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Chen S, Li L, Jiao L, Gong S, Wang Z, Liu H, Geldsetzer P, Yang J, Barnighausen T, Wang C. Long-term care insurance in China: Current challenges and recommendations. J Glob Health 2024; 14:03015. [PMID: 39325928 PMCID: PMC11426933 DOI: 10.7189/jogh.14.03015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Affiliation(s)
- Simiao Chen
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Linye Li
- Chinese Academy of Social Sciences, Beijing, China
| | - Lirui Jiao
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sen Gong
- Center for International Knowledge on Development, Beijing, China
| | - Zhuoran Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, California, USA
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Till Barnighausen
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- National Clinical Research Centre for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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Wang L, Sun R, Tian L, Xu RH. Influence of age on financial toxicity in cancer patients. Asia Pac J Oncol Nurs 2024; 11:100552. [PMID: 39220148 PMCID: PMC11362785 DOI: 10.1016/j.apjon.2024.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 09/04/2024] Open
Abstract
Objective The aim of this study was to assess the level of financial toxicity (FT) experienced by the following three age groups of cancer patients in China: young working-aged patients (age < 40 years), middle-aged patients (40-64 years), and older patients (≥ 65 years). Methods The data used for this study were collected via a cross-sectional survey conducted in China. FT was assessed using the Comprehensive Score for Financial Toxicity (COST). ANOVA was used to examine the differences in FT status between age groups. Multivariate linear regression models were employed to assess the association between age and FT, adjusted by socioeconomic and other clinical characteristics. Results A total of 556 cancer patients completed the survey. Approximately 54.3% of the participants were male and 45.7% were female. The majority (61.5%) were aged 40-64 years, while 27.7% were aged 65 or older. The mean FT scores for young patients (< 40 years), middle-aged patients (40-64 years), and older patients (≥ 65 years) were 16.7, 12.8, and 12.4, respectively. The results of the regression analysis revealed that, without adjusting for background characteristics, young patients had significantly higher mean COST scores. This suggests they experienced lower levels of FT compared to patients in other age groups. Stratified analysis revealed that, for older patients, only educational level and type of insurance scheme were significant factors in predicting the COST score. Conclusions This study provides empirical evidence for developing targeted interventions and policies to reduce the FT for patients in different age groups. Given that FT is complicated, a longitudinal study should be conducted to explore the long-term impact of FT on cancer patients' quality of life and well-being.
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Affiliation(s)
- Lingling Wang
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
- Department of Blood Transfusion Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Ruiqi Sun
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Lidan Tian
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Tang R, Zhang X, Yan S, Guan B, Li Y, Luo Q, Lai R, Wan H, Yang Y, Zeng L. Assistive device utilization among disabled elderly in China: A cross-sectional study. Public Health Nurs 2024; 41:653-663. [PMID: 38652371 DOI: 10.1111/phn.13329] [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: 12/18/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This study aimed to examine the characteristics of assistive device users and influencing factors among disabled elderly in China. METHODS A total of 13,510 disabled elderly in Sichuan Province were surveyed. Disability was assessed using the Barthel Activities of Daily Living Scale, mental status, sensory perception, and social engagement evaluation. Univariate analysis and logistic regression analysis were employed to identify the impact factors. RESULTS The prevalence of assistive device utilization among participants was 79.2% (10,700/13,510, 95% CI 78.5%-79.9%), with the wheelchair being the most commonly used device. Various factors were found to influence the usage of the device, including disability level, somatic disability, age, caregivers, income, caregiver fees, and living situation (p < .05). Additionally, several factors were identified associated with the frequency of device usage, such as somatic disability, education background, income, caregiver fees, living situation, access to acquire assistive devices, duration of assistive device usage, education on assistive devices, and satisfaction level (p < .05). CONCLUSIONS The use of assistive devices among elderly individuals in China is prevalent. There are many factors that affect the use of assistive devices, which can provide a reference for the formulation of policies in the field of assistive devices.
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Affiliation(s)
- Rong Tang
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Xia Zhang
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Shu Yan
- Medical Affairs Department, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Bi Guan
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yan Li
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Qing Luo
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Rongmei Lai
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Haiyan Wan
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yongxue Yang
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Liangnan Zeng
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, 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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Chen S, Li L, Jiao L, Wang C. Long-term care insurance and the future of healthy aging in China. NATURE AGING 2023; 3:1465-1468. [PMID: 38093139 DOI: 10.1038/s43587-023-00540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Linye Li
- Chinese Academy of Social Sciences, Beijing, China
| | - Lirui Jiao
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 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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Ye X, Hu M, Lin H. Effects of the Long-term Care Insurance on Health Among Older Adults: A Panel Data From China. Int J Health Policy Manag 2023; 12:7664. [PMID: 38618818 PMCID: PMC10590242 DOI: 10.34172/ijhpm.2023.7664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 08/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND China's long-term care insurance (LTCI) has been launched since 2016 to ensure that older disabled people obtain affordable care services. However, rigorous evaluations of the health effects of China's LTCI pilots have been limited. This paper aimed to examine the effects of LTCI on health among older adults aged 60 years and above. METHODS Drawing from panel data of the China Health and Retirement Longitudinal Study (CHARLS), we used a propensity score matching (PSM) and difference-in-difference (DID) approach to identify the health effects of the LTCI program and reduce the selection bias. Further, heterogeneity of the effects was examined by physical and intellectual function to evaluate whether the effects differed among subgroups of older population. RESULTS The implementation of LTCI significantly improved self-rated health (β = 0.15, P<.05) and cognitive function (β = 0.59, P<.01) for older adults. The results were robust when keeping only those living in pilot cities (β = 0.31, P<.05 for self-rated health status; β = 0.98, P<.001 for cognitive function) or non-pilot cities (β = 0.14, P<.05 for self-rated health status; β = 0.60, P<.01 for cognitive function) as the control group. The effects of LTCI were especially manifested in older adults with physical disability (β = 0.13, P<.01 for self-rated health; β = 0.76, P<.001 for cognitive function) or intellectual disability (β = 0.16, P<.01 for self-rated health). CONCLUSION From a policy perspective, these findings suggested that LTCI in China could benefit the health outcomes of older adults, especially those with physical or cognitive disabilities. Policy-makers can target resources more effectively to improve health outcomes for the most vulnerable populations.
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Affiliation(s)
- Xin Ye
- Institute for Global Public Policy, Fudan University, Shanghai, China
- LSE-Fudan Research Centre for Global Public Policy, Fudan University, Shanghai, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hugo Lin
- CentraleSupélec, Paris-Saclay University, Paris, France
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Yucen W, Min C. Ethical value and challenges of long-term care insurance. Nurs Ethics 2023; 30:222-231. [PMID: 36287031 DOI: 10.1177/09697330221128905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Issues of the aging population and disability of older persons have been rapidly developing in China over the past 20 years. Since 2016, the Chinese government has been exploring remedies to alleviate social and family burdens and ensure the dignity of the disabled old persons by implementing long-term care insurance systems in a few pilot cities across the country. PURPOSE The purpose of this study is to present the current challenges faced by China's long-term care insurance system and put forth suggestions for the future, based on literature research and the feedback obtained from its implementation in pilot areas. RESEARCH DESIGN This paper conducts a theoretical study based on the principles of public health ethics. STUDY SAMPLE Since 2016, China has launched two batches of pilot cities for long-term care insurance. The analysis object of this study is the feedback on the policy implementation of the existing 29 pilot cities that participated. The relevant data involved in the analysis are from the authors' field research and published literature on the analysis of pilot cities. ANALYSIS The ethical value and importance of long-term care insurance policies in China are evaluated from the perspectives of policy philosophy and social individual interests. RESULTS The results of this evaluation show that the core ethical values were not met in the development of China's current long-term care insurance system. Moreover, distributive justice norms were neglected, and access to the system between different social groups and within the groups covered by it was unequal. CONCLUSIONS This paper argues that long-term care insurance should not differentiate between urban and rural areas in allocating nursing resources. Additionally, it would be essential to build democratic supervision and manage public opinions by adopting open and transparent information-sharing policies. Standards of disability assessments and treatment payment should be at par to ensure a balance between the rights and obligations of policyholders.
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Affiliation(s)
- Weng Yucen
- Research Centre for Medical Humanities, Fujian Medical University, Fujian, China
| | - Chen Min
- Research Centre for Medical Humanities; Health Research Institute, 74551Fujian Medical University, Fujian, China
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Che RP, Cheung MC. Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11626. [PMID: 36141900 PMCID: PMC9517182 DOI: 10.3390/ijerph191811626] [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: 08/24/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults' intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults' intended use of long-term care and contribute to the delivery of appropriate care services by public policy.
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