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Zhang J, Hu M, Jia Y, Gu Y, Chen W. How should regulatory schemes be optimized to enhance deterrence against medical insurance fraud by enrollees? Evidence from a discrete choice experiment in China. Soc Sci Med 2024; 354:117059. [PMID: 38968901 DOI: 10.1016/j.socscimed.2024.117059] [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: 02/07/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 07/07/2024]
Abstract
Medical insurance fraud (MIF) poses a substantial global financial challenge, necessitating effective regulatory strategies, especially in China, where such measures are in a critical developmental phase. This study investigates the effectiveness of various regulatory components in deterring MIF among enrollees and explores preference heterogeneity among individuals with different characteristics, utilizing a discrete choice experiment survey. Grounded in deterrence theory, our conceptual framework incorporates five attributes: intensity of economic penalties, restrictions on medical insurance benefits, deterioration of social reputation, and certainty and celerity of penalties. Employing a D-efficiency design, 24 choice sets were generated and blocked into three versions. A multistage stratified sampling method was adopted to collect data from the basic medical insurance enrollees in Shanghai. The survey was conducted from September to October 2022. The sample representativeness was further improved via the entropy balancing approach. Data from the final sample of 1034 respondents were analyzed using mixed logit models (MIXLs), incorporating interactions with individual characteristics to assess preference heterogeneity. Results reveal that escalating economic penalties, suspending insurance benefits, listing individuals as unfaithful parties, ensuring penalty certainty, and expediting enforcement significantly enhance the deterrent effect. We observed preference heterogeneity across different demographics, including age, gender, education, health status, and employment status. The study underscores the pivotal role of economic penalties in deterring MIF, while also acknowledging the significance of non-economic measures such as enforcement efficiency and social sanctions. These findings offer valuable insights for policymakers to tailor and strengthen regulatory schemes against MIF, contributing to the advancement of more effective and precise healthcare policies.
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Affiliation(s)
- Jinsui Zhang
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
| | - Min Hu
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
| | - Yusheng Jia
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China; Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY, 14642, USA.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation & Macquarie Business School, Level 5, 75 Talavera Road, Macquarie University, NSW, 2109, Australia.
| | - Wen Chen
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
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Zhang L, Li D, Li X, Yan J. Patient preferences for generic substitution policies: a discrete choice experiment in China. Front Pharmacol 2024; 15:1400156. [PMID: 39015369 PMCID: PMC11250648 DOI: 10.3389/fphar.2024.1400156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/13/2024] [Indexed: 07/18/2024] Open
Abstract
Background: Generic substitution policies have been widely implemented worldwide to enhance the accessibility of medications. Nevertheless, certain patients have voiced discontent with these policies. This study aimed to evaluate the patient preferences for generic substitution policies and explore the potential for optimization to enhance patient acceptance. Methods: A discrete choice experiment (DCE) was conducted to estimate the relative importance (RI) of five attributes, including generic consistency evaluation (GCE), reimbursement rate, medication use control, information disclosure, and post-marketing surveillance. Respondents were recruited among inpatients and outpatients in three cities and surveys were conducted face-to-face. Preference coefficients, RI of attributes, and the uptake rate of various policies were computed using a mixed logit model. The interaction effects were also included to examine preference heterogeneity. Results: A total of 302 patients completed the survey. All five attributes significantly impacted policy acceptance. GCE held the highest RI value at 56.64%, followed by reimbursement rate (RI = 12.62%), information disclosure (RI = 12.41%), post-marketing surveillance (RI = 9.54%), and medication use control (RI = 8.80%). Patient preferences varied depending on their gender and income. The patient uptake rate of China's current policy was only 68.56%. If all generics were to pass GCE without altering the other attributes, the uptake rate of policies would rise to 82.63%. Similarly, implementing information disclosure without changing other attributes would result in a 78.67% uptake rate, which is comparable to the effect of a 10% increase in reimbursement rate for generics (78.81%). Combining these policies could mitigate the adverse effects of mandatory substitution on patient. Conclusion: Chinese patient preferences for generic substitution policies were mainly influenced by GCE. China's current generic substitution policy has room for further optimization to enhance patient acceptance.
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Affiliation(s)
- Lingli Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Dashuang Li
- Medical Services Department, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Li
- School of Pharmacy, Nanjing Medical University, Nanjing, China
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianzhou Yan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
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Senanayake S, Kularatna S, Crawford-Williams F, Brain D, Allen M, Hettiarachchi RM, Hart NH, Koczwara B, Ee C, Chan RJ. Cancer survivor preferences for breast cancer follow-up care: a discrete choice experiment. J Cancer Surviv 2024:10.1007/s11764-024-01629-9. [PMID: 38871994 DOI: 10.1007/s11764-024-01629-9] [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: 10/16/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To identify the key attributes of breast cancer follow-up care models preferred by cancer survivors in Australia. METHODS A discrete choice experiment (DCE) was conducted to elicit preferences for attributes of breast cancer follow-up care. Respondents were presented with two hypothetical scenarios, known as choice sets, and asked to select a preference. Respondents were individuals living in Australia who were diagnosed with breast cancer within the past five years prior to survey completion and were recruited through the Breast Cancer Network of Australia and other community or consumer networks. Latent class modelling (LCM) approach under a random utility framework was used for the analysis. RESULTS 123 breast cancer survivors completed the DCE survey. LCA revealed two latent classes, those with older age and lower quality of life (class 1) and younger women with higher quality of life (class 2). Class 2 preferred a care team comprising specialists, nurses and GPs and emphasised the importance of shared survivorship care plans. Class 1 remained neutral regarding the team's composition but was notably concerned about the out-of-pocket costs per consultation, a finding not seen in Class 2. CONCLUSIONS Age and quality of life status are associated with patient preference for types and attributes of breast cancer follow-up care. The health system can work towards enhancing flexibility of follow-up care delivery, ultimately achieving person-centred care. IMPLICATIONS FOR CANCER SURVIVORS Efforts need to be made by policymakers to ensure consumer preferences are taken into consideration to implement tailored person-centred follow-up care pathways.
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Affiliation(s)
- Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore.
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - David Brain
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Michelle Allen
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), 60 Musk Avenue, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Ruvini M Hettiarachchi
- Centre for the Business and Economics of Health (CBEH), University of Queensland, Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Faculty of Health, Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Sydney, NSW, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, SA, Australia
| | - Carolyn Ee
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Nicolet A, Perraudin C, Krucien N, Wagner J, Peytremann-Bridevaux I, Marti J. Preferences for innovations in healthcare delivery models in the Swiss elderly population: a latent class, choice modelling study. Eur J Public Health 2024; 34:260-266. [PMID: 38243764 PMCID: PMC10990495 DOI: 10.1093/eurpub/ckae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND With the increasing number of people affected by multiple chronic conditions, it is essential for public-health professionals to promote strategies addressing patient needs for coordinated care. We aim to explore preference heterogeneity for better-coordinated care delivery models in Swiss older adults, and identify profiles of individuals more open to healthcare reforms. METHODS A DCE (discrete choice experiment) survey was developed online and on paper for the Swiss adults aged 50+, following best practice. To elicit preferences, we estimated a latent class model allowing grouping individuals with similar preferences into distinct classes, and examined what background characteristics contributed to specific class membership. RESULTS The optimal model identified three classes with different openness to reforms. Class 1 (49%) members were concerned with premium increases and were in favour of integrated care structures with care managed by interprofessional teams. Individuals in class 2 (19%) were younger, open to reforms, and expressed the needs for radical changes within the Swiss healthcare system. Class 3 respondents (32%) were strongly reluctant to changes. CONCLUSIONS Our study goes beyond average preferences and identifies three distinct population profiles, a majority open to reforms on specific aspects of care delivery, a smallest group in favour radical changes, and a third strongly against changes. Therefore, tailored approaches around healthcare reforms are needed, e.g. explaining the role of interprofessional teams in coordinating care, electronic health records and insurance premium variation.
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Affiliation(s)
- Anna Nicolet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Clémence Perraudin
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Joël Wagner
- Department of Actuarial Science, Faculty of Business and Economics (HEC), and Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland
| | | | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Föhn Z, Nicolet A, Marti J, Kaufmann C, Balthasar A. Stakeholder Engagement in Designing Attributes for a Discrete Choice Experiment With Policy Implications: An Example of 2 Swiss Studies on Healthcare Delivery. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:925-933. [PMID: 36646277 DOI: 10.1016/j.jval.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/13/2022] [Accepted: 01/05/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The use of discrete choice experiments (DCEs) has become increasingly popular in health policy development by involving and analyzing the preferences of target groups for different aspects of the policy intervention. In this article, we aim to contribute to the standardization of the process of attribute and attribute level development for DCEs with policy relevance. To do so, we propose and empirically illustrate a framework tool for the development and reporting of attributes and attribute levels, with the systematic engagement of relevant stakeholders. METHODS The framework tool was kept general to allow its use as a standard reporting approach on the development process of a DCE, involving relevant stakeholders at each stage. The proposed 3-stage process consists of (1) collection, (2) selection, and (3) refinement of the DCE attributes and attribute levels. The application of the framework tool is illustrated by 2 projects, Health2040 and COCONUTS-both concerning the preferences of the Swiss population for the future organization of healthcare. RESULTS By engaging stakeholders, we identified and included attributes and attribute levels that would not have been identified solely through the existing literature. In addition, including multiple stakeholders from different professional backgrounds ensured that the selected attributes and attribute levels were policy relevant, were applicable in practice, and reflected the opinions of multiple actors in healthcare. CONCLUSION The proposed framework helps to strengthen the standardization of the reporting on attribute and attribute level development with stakeholder engagement and to guide future research teams designing a DCE with policy implications.
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Affiliation(s)
- Zora Föhn
- Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, Switzerland; Interface Politikstudien Forschung Beratung, Lucerne, Switzerland.
| | - Anna Nicolet
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Cornel Kaufmann
- Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, Switzerland; Interface Politikstudien Forschung Beratung, Lucerne, Switzerland
| | - Andreas Balthasar
- Faculty of Humanities and Social Sciences, University of Lucerne, Lucerne, Switzerland
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Liu H, Ma J, Zhao L. Public long-term care insurance and consumption of elderly households: Evidence from China. JOURNAL OF HEALTH ECONOMICS 2023; 90:102759. [PMID: 37146408 DOI: 10.1016/j.jhealeco.2023.102759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
This study investigates the impact of long-term care insurance (LTCI) on the non-health consumption of elderly households. By exploiting a quasi-experiment on the public LTCI pilot program in China, we identify the effect of LTCI using a triple-difference approach. Using longitudinal data from the China Health and Retirement Longitudinal Study, we find that LTCI has led to an increase in the non-health consumption of elderly households by 15.7%, mostly observed in households having no older members with need for long-term care (LTC). Further evidence suggests that the effects are stronger for households with higher expected LTC risks, less wealth or family insurance, and covered by more generous schemes. Finally, LTCI increases the expectation of using formal LTC when disabled and subjective longevity expectations for older adults having no need for LTC. Overall, these findings offer empirical support for the role of LTCI in mitigating precautionary savings against LTC risks.
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Affiliation(s)
- Hong Liu
- School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Street, Beijing 100872, China.
| | - Jinqiu Ma
- China Economics and Management Academy, Central University of Finance and Economics, Beijing 100081, China.
| | - Liqiu Zhao
- School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Street, Beijing 100872, China.
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Ma H, Jia E, Ma H, Pan Y, Jiang S, Xiong J. Preferences for public long-term care insurance among middle-aged and elderly residents: A discrete choice experiment in Hubei Province, China. Front Public Health 2023; 11:1050407. [PMID: 36778541 PMCID: PMC9909219 DOI: 10.3389/fpubh.2023.1050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objective It is critical to incorporate residents' preferences into the design of long-term care insurance (LTCI). However, little is known about middle-aged and elderly residents' preferences for personalized need-related attributes of LTCI in China. Through a discrete choice experiment (DCE), we aimed to focus on the direct beneficiaries of LTCI and then elicit their preferences for LTCI under a hypothetical scenario of dysfunction. Methods Attributes and levels were defined through a literature review and two rounds of expert consultations (n = 8). A D-optimal fractional factorial design was used to generate the DCE questionnaire. Face-to-face interviews with middle-aged and elderly residents were conducted in two cities in Hubei Province, China, between November and December 2020. A mixed logit model was utilized for estimation. Results Five attributes were identified and incorporated into the DCE questionnaire. A total of 390 participants completed DCE questionnaires. Care facilities, care content, reimbursement rate, caregivers, and annual premium per person all had a significant impact on residents' preferences. Residents had significantly higher preferences for the LTCI scheme with home and community-based care centers (β = 1.40, p < 0.01), multi-level services (β = 0.44, p < 0.01), 90% reimbursement rate (β = 0.37, p < 0.01), and sufficiently trained caregivers (β = 0.26, p < 0.01). Individual characteristics, such as gender, employment, and education level were the factors that drove heterogeneity in preferences for LTCI. Conclusion This study provides new evidence on the preferences of middle-aged and elderly residents for personalized need-related public LTCI features. The design of the LTCI scheme in China needs to take these findings into account to maximize the utility for direct beneficiaries of LTCI and enhance their enrollment.
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Affiliation(s)
- He Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Erping Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huimin Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanzhi Pan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juyang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Juyang Xiong ✉
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Amilon A, Kjær AA, Ladenburg J, Siren A. Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark. Soc Sci Med 2022; 311:115332. [PMID: 36084519 DOI: 10.1016/j.socscimed.2022.115332] [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: 02/08/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
Aging populations put pressure on the provision and financing of long-term care (LTC) services in many countries. The projected increase in LTC expenditures may in particular constitute a threat to the future sustainability of public budgets in welfare states, where LTC is financed through taxes. To accommodate the increasing number of 80+ year-olds in society, policy-makers and service administrators need a better understanding of care preferences among future older adults: What types of services do older citizens prefer most, and which factors shape their LTC preferences? A discrete choice experiment (DCE) was administered to a representative sample of the Danish population aged 54-64 from May to July 2019 (n = 1154), investigating which factors shape individuals' preferences and willingness-to-pay (WTP) for their future LTC. Our results reveal that respondents are willing to make additional out-of-pocket payments to supplement the care provided for free by the municipality. The WTP was highest for services such as receiving help from a regular care team ($129 per month) and an extra shower a week ($116 per month). Moreover, we find heterogeneous care preferences, with three user characteristics associated with higher WTP for services: higher education, high wealth, and a low trust in the publicly financed care system. Our results raise concerns that inequalities between relatively more- and less-resourceful older adults may increase in Scandinavian-type welfare states in the future. Such increasing inequality in service provision may undermine citizens' trust in and support of the publicly financed care system.
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Affiliation(s)
- Anna Amilon
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Agnete Aslaug Kjær
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark; Den Tværgående Analyseenhed, Københavns Kommune, Rådhuspladsen 1, 1599, Copenhagen, Denmark.
| | - Jacob Ladenburg
- The Rockwool Foundation, Ny Kongensgade 6, 1472, Copenhagen, Denmark; Technical University of Denmark, Produktionstorvet 424, 024, 2800, Kgs. Lyngby, Denmark.
| | - Anu Siren
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark; Tampere University, Arvo Ylpön katu 34, 33,520, Tampere, Finland.
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Lei X, Bai C, Hong J, Liu H. Long-term care insurance and the well-being of older adults and their families: Evidence from China. Soc Sci Med 2022; 296:114745. [DOI: 10.1016/j.socscimed.2022.114745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/13/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
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Teahan Á, Walsh S, Doherty E, O'Shea E. Supporting family carers of people with dementia: A discrete choice experiment of public preferences. Soc Sci Med 2021; 287:114359. [PMID: 34530220 DOI: 10.1016/j.socscimed.2021.114359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Community-based care for people with dementia is mainly provided by family carers, many of whom experience decreased mental, physical and financial well-being due to their caring role. Many countries are now implementing ageing-in-place policies that have increased pressure on family carers as care-work is redistributed from residential to community-based settings. Family caring responsibilities for people with dementia are made even more complicated by the economic, social and cultural expectations that underpin existing provision. Support for family carers is, therefore, an important policy topic across many countries. The focus of this paper is on the propensity of citizens to support enhanced care for family carers in Ireland, as demonstrated by their willingness-to-pay additional taxation to fund different combinations of carer support measures, developed through careful and sustained dialogue with multiple stakeholders, especially family carers themselves. We carried out a discrete choice experiment (DCE) with 509 members of the general public in Ireland between January and February 2021. Using mixed logit models, our findings show that citizens value four key attributes: regular caring breaks for family carers (day-care and long-break respite); financial compensation (carer's allowance); and emotional support (carer peer support groups). We also estimated the welfare impact of moving from current provision to enhanced support packages for family carers of people with dementia. The welfare gains accumulate to €1035.80 for the most complete levels of provision across the four support attributes. Overall, respondents in this paper showed empathy and understanding towards family carers of people with dementia through their willingness to contribute to funding additional services and supports.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland.
| | - Sharon Walsh
- School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Edel Doherty
- School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland.
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Wang Q, Abiiro GA, Yang J, Li P, De Allegri M. Preferences for long-term care insurance in China: Results from a discrete choice experiment. Soc Sci Med 2021; 281:114104. [PMID: 34126290 DOI: 10.1016/j.socscimed.2021.114104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
Rapid population aging has led countries to consider the introduction of long-term care insurance (LTCI) as an essential component of a comprehensive social health protection package. Limited evidence, however, exists on people's preferences for such insurance products, especially in countries where their availability is still restricted. Using a discrete choice experiment (DCE), we investigated preferences, willingness to pay, and heterogeneity in preferences for attributes of a social LTCI among community members in China. We adopted a multi-methods approach, combining information across different data sources to identify five DCE attributes: individual premium, benefit package, coverage ceiling, government subsidy for participants, and reimbursement of home-based care provided by family caregivers. We constructed our experiment using a D-efficient design and ran the DCE survey among 1067 community members in urban and rural areas in Shenyang and Dalian, Liaoning Province from Dec 2019 to Jan 2020. We relied on a panel mixed logit model to analyze the data. Our findings indicated that people had significantly higher preferences for the LTCI product with a higher coverage ceiling, a lower individual premium, a higher government subsidy, a reimbursement of home-based care provided by family caregivers, and an expansion of the benefit package to also include necessary daily assistance. The coverage ceiling was found to be the most important attribute, followed by the reimbursement of home-based care provided by family caregivers and the individual premium. Our findings also revealed that the area of residence, prior commercial insurance ownership, age, having children, and income were the factors that drove heterogeneity in preferences for LTCIs. These findings bear important policy implications, as they provide clear guidance on product design, enabling decision-makers to increase the attractiveness and sustainability of LTCI.
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Affiliation(s)
- Qun Wang
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian, China.
| | - Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana; Department of Planning, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Jin Yang
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian, China
| | - Peng Li
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian, China
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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He AJ, Qian J, Chan WS, Chou KL. Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong. Soc Sci Med 2021; 270:113632. [DOI: 10.1016/j.socscimed.2020.113632] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
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Chen L, Zhang L, Xu X. Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge. BMC Health Serv Res 2020; 20:1057. [PMID: 33218328 PMCID: PMC7677443 DOI: 10.1186/s12913-020-05878-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
Background The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China’s public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. Methods This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. Results The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. 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 Some policy implications on the future development of China’s LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.
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Affiliation(s)
- Linhong Chen
- School of Mathematics and Statistics, Chongqing Technology and Business University, Chongqing, 400067, China.,School of Public Administration, Sichuan University, Chengdu, 610065, China
| | - Lu Zhang
- Research Center for Economy of Upper Reaches of the Yangtse River, Chongqing Technology and Business University, Chongqing, 400067, China
| | - Xiaocang Xu
- School of Economics, Chongqing Technology and Business University, Chongqing, 400067, China. .,Department of Actuarial Studies & Business Analytics, Macquarie University, Sydney, 2109, Australia.
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