL) in dementia and adaptation to social life. In the analysis of older adults requiring support, OR users had a lower deterioration in care levels and less decline in the ADL in dementia and behavioral and psychological symptoms than ODLC users did. There was no difference between the two services with respect to older adults requiring long-term care. The OR service has had an increasingly preventive effect on the deterioration of care levels compared to the ODLC service, which was particularly evident in older adults requiring support.
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