Impact of Formal Care Use on Informal Care from Children after the Launch of Long-Term Care Insurance in Shanghai, China

Zhang, Huimin; Zhang, Xiaoyi; Zhao, Youhua; Huang, Jianfeng; Liu, Wenwei

doi:10.3390/ijerph17082938

Cited by 13 publications

(21 citation statements)

References 22 publications

(29 reference statements)

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“…In addition, on the effect of China’s LTCI policy, scholars have mainly focused on the economic effect. Moreover, as the policy beneficiary groups in the pilot areas are mainly severely disabled individuals, [ 36 , 37 ] ignored the health effect of LTCI policy, and the improvement of health quality is one of the most direct objectives of LTCI. Therefore, we consider the first batch of national LTCI pilot areas as the main study body, based on the three phases tracking survey data of China Health and Retirement Longitudinal Study (CHARLS).…”

Section: Literature Reviewmentioning

confidence: 99%

Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China

Liu

2022

Arch Public Health

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Background Since the national long-term care (LTCI) policy pilot in 2016 of China, the LTCI policy has had significant impact on the residents in the pilot area. Methods From the perspective of medical expenses and health security equity, this study selects tracking survey data from the CHARLS database in 2013, 2015, and 2018 and empirically investigates the effect of LTCI policy pilot by using differences-in-differences method (DID). Moreover, this study measures the economic distribution and health equity of the treated and untreated groups using the concentration and Theil indices. Results The results showed that group heterogeneity of medical expenses and health level of elderly in the treatment group were narrowing. Moreover, the policy results showed that the LTCI policy pilot significantly affects the outpatient, hospital expenses, and length of stay of elders. Residence registration, income level, and basic medical insurance play a significant regulatory role. Additionally, LTCI policy pilot significantly improved the overall health of the elderly. Conclusions The measurement results of inequality show that the policy increases the income of low-income people, lowers the inequality level of outpatient and inpatient reimbursement, and reduces the concentration index of ADL disability and serious diseases. However, the inequality of serious diseases is becoming higher. Based on this, this paper provides several suggestions on optimizing the pilot policy of LTCI.

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Section: Literature Reviewmentioning

confidence: 99%

Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China

Liu

2022

Arch Public Health

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“…Zhang et al (2020) 39 conducted an interview-based survey to study the impact of LTCI on informal care in Shanghai. LTCI was associated with a reduction of a weekly average of 12.36 hours of informal care (including household activities of daily living [HDL] tasks, activities of daily living [ADL] tasks, instrumental activities of daily living [IADL] tasks and supervision tasks) in 407 families.…”

Section: Resultsmentioning

confidence: 99%

“…CNKI=China National Knowledge Infrastructure Based on these comprehensive criteria, six studies which all used regression analysis and had a sample size less than 10,000 participants were rated low evidence quality, including Qi et al ( 2019), 37 Zhang et al (2020), 39 Zhang et al ( 2019), 40 Chen et al (2020), 41 Dai et al ( 2019), 42 and Zhang (2019). 43 Two studies, Feng et al (2020) 36 and Ma et al (2019), 38 were classified as having medium evidence quality as they utilized a difference-in-differences design and had a sample size greater than 10,000 participants.…”

Section: Figure 1 Systematic Review Study Selection Flow Diagrammentioning

confidence: 99%

The impact of long-term care insurance in China on beneficiaries and caregivers: A systematic review

Chen

Yang

et al. 2021

Journal of Global Health Economics and Policy

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Background China’s long-term care insurance (LTCI) policy has been minimally evaluated. This systematic review aimed to assess the impact of China’s LTCI pilot on beneficiaries and their caregivers. Methods This review is based on a search of peer-reviewed studies in English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases from January 2016 through July 2020, with all studies published in English or Chinese included. We included quantitative analyses of beneficiary-level data that assessed the impact of LTCI on beneficiaries and their caregivers, with no restriction placed on the outcomes studied. Results Nine studies met our inclusion criteria. One study was a randomised trial and two used quasi-experimental approaches. Four studies examined LTCI’s effect on beneficiaries’ quality of life, physical pain, and health service utilisation; one study reported the effect on beneficiaries’ healthcare expenditures; and one study evaluated the impact on caregivers’ care tasks. These studies generally found LTCI to be associated with an improvement in patients’ quality of life (including decreased physical pain), a reduction in the number of outpatient visits and hospitalisations, decreased patient-level health expenditures (e.g. one study reported a reduction in the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0%, 17.7%, and 11.4%, respectively), and reduced informal care tasks for caregivers. In addition, four out of four studies that evaluated this outcome found that beneficiaries’ overall satisfaction with LTCI was high. Conclusion The current evidence base for the effects of LTCI in China on beneficiaries and their caregivers is sparse. Nonetheless, the existing studies suggest that LTCI has positive effects on beneficiaries and their caregivers. Further rigorous research on the impacts of LTCI in China is needed to inform the future expansion of the program.

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“…To date, only two studies have examined the policy effect on informal care use in China (Lei et al, 2022; Zhang et al, 2020). Zhang et al (2020) found that each additional hour of formal care provided by the LTCI brought about a reduction of 0.47 hours of informal care in Shanghai City, China. As the study was based on retrospective data and did not have a control group, it could not exclude changes in informal care use caused by unobserved factors, such as positive attitudes toward formal care.…”

Section: Formal and Informal Care: A Literature Reviewmentioning

confidence: 99%

Public long‐term care insurance scheme and informal care use among community‐dwelling older adults in China

Chen

Ning

2022

Health Social Care Comm

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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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Impact of Formal Care Use on Informal Care from Children after the Launch of Long-Term Care Insurance in Shanghai, China

Cited by 13 publications

References 22 publications

Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China

Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China

The impact of long-term care insurance in China on beneficiaries and caregivers: A systematic review

Public long‐term care insurance scheme and informal care use among community‐dwelling older adults in China

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