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Wang L. The impact of long-term care insurance pilot on the mental health of older adults: Quasi-experimental evidence from China. SSM Popul Health 2024; 25:101632. [PMID: 38405165 PMCID: PMC10891319 DOI: 10.1016/j.ssmph.2024.101632] [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: 12/16/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
The Chinese government launched pilot programs for a long-term care insurance system in response to the ongoing increase in the aging population. This study uses the difference-in-differences (DID) model to analyze the impact of long-term care insurance on older adults' mental health based on China Health and Retirement Longitudinal Study (CHARLS) four-period panel data from 2011 to 2018. This study found that long-term care insurance reduced Center for Epidemiological Studies Depression Scale (CES-D) scores among older adults by 1.059 points. Moreover, there was an improvement of 0.181 and 0.870 points in mental status and scenario memory scores, respectively. The impact of the long-term care insurance pilot program on improving the mental health of older adults was more pronounced, especially for those with chronic diseases or disabilities as well as those living in rural and western regions. This study also revealed that long-term care insurance enhances mental health by reducing medical expenses and increasing daily companionship and social interaction. Therefore, a pilot study of long-term care insurance showed a significant improvement in the mental health of older adults. To provide a comprehensive care service system for older adults, the government should expand the scope of the pilot program and increase the accessibility of mental health services for older adults.
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Affiliation(s)
- Lianjie Wang
- Department of Sociology, Jiangnan University, Wuxi, China
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Luo Y, Yuan K, Li Y, Liu Y, Pan Y. The "spillover effect" of long-term care insurance in China on spouses' health and well-being. Soc Sci Med 2024; 340:116487. [PMID: 38096600 DOI: 10.1016/j.socscimed.2023.116487] [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: 05/10/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024]
Abstract
This study examined the spillover effect of long-term care insurance (LTCI) on the health outcomes and well-being of spouses for Chinese middle and old-aged adults with expected LTC demand or actual care burdens. Using panel data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we investigated the impact of the introduction of LTCI pilots across several cities on old individuals by using the difference-in-differences (DID) approach. We found a spillover effect of LTCI on the health and well-being outcomes of spouses of middle and old-aged individuals with functional limitations. It might due to the fact that LTCI could relieve economic burden by reducing out-of-pocket medical expenditures, which further affects health and well-being of spouses. The spillover effect on health and well-being was found to be stronger for male spouses and low-educated spouses. Spouses of the individuals aged below 80 years old and those live without adult children were more likely to benefit from the introduction of LTCI. Moreover, providing combination benefits seems to make spouses better off than offering direct services. Therefore, the results implied that the expansion of LTCI not only helped the care recipients themselves but could also improve the health and well-being of the spouses of functionally impaired older adults.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Kexin Yuan
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Yuxiao Li
- School of Applied Economics, Renmin University of China, Beijing, China
| | - Yating Liu
- School of Nursing, Peking University, China
| | - Yao Pan
- School of Economics, Zhongnan University of Economics and Law, Wuhan, China.
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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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Yu Y, Zhang J, Chen C, Petrovic M, Pei X, Zhang WH. Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study. J Aging Soc Policy 2023:1-36. [PMID: 37889943 DOI: 10.1080/08959420.2023.2265771] [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: 02/13/2023] [Accepted: 06/30/2023] [Indexed: 10/29/2023]
Abstract
Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.
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Affiliation(s)
- Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- The Research Center for Medical Sociology, Tsinghua University, Beijing, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Xiaomei Pei
- Department of Sociology, School of Social Sciences, Tsinghua University, Beijing, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
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Tseng PY, Wu CL, Chen JD, Ma KJ, Yao CY, Wang JY. Association between use of different long-term care services and risks of mental disorder and mortality as well as medical utilization. Front Psychiatry 2023; 14:1073030. [PMID: 37850103 PMCID: PMC10577215 DOI: 10.3389/fpsyt.2023.1073030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors. Methods This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score-matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50-60 years (10.47%), 61-70 years (14.48%), 71-80 years (35.59%), and 81 years and older (39.45%). The mean age was 70.18 years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM). Results Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR) = 3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1 years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR = 1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users. Conclusion Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization.
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Affiliation(s)
- Pei-Ying Tseng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical, Lee’s General Hospital, Miaoli, Taiwan
| | - Chia-Ling Wu
- Hospital Accreditation Department, Joint Commission of Taiwan, Taipei, Taiwan
| | - Jen-De Chen
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
| | - Kai-Jie Ma
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chi-Yu Yao
- Department of Psychiatry, An-Nan Hospital, Tainan, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
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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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Cao N, Shi T, Pan C. Does long-term care insurance reduce the disability among middle-aged and older adults? Evidence from China. BMC Public Health 2023; 23:1138. [PMID: 37312092 DOI: 10.1186/s12889-023-16057-0] [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: 12/25/2022] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
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.
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Affiliation(s)
- Na Cao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou Medical University Chashan Campus, Wenzhou City, 325035, Zhejiang Province, China
- School of Public Health, Wuhan University, Wuhan City, Hubei Province, China
| | - Tong Shi
- School of Public Health, Wuhan University, Wuhan City, Hubei Province, China
| | - Chaoping Pan
- School of Public Health and Management, Wenzhou Medical University, Wenzhou Medical University Chashan Campus, Wenzhou City, 325035, Zhejiang Province, China.
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Wang J, Guan J, Wang G. Impact of long-term care insurance on the health status of middle-aged and older adults. HEALTH ECONOMICS 2023; 32:558-573. [PMID: 36403228 DOI: 10.1002/hec.4634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
With the increase of aging population, long-term care insurance (LTCI) systems have become important for improving individuals' health. However, the effect of LTCI on health is unclear, especially in developing countries, owing to the lack of random policy shocks and comprehensive databases. This study investigates the Chinese LTCI pilot program, using four waves of the China Health and Retirement Longitudinal Study database (sample aged ≥45 years) from 2011 to 2018. The recent difference-in-differences approaches for staggered design, which are capable of dealing with the negative weights issue, are used to investigate changes in health status, measured by self-rated health (SRH), (instrumental) activities of daily living, self-rated depression, and cognition, in pilot and non-pilot cities before and after LTCI implementation. Long-term care insurance has a significant average effect on SRH improvement and a long-term positive effect on cognition for middle-aged and older populations. This study provides the first evaluation of LTCI policy on health outcomes using the recent difference-in-differences approaches. It provides evidence for the overall health improvement achieved through the LTCI and offers positive reinforcement and potential areas for improvement in establishing LTCI worldwide.
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Affiliation(s)
- Jingyi Wang
- School of Insurance and Economics, University of International Business and Economics, Beijing, China
| | - Jing Guan
- School of Economics, Beijing Technology and Business University, Beijing, China
| | - Guojun Wang
- School of Insurance and Economics, University of International Business and Economics, Beijing, China
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Chen Y, Zhao H. Long-term care insurance, mental health of the elderly and its spillovers. Front Public Health 2023; 11:982656. [PMID: 36935677 PMCID: PMC10020345 DOI: 10.3389/fpubh.2023.982656] [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: 06/30/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
The paper studies the effects of the long-term care insurance (LTCI) program in China on the mental health of older adults and the wellbeing of their families. We employ the staggered difference-in-differences approach based on the LTCI pilots from 2015 to 2017. First, we find the LTCI program improves older adults' happiness and reduces depression symptoms significantly. The effects on the improvement in memory and cognition are associated with the elderly with activities of daily living-related need for care. Second, the effects of LTCI are partially mediated through providing community services, relieving care burdens, and reducing the incidence of diseases. More importantly, LTCI coverage improves caregivers' physical health and social activities, reflecting its welfare spillover effects. Furthermore, the relationship between LTCI and mental health differs due to the difference in LTCI designs and older adults' demographic characteristics. This presents a need to consider mental health in the services and evaluation criteria of LTCI.
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Affiliation(s)
- Yunfei Chen
- School of Economics, Shanghai University, Shanghai, China
| | - Hong Zhao
- School of Economics, Qingdao University, Qingdao, China
- *Correspondence: Hong Zhao
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Ma G, Xu K. Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:192. [PMID: 36612515 PMCID: PMC9819384 DOI: 10.3390/ijerph20010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.
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Affiliation(s)
| | - Kun Xu
- Correspondence: ; Tel.: +86-198-1075-0586
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Yoshimoto T, Nawa N, Uemura M, Sakano T, Fujiwara T. The impact of interprofessional communication through ICT on health outcomes of older adults receiving home care in Japan - A retrospective cohort study. J Gen Fam Med 2022; 23:233-240. [PMID: 35800645 PMCID: PMC9249939 DOI: 10.1002/jgf2.534] [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: 10/10/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Information communication technology (ICT) is crucial to modern communication and information sharing. Effective interprofessional collaboration is essential in the care of elderly people. However, little is known about the effects of ICT on care provision for elderly people in a home setting. This retrospective cohort study examines the impact of interprofessional collaboration using ICT on the health outcomes of elderly home care patients. Methods The Team® mobile application promotes cooperation in local medical health care. It enables providers to obtain and share patient information within a single, cloud-based platform. We collected and analyzed data from 554 patients from Nagaoka (Niigata prefecture, Japan) who received home care services from 2015 to 2020. We calculated the cumulative hazard ratio (HR) of death or admission to a hospital or nursing home for patients whose information was shared among different professions using the platform, and for those whose information was not shared. We used a Cox proportional hazards model, adjusted for covariates, and applied propensity score matching. Results The average age of the study population was 83.5 years; the median follow-up period was 579.0 days. The risk of death or admission to a hospital or nursing home significantly decreased in the information-shared group, compared with the control group (adjusted HR: 0.47 [p < 0.01]). Significance remained after propensity score matching (HR: 0.58; p = 0.01). Conclusions Interprofessional collaboration using ICT may reduce the risk of death or admission to a hospital or nursing home among elderly home care patients in Japan.
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Affiliation(s)
- Takeru Yoshimoto
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
| | - Nobutoshi Nawa
- Department of Medical Education Research and DevelopmentTokyo Medical and Dental UniversityTokyoJapan
| | | | | | - Takeo Fujiwara
- Department of Global Health PromotionTokyo Medical and Dental UniversityTokyoJapan
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Ohashi K, Fujiwara K, Tanikawa T, Bando K, Aoki T, Ogasawara K. Differences in spatial patterns of long-term care depending on severity in Hokkaido, Japan. GEOSPATIAL HEALTH 2022; 17. [PMID: 35579241 DOI: 10.4081/gh.2022.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
The increasing demand for long-term care (LTC) among the ageing population is a serious problem worldwide, which has greatly increased also in Japan since the introduction of the LTC insurance system there. Since there is a difference between insurers with respect to the proportion of people needing LTC, this study aimed at clarifying the spatial patterns of LTC. Insurer (n=156) LTC data for the period 2012-2019 were obtained from Ministry of Health, Labour, and Welfare and those needing LTC were classified into three classes: total, mild and severe with ageand sex-adjusted proportions needing LTC. Global and local Moran’s I statistics were calculated for each 2-year period to clarify the trends of global and local spatial clusters. From 2012 to 2019, the mean proportion of mild class cases increased (10.6% to 11.6%), whereas that of severe class cases decreased slightly (5.9% to 5.7%). The spatial pattern of the proportion of each class revealed positive spatial autocorrelation. Based on analysis by local Moran’s I, differences in spatial patterns were emphasised between the mild and severe classes. In Hokkaido, High-High clusters of mild cases were identified in the central and southern parts and severe ones in the northern and southern parts. Spatial patterns differed depending on the LTC class. Some insurers had distinctly higher or lower certification rates than those of their neighbourhoods.
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Affiliation(s)
- Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido.
| | - Kensuke Fujiwara
- Graduate School of Commerce, Otaru University of Commerce, Otaru, Hokkaido.
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido.
| | - Kyohei Bando
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido.
| | - Tomohiro Aoki
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido.
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido.
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Chen H, Ning J. The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China. Health Policy Plan 2022; 37:717-727. [PMID: 35032390 DOI: 10.1093/heapol/czac003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/01/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.
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Affiliation(s)
- He Chen
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Road, Beijing, Haidian 100872, China
| | - Jing Ning
- School of Government, University of International Business and Economics, No. 10, Huixin Dongjie, Beijing, Chaoyang 100029, China
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Kitamura M, Izawa KP, Ishihara K, Matsuda H, Okamura S, Fujioka K. Physical Activity and Sarcopenia in Community-Dwelling Older Adults with Long-Term Care Insurance. Eur J Investig Health Psychol Educ 2021; 11:1610-1618. [PMID: 34940392 PMCID: PMC8700727 DOI: 10.3390/ejihpe11040114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to clarify the difference in physical activity (PA) due to sarcopenia in community-dwelling older adults with long-term care insurance (LTCI). This was a cross-sectional study that investigated data of 97 consecutive community-dwelling older Japanese adults with LTCI who underwent rehabilitation at one day care center in Japan from November 2018 to May 2019. Sarcopenia was determined according to criteria of the Asian Working Group for Sarcopenia. Unpaired t-test, Mann-Whitney U test, chi-square test and analysis of covariance were used to compare participant characteristics and clinical parameters between the older adults with and without sarcopenia. A receiver operating characteristic (ROC) curve was constructed to determine the cut-off value of PA for sarcopenia. The sarcopenia group (n = 20) had significantly lower body mass index (BMI), skeletal muscle mass index, gait speed, and PA than those in the no sarcopenia group (n = 28) (p < 0.05). After adjustment for BMI and sex, the sarcopenia group showed significantly lower PA than the no sarcopenia group. Findings showed that the cut-off value of PA indicating sarcopenia by ROC curve analysis was 1494.4 steps/day (p < 0.05); this value may aid in identifying sarcopenia in older adults with LTCI.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Fukuokawajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka 811-0213, Japan;
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Correspondence: ; Tel.: +81-78-796-4566
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-Chome, Kita-ku, Okayama 700-0804, Japan
| | - Hiroaki Matsuda
- Department of Rehabilitation, Rifuru Yukuhashi Day Care Center, 379-1 Takase, Yukuhashi 824-0027, Japan; (H.M.); (S.O.); (K.F.)
| | - Soichiro Okamura
- Department of Rehabilitation, Rifuru Yukuhashi Day Care Center, 379-1 Takase, Yukuhashi 824-0027, Japan; (H.M.); (S.O.); (K.F.)
| | - Koji Fujioka
- Department of Rehabilitation, Rifuru Yukuhashi Day Care Center, 379-1 Takase, Yukuhashi 824-0027, Japan; (H.M.); (S.O.); (K.F.)
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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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16
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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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17
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Sohn M, O'Campo P, Muntaner C, Chung H, Choi M. Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level. Soc Sci Med 2020; 247:112812. [PMID: 32066015 DOI: 10.1016/j.socscimed.2020.112812] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 01/05/2023]
Abstract
The long-term care insurance (LTCI) has been implemented to help the government take responsibility for social prevention and protection measures to maintain and improve older adults' health and well-being since 2008. This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea. The data used from the national representative Elderly Cohort Database for 2009 to 2013. We analyzed longitudinal panel data from 61,235 persons aged 65 years and older. We generated Kaplan-Meier survival curves and Cox proportional hazard models by use and type of long-term care services (LTCSs) (e.g., non-user, facility, and in-home benefits) and income level. The covariate-adjusted approximate mortality rates by LTCSs type for facility and in-home benefits group compared to non-LTCS users were 0.761 and 0.803, respectively. The approximate mortality rates were higher in the middle low- (Hazard Ratio [HR] = 1.131, p < .001), low- (HR = 1.125, p < .001), and middle- (HR = 1.122, p < .001) than the high income group. In particular, the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. Consequently, these findings point to the need for program improvements to the quality and quantity of the in-home LTCSs for elderly Koreans. Ensuring a "continuum of care" through education for service providers and stronger relationships with the recipients' families could improve overall quality. There is a particular need to devote more attention to the needs of low-income elderly who currently lack sufficient the health coverage.
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Affiliation(s)
- Minsung Sohn
- Department of Health and Care Administration, The Cyber University of Korea, Seoul, South Korea
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
| | - Haejoo Chung
- School of Health Policy & Management, College of Public Health Science, Korea University, Seoul, South Korea; BK21Plus Program in Embodiment: Health-Society Interaction, Department of Public Health Science, Graduate School of Korea University, Seoul, South Korea
| | - Mankyu Choi
- School of Health Policy & Management, College of Public Health Science, Korea University, Seoul, South Korea; BK21Plus Program in Embodiment: Health-Society Interaction, Department of Public Health Science, Graduate School of Korea University, Seoul, South Korea.
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18
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Choi JS, Yi YJ, Donnelly LR. Oral health of older residents in care and community dwellers: nursing implications. Int Nurs Rev 2017; 64:602-609. [PMID: 29034970 DOI: 10.1111/inr.12417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Poor oral health is associated with a reduced quality of life and serious illnesses. Consequently, nurses need to be more aware of oral health to improve the general health of residents in care. AIM To evaluate and compare oral health behaviours and levels of salivary haemoglobin and dental biofilm acidogenicity, which can be used to evaluate oral disease activity, between residents and community dwellers in South Korea. METHODS This cross-sectional study included 133 participants: 64 residents and 69 community dwellers. All participants completed a questionnaire and tests to measure their salivary haemoglobin and dental biofilm acidogenicity. RESULTS A higher percentage of community dwellers than of residents brushed their teeth three times a day, cleaned their tongue, used interdental cleaning devices and had visited a dental clinic within 1 year. The levels of salivary haemoglobin and dental biofilm acidogenicity tended to be higher in residents than in community dwellers. CONCLUSION Residents showed poorer oral health behaviours and higher levels of gingival bleeding and acid production by oral bacteria than did community dwellers. IMPLICATIONS FOR NURSING PRACTICE Nursing staff should enhance their monitoring of oral hygiene status and provide quality oral care to residents through cooperation with dental professionals. IMPLICATIONS FOR NURSING AND HEALTH POLICY Policymakers should be aware that oral health is an essential component of improving general health and well-being and therefore strive to develop policies to promote oral care services provided to residents. Nursing policies, such as mandating oral care and hands-on training in oral care for nursing staff, are important. We also suggest that factors related to oral care be added to the establishment or accreditation standards of care facilities.
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Affiliation(s)
- J S Choi
- College of Health Science, Gachon University, Incheon, Korea
| | - Y J Yi
- College of Nursing, Gachon University, Incheon, Korea
| | - L R Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Lin HR, Otsubo T, Imanaka Y. Survival analysis of increases in care needs associated with dementia and living alone among older long-term care service users in Japan. BMC Geriatr 2017; 17:182. [PMID: 28814271 PMCID: PMC5559793 DOI: 10.1186/s12877-017-0555-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Japan is known for its long life expectancy and rapidly aging society that there are various demands of older adults need to be fulfilled with, and one of them is long-term care needs. Therefore, Japan implemented the Long-Term Care Insurance in year 2000 for citizens who are above 65-year old and citizens who are above 40-year old in needs of long-term care services. This study was undertaken to longitudinally examine the influence of dementia and living alone on care needs increases among older long-term care insurance service users in Japan. METHODS Long-term care insurance claims data were used to identify enrollees who applied for long-term care services between October 2010 and September 2011, and subjects were tracked until March 2015. A Kaplan-Meier survival analysis was conducted to examine increases in care needs over time in months. Cox regression models were used to examine the effects of dementia and living alone on care needs increases. RESULTS The cumulative survival rates before care needs increased over the 4.5-year observation period were 17.6% in the dementia group and 31.9% in the non-dementia group. After adjusting for age, sex, care needs level, and status of living alone, the risk of care needs increases was found to be 1.5 times higher in the dementia group. Living alone was not a significant risk factor of care needs increases, but people with dementia who lived alone had a higher risk of care needs increases than those without dementia. CONCLUSION Dementia, older age, the female sex, and lower care needs levels were associated with a higher risk of care needs increases over the study period. Among these variables, dementia had the strongest impact on care needs increases, especially in persons who lived alone.
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Affiliation(s)
- Huei-Ru Lin
- The Japan Foundation for Aging and Health, 4F, 1-1 Aza Gengoyama, Oaza Morioka, Higashiura-cho, Chita-gun, Aichi, 470-2101, Japan.,Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Tetsuya Otsubo
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Choi JK, Kang M, Joung E. The Impact of In-Home Services Utilization on the Institutionalization of Older People in Korea. J Aging Soc Policy 2017; 29:433-443. [PMID: 28414578 DOI: 10.1080/08959420.2017.1319318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As a result of aging populations, institutionalization of older people is creating an increasing financial burden in many countries. The purpose of the present study was to explore the impact of in-home service utilization on institutionalization. The subjects were newly certified as eligible for long-term care insurance between January and February 2009 in Korea. The follow-up period was 40 months, to April 2012. We used logistic regression models to identify factors influencing the transition to institutional service, adjusting for gender, age, living status, income level, activities of daily living, and chronic disease. The institutionalization rate was estimated to be 17.3% over 40 months. The interval from transitional living to institutionalization was 36 ± 8 months. Risk factors of transition to institutional services are being female, having advanced age, living with friends or cousins, getting dementia, and not using in-home services. We determined that institutionalization is mitigated by use of in-home services. Therefore, supplying appropriate in-home services to current nonusers would help to greatly reduce the rate of institutionalization of older people.
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Affiliation(s)
- Jung-Kyu Choi
- a Senior Researcher, Institute of Health Insurance and Clinical Research , National Health Insurance Corporation, Ilsan Hospital , Goyang , Republic of Korea
| | - Minjin Kang
- b Researcher, Institute of Health Insurance and Clinical Research, National Health Insurance Corporation, Ilsan Hospital , Goyang , Republic of Korea
| | - Euasin Joung
- c Chief Researcher, Health Insurance Policy Research Institute, National Health Insurance Service , Wonju , Republic of Korea
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