Assessing the Sustainability of Long-Term Care Insurance Systems Based on a Policy–Population–Economy Complex System: The Case Study of China

Abstract

Although China launched long-term care insurance (LTCI) pilot program in 2016, there are great challenges associated with developing a sustainable LTCI system due to limited financial resources and a rapid increase in the aging population. This study constructed an LTCI policy–population–economics (PPE) system to assess the sustainability of the LTCI system in China. Based on the latest 76 LTCI policy documents published between 2016 and 2021, this study evaluated the strength of LTCI policy modeling in 14 pilot cities by constructing a policy modeling consistency (PMC) index containing 9 main variables and 36 sub-variables. The coupling coordination model was used to evaluate the interaction between LTCI policy, population aging, and economic development. The results showed that the PMC index ranged from 0.527 to 0.850. The policy strength of Qingdao, Nantong, and Shanghai was the highest (PMC > 0.8). Anqing, Qiqihaer, Chongqing, and Chengdu had the lowest level of policy strength (PMC < 0.6). The main policy weaknesses were the coverage of the LTCI, the sources of funds, the scope of care services, and benefit eligibility. The coupling coordination degree of PPE systems varied from 0.429 to 0.921, with a mean of 0.651. Shanghai, Nantong, and Suzhou had the highest level of coordination. The coordination between subsystems of PPE in most pilot cities (12 of 14 cities) was at a basic or low level. The findings from this study concluded that the coordination within the PPE system should be improved to develop a sustainable LTCI system. To improve the coordination of the PPE system, it is suggested that the country should maintain sustainable economic growth and modify LTCI policies based on demographic transitions and economic development.

Public trust in the long-term care insurance pilot program in China: An analysis of mediating effects

“…Although the Chinese government has been determined to make the LTCI the “sixth insurance” of the social security system, only a small fraction of adult populations have been covered through the pilot program ( 7 ). In addition, there are many persistent issues in the supervision and management of the system ( 9 , 13 ). That is to say, existing problems in the delivery of the long-term care services may affect the public's opinion with regard to the fairness and accessibility of the insurance and hinder people's willingness to evaluate the program in a positive way.…”

“…As a new insurance program in China, the construction of LTCI is based on the current status of economic development and population aging ( 6 , 9 ). The Chinese government has adopted a path from pilot testing to implementation in order to build a LTCI system at a national level ( 13 ). In the process of piloting, the public's knowledge and understanding of LTCI have gradually improved, forming psychological anticipations for the LTCI system.…”

“…Specifically, this study analyzed the complex relationships among insurance awareness, satisfaction, and trust in the LTCI pilot program based on the pilot city Guangzhou. Guangzhou is different from some of the other pilot cities—such as Shanghai and Qingdao—because the city has a lower proportion of aging population and a higher level of economic development in comparison to most other participating sites ( 13 ). The pilot program in Guangzhou was initiated in 2017.…”

“…Compared with most pilot cities that only cover the individuals with severe disability, Guangzhou's LTCI program has a broader coverage. It covers all disabled persons and those with moderate and severe dementia ( 13 ). The reimbursement rate is among the highest in the pilot cities.…”

Integrating Health and Care for Older People in China: What Has Been Accomplished? What is Next?

“…The third is lack of evidence-based protocols and standards for care integration. As China's integrated care delivery system is in its early stage, the protocols and guidelines for care integration are extremely sparce, especially the guidelines for proactive interventions towards healthy and mildly disabled elderly [19]. Although there are international guidelines and protocols such as WHO's ICOPE approach, they are not fully validated and implemented in China [20].…”