Health status, care needs, and assessment for beneficiaries with or without dementia in a public long-term care insurance pilot in Guangzhou, China

Abstract

Background Chinese government launched a pilot study on public long-term care insurance (LTCI) recently. Guangzhou is one of the fifteen pilot cities, officially started providing LTCI in August 2017. An in-depth analysis of experimental data from the pilot city may provide suggestions for developing a fair and effective LTCI system. This study aimed to evaluate the LTCI pilot by exploring the characteristics and care needs of claimants, and performance of the assessment tool. Methods A retrospective cross-sectional study in which claims data between July 2018 and March 2019 in the Guangzhou pilot was analyzed. LTCI claimants during the study period were included. The care needs were determined based on claimants’ physical function assessed by the Barthel Index and their medical conditions. Rasch analysis was used to explore the performance of the Barthel Index. Results Among 4810 claimants included, 4582 (95.3%) obtained LTCI benefits. Of these beneficiaries, 4357 (95.1%) were ≧ 60 years old, and 791 (17.3%) had dementia. Among 228 (4.7%) unsuccessful claimants, 22 (0.5%) had dementia. The prevalence of stroke was high in beneficiaries with (38.1%) or without dementia (56.6%), as well as in unsuccessful claimants with (40.9%) or without dementia (52.4%). Beneficiaries without dementia needed more support for basic activities of daily living and nursing care than those with dementia, while beneficiaries with dementia were more likely to be institutionalized. Five (22.7%) unsuccessful claimants with dementia and 48 (23.3%) unsuccessful claimants without dementia were disabled in at least two basic self-care activities. Regarding Barthel Index, Rasch analysis showed threshold disordering in “mobility” and “climbing stairs”, and the narrow interval was observed between all the adjacent categories of the ten items (< 1.4 logits). Conclusions Stroke and dementia were two common reasons for needing long-term care in LTCI claimants. The Barthel Index is not suitable for assessing and dividing LTCI claimants, because of inappropriate items and narrow category responses. A comprehensive assessment and grading system is required, together with needs-led care services. The eligibility should be expanded gradually based on balance finance solutions.

Factors Associated with the Adult Children’s Willingness to Utilize Elderly Medical Escort Service for Outpatient Visit In China: A Mixed-methods Research

“…People familiar with the hospital consultation process could provide services for the elderly with the stable condition and self-care abilities; nursing students and interns, a group with certain medical professional knowledge after training, could accompany the elderly with the stable condition and semi-disabled to the consultation; the elderly with more semidisabled and disabled with the serious condition could be accompanied by nurse practitioners with clinical work experience. Hence, a comprehensive assessment and grading system is required, together with needs-led EMES [32].…”

Utilizing Consumer-Directed Care Among Older Adults: Identifying Barriers From Behavioral Economics Perspectives

“…Of the few studies to uncover barriers to accessing LTCI in Guangzhou, Wu et al (2020) found that people with dementia failed to apply for LTCI benefits because the need assessment tool, that is, the Barthel index, did not assess claimants' cognitive impairments. Additionally, Zhang et al (2021) suggested that permitting people to control and direct services and providing more information and support might increase service utilization in Guangzhou.…”

Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality

“…Retired people, people who had not made prior contributions to LTCI, and people suffering long-term functional disabilities (six months or more), can receive LTCI benefits if they previously had medical insurance. 11 …”

“…In contrast, public LTCI may have protective effects on health, particularly for vulnerable individuals (such as those with chronic conditions) as the policy aims for inclusivity and social effectiveness by offering basic care provision and longer-term services and supports. 11 …”