Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge

Abstract

Background The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China’s public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. Methods This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. Results The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. Conclusion Some policy implications on the future development of China’s LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

“…This means older people in China need more long-term care services, and these services are facing greater challenges. Therefore, since 2016, China has implemented a long-term care insurance (LTCI) policy to relieve the problems created by population aging and associated issues in the healthcare system [ 3 ]. The LTCI is a pre-plot social insurance system among 15 selected cities in China, which provides basic life care and daily nursing services to the disabled and older adults, and also shares the nursing expenses incurred by people who cannot take care of themselves due to chronic diseases or physical and psychological disability [ 3 , 4 ].…”

Reimagining Financing and Payment of Long-Term Care

“…3 Although the full effect of these programs on access, quality, equity, and costs of care is difficult to assess comprehensively, recent reviews have found that public LTC systems generally improve the health and life quality of older adults and may help alleviate the financial burden of LTC on families, though the evidence is mixed. 4 In the United States, we lack a comprehensive approach to financing LTC.…”

“…Numerous models for this exist in other countries. 4 Some countries structure benefits to encourage the use of family care, paying family caregivers and providing them with training and other supports; most cover a wide variety of HCBS; and most structure benefits to discourage the use of nursing home care unless it is the only option. To avoid overuse, assessments can continue to be required to establish the level of severity, similar to existing requirements in Medicaid.…”

Is long-term care a building or a societal moral philosophy?

“…18 Other countries (e.g., Germany) introduced mandatory insurance policies for the LTC needs of the population. 20 Both models follow autonomy principles to include individuals (or caregivers) in their care plans and have provisions of a monthly allowance to OAs for their care needs. 21…”