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Ning J, Chen H, Li M. Does income matter for the policy effect of public long-term care insurance on informal care use in China? A quasi-experimental study. J Health Serv Res Policy 2024; 29:248-256. [PMID: 38713011 DOI: 10.1177/13558196241252394] [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] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Since 2016, the Chinese government has been piloting a public long-term care insurance (LTCI) scheme. This study examined whether the LTCI scheme reduced the use of informal care and how this has varied across income groups. METHOD We used data from the 2011, 2014, and 2018 waves of Chinese Longitudinal Healthy Longevity Survey, focusing on community-dwelling older adults aged 65 years and older. We used staggered difference-in-differences analyses with propensity score matching to examine the effects of the policy. RESULTS The LTCI scheme reduced the probability and intensity of informal care use by 5.7% (p < .05) and 17.4% (p < .05), respectively. The policy impact was limited to older people in the middle-income group, reducing the probability and intensity of informal care use by 15.6% (p < .001) and 43.1% (p < .05), respectively. We did not find a statistically significant policy effect for older adults with high or low incomes. CONCLUSIONS The LTCI scheme had different effects on reducing the informal care burden for family caregivers by income level. We suggest that the scheme should entitle people with low incomes to a preferential co-payment rate, thereby enhancing their access to formal care.
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Affiliation(s)
- Jing Ning
- School of Government, University of International Business and Economics, Beijing, China
| | - He Chen
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Man Li
- School of Public Administration and Policy, Renmin University of China, Beijing, China
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Jiang W, Yang H. The effect of long-term care insurance on women's health outcomes in China: evidence from a disability inclusion action. BMC Public Health 2024; 24:2262. [PMID: 39164684 PMCID: PMC11337582 DOI: 10.1186/s12889-024-19800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Long-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers. METHODS Using the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women's health outcomes. RESULTS LTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village. CONCLUSIONS After the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI' improvement on women's health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women's health inequalities in geography and society.
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Affiliation(s)
- Wenjing Jiang
- Center for Social Security Studies, Wuhan University, Wuhan, 430072, China
- School of Political Science & Public Administration, Wuhan University, Wuhan, 430072, China
| | - Hongyan Yang
- Center for Social Security Studies, Wuhan University, Wuhan, 430072, China.
- School of Political Science & Public Administration, Wuhan University, Wuhan, 430072, China.
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Li H, Liu S, Zhou L. Intensity and associated factors of home health care service needs among elderly patients with chronic diseases in the community: A cross-sectional survey. Public Health Nurs 2024. [PMID: 38946500 DOI: 10.1111/phn.13365] [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: 10/12/2023] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Abstract
AIM AND OBJECTIVES This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. DESIGN A cross-sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. METHODS Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. RESULTS A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD = 7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR = 1.289; 95% CI: 1.055-1.575, p = .013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p < .05). CONCLUSION Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems.
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Affiliation(s)
- Hang Li
- Department of Urology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan, China
| | - Suzhen Liu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan, China
| | - Luling Zhou
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan, China
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Zhang J, Wang JSH, Chan WK. Utilizing Consumer-Directed Care Among Older Adults: Identifying Barriers From Behavioral Economics Perspectives. Res Aging 2024; 46:275-286. [PMID: 38189254 DOI: 10.1177/01640275231226228] [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] [Indexed: 01/09/2024]
Abstract
Consumer-directed Care (CDC) empowers older people to flexibly arrange services and enhances their well-being. Prior studies have suggested that limited attention and hassle costs are major demand-side barriers to using CDC. However, many other psychosocial factors were unexplored. In this study, we explore associations between CDC utilization and a wider range of psychosocial factors based on behavioral economics theories. A cross-sectional telephone survey of older persons (or family members that represent them) was conducted in Guangzhou, China in 2021. We adopted a two-stage sampling method based on administrative records and analyzed the data using multivariate logistic models. Procedural literacy, hassle costs, and social norms regarding CDC were associated with using CDC. The findings reveal nuances in the decision-making process, and people are not unboundedly rational in making care-related decisions. Policymakers could employ cost-effective tools to facilitate CDC utilization and optimize resources to address the most crucial service barriers.
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Affiliation(s)
- Jinbao Zhang
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | - Wing Kit Chan
- Center for Chinese Public Administration Research/School of Government, Sun Yat-sen University, Guangzhou, China
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Che T, Li J, Li J, Chen X, Liao Z. Long-term care needs and hospitalization costs with long-term care insurance: a mixed-sectional study. Front Public Health 2024; 12:1226884. [PMID: 38651130 PMCID: PMC11034482 DOI: 10.3389/fpubh.2024.1226884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background With the rapid aging of the population, the health needs of the older adult have increased significantly, resulting in the frequent occurrence of the "social hospitalization" problem, which has led to a rapid increase in hospitalization costs. This study investigates whether the "social hospitalization problem" arising from the long-term care needs can be solved through the implementation of long-term care insurance, thereby improving the overall health of the older adults and controlling the unreasonable increase in hospitalization costs. Methods The entropy theory was used as a conceptual model, based on data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. The least-squares method was used to examine the relationship between long-term care needs and hospitalization costs, and the role that long-term care insurance implementation plays in its path of influence. Results The results of this study indicated that long-term care needs would increase hospitalization cost, which remained stable after a series of tests, such as replacing the core explanatory variables and introducing fixed effects. Through the intermediary effect test and mediated adjustment effect test, we found the action path of long-term care needs on hospitalization costs. Long-term care needs increases hospitalization costs through more hospitalizations. Long-term care insurance reduces hospitalization costs. Its specific action path makes long-term care insurance reduce hospitalization costs through a negative adjustment of the number of hospitalizations. Conclusion To achieve fair and sustainable development of long-term care insurance, the following points should be achieved: First, long-term care insurance should consider the prevention in advance and expand the scope of participation and coverage; Second, long-term care insurance should consider the control in the event and set moderate levels of treatment payments; Third, long-term care insurance should consider post-supervision and explore appropriate payment methods.
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Affiliation(s)
- Tiantian Che
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, China
| | - Jia Li
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, China
| | - Jun Li
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, China
| | - Xiaobo Chen
- School of Investment Project Management, Dongbei University of Finance and Economics, Dalian, China
| | - Zangyi Liao
- School of Political Science and Public Administration, China University of Political Science and Law, Beijing, China
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Li Q, Chen Y, Zhang Y, Liu X. Evaluation of China's long-term care insurance policies. Front Public Health 2024; 12:1252817. [PMID: 38605882 PMCID: PMC11007106 DOI: 10.3389/fpubh.2024.1252817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. Methods We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Results Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. Discussion The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.
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Affiliation(s)
- Qiang Li
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
| | - Yiwen Chen
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
| | - Yongmei Zhang
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
- School of Economics and Management, Shandong Agricultural Engineering University, Jinan, China
| | - Xue Liu
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
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Cui C, Zhang Y, Ding R, He P. Impact of the Essential Public Health Service program on financial protection and health outcomes among hypertensive patients: A quasi-experimental study in China. Soc Sci Med 2024; 345:116705. [PMID: 38422688 DOI: 10.1016/j.socscimed.2024.116705] [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: 04/25/2023] [Revised: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The Chinese government launched the Essential Public Health Service (EPHS) program nationwide in 2009. However, prior studies have not provided clear and integrated evidence on whether the EPHS program improves health outcomes and prevents financial risks among individuals. Because hypertension is the chronic disease with the highest prevalence, this study evaluated the impact of the EPHS program among hypertensive patients to provide evidence for the progress of the program. METHODS A cohort of hypertensive patients was identified from the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS). The outcomes assessed included hospitalization expenditure, outpatient expenditure and cardiovascular disease (heart attack and stroke). The key independent variable was whether an individual received EPHS-covered blood pressure measurements in 2013-2015. Based on the International Health Partnership+ (IHP+) common monitoring and evaluation (M&E) framework, a difference-in-differences (DID) method with propensity score matching (PSM) was used to examine the impact of the EPHS program on hypertensive patients. RESULTS The results showed that among hypertensive patients covered by the EPHS program, outpatient total costs/OOP costs were reduced by 29.8% and 30.8%, respectively, and hospitalization total costs/OOP costs were reduced by 34.9% and 35.6%, respectively. The EPHS program reduced the probability of heart attack and stroke among hypertensive patients by 3.5% and 2.7%, respectively. Mechanistic tests showed that the EPHS program improved health outcomes by reducing alcohol consumption and increasing physical activity, thereby further reducing health expenditure among hypertensive patients. The impacts of the EPHS program on hypertensive patients varied by age, educational attainment, residential region, and alcohol consumption status. CONCLUSION The EPHS program in China significantly improved health outcomes and prevented financial risks for hypertensive patients. This evidence provides a valuable reference for low- and middle-income countries with their essential public health service programs.
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Affiliation(s)
- Chengsen Cui
- School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China; China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Yue Zhang
- School of Accountancy, Central University of Finance and Economics, No.39 South College Road, Haidian District, Beijing, 100081, China.
| | - Ruoxi Ding
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No.51 Hua Yuan Bei Road, Haidian District, Beijing, 100191, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Li X, Yin Y, Zhang H. Nonlinear association between self-reported sleep duration and cognitive function among middle-aged and older adults in China: The moderating effect of informal care. Sleep Med 2024; 115:226-234. [PMID: 38377839 DOI: 10.1016/j.sleep.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Cognitive impairment is a major public health problem urgently to be solved. This study aims to examine the association between sleep duration and cognitive function and its two subdimensions: episodic memory and mental status, and to explore the moderating effects of informal care on these associations among middle-aged and older adults in China. METHODS Data was drawn from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, 2015 and 2018 datasets. Sleep duration and informal care were self-reported. Cognitive function was measured using CHARLS Harmonized Cognitive Assessment Protocol. Effects of informal care on sleep duration-cognitive function were assessed using Generalized Estimating Equations models. RESULTS The relationships between sleep duration and cognitive function, episodic memory, and mental status were all found to follow an inverted U-shaped pattern. Spouse care weakened the adverse effects of extreme sleep duration on cognitive function while the children care amplified them. Further, we only observed the moderating effects of spouse and children care on the association between sleep duration and episodic memory, but not mental status. CONCLUSIONS The relationships between sleep duration and cognitive function, along with its different dimensions, are nonlinear in nature. The impacts of sleep duration on cognitive function and its dimensions are contingent upon the levels of informal care received and the sources of that care. We provide valuable insights into the complex interplay between sleep duration, informal care, and cognitive function.
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Affiliation(s)
- Xuezhu Li
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yujie Yin
- Department of Management, Marketing and Information Systems, Hong Kong Baptist University, Hong Kong, 999077, China
| | - Hui Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Tian Y, Fan L, Zhou M, Du W. Impact of long-term care insurance on health inequality in older adults in China based on the concentration index approach. Int Health 2024; 16:83-90. [PMID: 37039047 PMCID: PMC10759298 DOI: 10.1093/inthealth/ihad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Several studies have shown that social security would reduce health inequalities. However, little was known about the relationship between long-term care insurance and health inequality. We aimed to evaluate the impact of long-term care insurance on health status and health inequality in older adults using a nationally representative cohort. METHODS Based on four waves of data from the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, 2015 and 2018), we used the staggered difference in difference (DID) design with the order probit regression models and the concentration index approach as well as decomposition analysis to assess the contribution of long-term care insurance towards residents' health status and health inequality in older adults aged ≥65 y. We further used the semi-parametric DID model for robustness testing. RESULTS Long-term care insurance demonstrated its role, improving self-assessed health in the study population (βcoefficient: 0.090, 95% CI 0.087 to 0.092, p<0.001). The estimation results of the semi-parametric DID were consistent with those of the staggered DID. The income-related health concentration index was 0.0005, having a contribution rate of 1.639% to health inequality in older adults. Decomposition analysis revealed that different policies and residential areas were more influential on the observed health inequalities. CONCLUSIONS The findings implied that long-term care insurance has widened the health inequality while improving health status in older adults. Additional investment in more comprehensive insurance coverage and increased accessibility to enhance implementation of long-term care insurance is warranted to close the gap.
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Affiliation(s)
- Yong Tian
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Lijun Fan
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Menghan Zhou
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Wei Du
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, 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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Liu H, Feng C, Yu B, Ma H, Li Y, Wu J, Dong B, Wang Z, Jia P, Dou Q, Yang S. Influences of long-term care insurance on pulmonary and urinary tract infections among older people with disability. J Am Geriatr Soc 2023; 71:3802-3813. [PMID: 37715571 DOI: 10.1111/jgs.18554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/05/2023] [Accepted: 07/26/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Pulmonary infection (PI) and urinary tract infection (UTI) have been the most common cause of hospitalization and most frequent infection respectively in older people with disability (OPWD). Long-term care insurance (LTCI) policy, intending to provide services to reduce the disease burden of OPWD, it remains unclear whether LTCI could reduce PI-, and UTI-related hospitalizations. This quasi-experimental study aimed to assess the influences of LTCI on all-cause, especially PI- and UTI-related hospitalizations among OPWD and the variation across sociodemographic characteristics. METHODS 32,120 participants in the Chengdu Long-term Care Insurance cohort were considered the intervention group, and 2,704 not covered by the LTCI were in the control group. A total of 3,134,160 hospitalization records were collected between January 2014 and June 2021. A doubly robust difference-in-differences (DID) method was used to estimate the average treatment effect on the treated (ATT), indicating the average effect of LTCI on intervention group. RESULTS The average monthly all-cause, PI-, and UTI-related hospitalization rates were 16.3%, 4.0% and 0.5% in the intervention group, respectively, and were 19.3%, 3.9% and 0.5% in the control group, respectively. Under LTCI, all-cause (ATT [95% CI]: 7.15% [6.41%, 7.88%]), PI- (3.25% [2.76%, 3.74%]), and UTI-related hospitalizations (0.46% [0.28%, 0.64%]) were decreased. The influences of LTCI became significant after 5 months since the LTCI implementation and remained stable over time. The impact was more pronounced among those with longer coverage. The overall reduction was stronger in those who were not married, lived alone, and resided in institutions. CONCLUSIONS LTCI may reduce the occurrence of all-cause, PI-, and UTI-related hospitalizations in OPWD, with stronger influences observed over an extended period of implementation. The implementation of LTCI can play a role in reducing the burden of infectious diseases in OPWD and the care burden of families and society.
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Affiliation(s)
- Hongyun Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chuanteng Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
| | - Hua Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuchen Li
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Geography, The Ohio State University, Columbus, Ohio, USA
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zihang Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- Hubei Luojia Laboratory, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
| | - Qingyu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China
- Respiratory Department, Chengdu Seventh People's Hospital, Chengdu, China
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Yi Y, Liu J, Jiang L. Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China. Front Public Health 2023; 11:1266949. [PMID: 37965517 PMCID: PMC10642179 DOI: 10.3389/fpubh.2023.1266949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures. Methods Using data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders. Results We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables. Conclusion This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.
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Affiliation(s)
| | | | - Ling Jiang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Xia C, Xu J, Ding X. Alienation from medical care policy, medical care avoidance, and the role of sex and risk perception. BMC Psychiatry 2023; 23:594. [PMID: 37582725 PMCID: PMC10428645 DOI: 10.1186/s12888-023-05104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Medical care avoidance affects individuals' health status. Previous studies on medical care avoidance have mainly focused on medical costs and people's satisfaction with medical services. This study investigates whether an individual's sense of policy alienation toward medical care policy (SPA-M) affects behavioral intention of medical care avoidance, and to what extent an intermediary variable-medical financial risk perception-mediates the relationship between SPA-M and medical care avoidance. METHODS A cross-sectional survey was conducted involving 434 people aged 35-59 years from Wuhu, a city in China's Anhui province. A moderated mediation model was constructed to investigate the research question and sex (biological: male and female) was used as a moderating variable between SPA-M and medical financial risk perception. RESULTS We found that SPA-M significantly impacted medical care avoidance, and that medical financial risk perception played a complete mediating role in this relationship, while sex moderated the relationship between SPA-M and medical financial risk perception. CONCLUSION This study contributes to the literature by enhancing our understanding of the factors that influence behavioral intention regarding medical care avoidance, deepening our understanding of the role of SPA-M in medical care policy, and expanding the role of sex differences in the analysis of the relationship between SPA-M, medical financial risk perception, and medical care avoidance, offering implications for public and community health.
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Affiliation(s)
- Chun Xia
- School of Educational Science, Anhui Normal University, Jiuhua-Nan-Road 189, Wuhu, Anhui Province, 241000, China
| | - Jia Xu
- School of Marxism, Anhui Normal University, Jiuhua-Nan-Road 189, Wuhu, Anhui Province, 241000, China.
| | - Xiuzhen Ding
- School of History, Anhui Normal University, Jiuhua-Nan-Road 189, Wuhu, Anhui Province , 241000, China
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14
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Lobanov-Rostovsky S, He Q, Chen Y, Liu Y, Wu Y, Liu Y, Venkatraman T, French E, Curry N, Hemmings N, Bandosz P, Chan WK, Liao J, Brunner EJ. Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people. BMC Public Health 2023; 23:1272. [PMID: 37391766 PMCID: PMC10311713 DOI: 10.1186/s12889-023-15583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/01/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. METHODS Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020. RESULTS Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. CONCLUSIONS China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.
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Affiliation(s)
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yuntao Chen
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Yuyang Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yanjuan Wu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Tishya Venkatraman
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Eric French
- Faculty of Economics, University of Cambridge, CB3 9DD Cambridge, UK
- Institute for Fiscal Studies, University of Cambridge, London, WC1E 7AE UK
| | - Natasha Curry
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Nina Hemmings
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Piotr Bandosz
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, 80-210 Poland
| | - Wing Kit Chan
- School of Government, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Eric John Brunner
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
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15
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Xu J, Tian G, Sun J, Liu J, Chen F, Shi Q, Zhang T, Zhang H, He J, Deng F, Zhang B, Wang H, Wu Q, Kang Z. Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018. Int J Equity Health 2023; 22:90. [PMID: 37194035 DOI: 10.1186/s12939-023-01908-4] [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: 07/06/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies. METHODS Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness. RESULTS From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years. CONCLUSIONS Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.
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Affiliation(s)
- Jinpeng Xu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Guomei Tian
- Department of Nuclear Medicine, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Jiale Sun
- Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Jian Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Fangting Chen
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qi Shi
- School of Health Management, Harbin Medical University, Harbin, China
| | - Ting Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Hongyu Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Jingran He
- School of Health Management, Harbin Medical University, Harbin, China
| | - Fangmin Deng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Bokai Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Haixin Wang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Zheng Kang
- School of Health Management, Harbin Medical University, Harbin, China.
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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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17
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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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18
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Different impact on health outcomes of long-term care insurance between urban and rural older residents in China. Sci Rep 2023; 13:253. [PMID: 36604590 PMCID: PMC9815686 DOI: 10.1038/s41598-023-27576-6] [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: 08/29/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Long-term care insurance (LTCI) is garnering attention internationally and is being considered a public policy in a growing number of countries. Previous research has focused on the effects of LTCI in developed countries, ignoring the health outcomes of developing countries, especially in rural regions. Therefore, this study investigates whether different impact on health outcomes is present in the effects of LTCI between urban and rural residents in China. We employed a quasi-experimental design with data from the China Health and Retirement Longitudinal Survey. The specific implementation time of each pilot city was sorted according to the LTCI policy texts, dividing these pilot cities into the treatment group and control group. Finally, difference-in-differences analyses were utilized to evaluate the health effects of LTCI between urban and rural residents, and the health effect in urban areas was further tested. The implementation of LTCI has effectively enhanced the self-rating health (SRH) of the entire group of residents; however, this effect may only be significant for the urban group. In particular, LTCI can increase the SRH of urban residents by 0.377 units compared to the urban residents without LTCI (P < 0.01). The result of the placebo effect test further verifies that LTCI could improve the health of residents to some extent. In China, LTCI may have triggered different impacts on health outcomes between urban and rural residents, and may not improve the SRH of rural residents and only prove efficacious for urban residents. Government and policy-makers should give more attention to the rural group as it needs long-term care the most.
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Chen H, Ning J. Public long-term care insurance scheme and informal care use among community-dwelling older adults in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6386-e6395. [PMID: 36254815 DOI: 10.1111/hsc.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
The public long-term care insurance (LTCI) scheme has been implemented in a few countries. Although the hypotheses of crowding-out, crowding-in and specialisation can facilitate our understanding of the relationship between LTCI and informal care use, existing studies may suffer from reverse causality. Employing a quasi-experimental design, this study examined the policy effect of LTCI on informal care use among community-dwelling older adults in China. Based on the data from three waves of the Chinese Longitudinal Healthy Longevity Survey, a staggered difference-in-differences (DID) with propensity score matching (PSM) approach was used to analyse the impact of LTCI on probability and hours of informal care use. The results showed that, for disabled older adults, LTCI reduced 43.3% of the probability and 82.4% of the weekly hours of informal care. LTCI also exhibited a spillover effect among nondisabled older adults through reducing the probability and weekly hours of informal care by 5.2% and 12.2%, respectively. Therefore, we argue that policymakers can consider rolling out the scheme for the entire country. Meanwhile, measures are needed to avoid a sharp decrease in informal care provision.
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Affiliation(s)
- He Chen
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Jing Ning
- School of Government, University of International Business and Economics, Beijing, China
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