IDEAS home Printed from https://ideas.repec.org/a/bla/ijhplm/v40y2025i3p646-654.html

Does Long‐Term Care Insurance Release the Unmet Long‐Term Care Needs and Promote Long‐Term Care Services? A Quasi‐Experimental Study in China

Author

Listed:
  • Liangwen Zhang
  • Sicheng Li
  • Ya Fang

Abstract

Objective Long‐term care insurance (LTCI) is a widely adopted approach to address the growing long‐term care (LTC) needs associated with ageing. Little is known about its effect on unmet LTC needs among different LTC populations in China. This study explored the effect of LTCI pilot programs on unmet LTC needs and their pathways among different LTC need populations in China. Methods Data were derived from the China Health and Retirement Longitudinal Study 2013, 2015, and 2018. Difference‐in‐Difference methods were used to estimate the impact of LTCI on unmet LTC needs and informal LTC services. According to the degree of ADL or IADL needs, participants were categorised into broad, intermediate, and narrow LTC need populations. Results The unmet LTC needs increased in both broad, intermediate, and narrow LTC need populations, while informal LTC hours received decreased for the intermediate and narrow LTC need populations. Informal LTC was identified as a mediator, contributing to increased unmet LTC needs. With LTCI coverage, heterogeneity analysis showed a direct effect, resulting in a 72.1% reduction in informal LTC hours without an increase in unmet LTC needs. Additionally, a spillover effect led to a 35.7% reduction in informal LTC hours and an average increase of 0.133 unmet needs. Conclusions With the inadequate formal LTC services, the LTCI implementation decreased the informal LTC provision and further increased the unmet LTC needs in almost all LTC need populations. Only for individuals with severe disabilities LTCI effectively substituted the informal LTC provided by families. The government needs to improve the quality of formal LTC services to avoid increasing unmet LTC needs.

Suggested Citation

  • Liangwen Zhang & Sicheng Li & Ya Fang, 2025. "Does Long‐Term Care Insurance Release the Unmet Long‐Term Care Needs and Promote Long‐Term Care Services? A Quasi‐Experimental Study in China," International Journal of Health Planning and Management, Wiley Blackwell, vol. 40(3), pages 646-654, May.
    • Handle: RePEc:bla:ijhplm:v:40:y:2025:i:3:p:646-654
    DOI: 10.1002/hpm.3907
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hpm.3907
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hpm.3907?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Afridi, Farzana & Li, Sherry Xin & Ren, Yufei, 2015. "Social identity and inequality: The impact of China's hukou system," Journal of Public Economics, Elsevier, vol. 123(C), pages 17-29.
    2. Chen, Lu & Fan, Hongli & Chu, Lanlan, 2019. "The hidden cost of informal care: An empirical study on female caregivers' subjective well-being," Social Science & Medicine, Elsevier, vol. 224(C), pages 85-93.
    3. Kim, Hongsoo & Kwon, Soonman, 2021. "A decade of public long-term care insurance in South Korea: Policy lessons for aging countries," Health Policy, Elsevier, vol. 125(1), pages 22-26.
    4. Manuela Angelucci & Giacomo De Giorgi, 2009. "Indirect Effects of an Aid Program: How Do Cash Transfers Affect Ineligibles' Consumption?," American Economic Review, American Economic Association, vol. 99(1), pages 486-508, March.
    5. Kang, Lili & Zhao, Guangchuan, 2022. "Financial support for unmet need for personal assistance with daily activities: Implications from China's long-term care insurance pilots," Finance Research Letters, Elsevier, vol. 45(C).
    6. Bruce Hollingsworth & Asako Ohinata & Matteo Picchio & Ian Walker, 2022. "The Impacts of Free Universal Elderly Care on the Supply of Informal Care and Labour Supply," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 84(4), pages 933-960, August.
    7. Feng, Jin & Wang, Zhen & Yu, Yangyang, 2020. "Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China," Social Science & Medicine, Elsevier, vol. 258(C).
    8. Elsa Perdrix & Quitterie Roquebert, 2022. "Does the amount of formal care affect informal care? Evidence among over-60s in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(3), pages 453-465, April.
    9. Huimin Zhang & Xiaoyi Zhang & Youhua Zhao & Jianfeng Huang & Wenwei Liu, 2020. "Impact of Formal Care Use on Informal Care from Children after the Launch of Long-Term Care Insurance in Shanghai, China," IJERPH, MDPI, vol. 17(8), pages 1-10, April.
    10. Zhu, Yumei & Österle, August, 2017. "Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status," Social Science & Medicine, Elsevier, vol. 191(C), pages 30-37.
    11. Bonsang, Eric, 2009. "Does informal care from children to their elderly parents substitute for formal care in Europe?," Journal of Health Economics, Elsevier, vol. 28(1), pages 143-154, January.
    12. Wei Huang & Chuanchuan Zhang, 2021. "The Power of Social Pensions: Evidence from China's New Rural Pension Scheme," American Economic Journal: Applied Economics, American Economic Association, vol. 13(2), pages 179-205, April.
    13. Siyuan Cao & Huiyuan Xue, 2023. "The impact of long‐term care insurance system on family care: Evidence from China," International Journal of Health Planning and Management, Wiley Blackwell, vol. 38(5), pages 1435-1452, September.
    14. Christophe Courbage & Guillem Montoliu-Montes & Joël Wagner, 2020. "The effect of long-term care public benefits and insurance on informal care from outside the household: empirical evidence from Italy and Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1131-1147, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lei, Xiaoyan & Bai, Chen & Hong, Jingpeng & Liu, Hong, 2022. "Long-term care insurance and the well-being of older adults and their families: Evidence from China," Social Science & Medicine, Elsevier, vol. 296(C).
    2. Fu, Liping & Wang, Ruizhen & He, Chaoying, 2025. "Gender differences in later life: Labor supply responses to spousal disability," Social Science & Medicine, Elsevier, vol. 366(C).
    3. Han, Xiao & Liu, Zining & Zheng, Wei, 2025. "Does public long-term care insurance affect spousal labor supply? Evidence from China," Economic Modelling, Elsevier, vol. 153(C).
    4. Ofek-Shanny, Yuval & Strulov-Shlain, Avner & Zeltzer, Dan, 2025. "Impacts of home-care subsidies: Evidence from quasi-random assignment," Journal of Public Economics, Elsevier, vol. 248(C).
    5. Luo, Yanan & Yuan, Kexin & Li, Yuxiao & Liu, Yating & Pan, Yao, 2024. "The “spillover effect” of long-term care insurance in China on spouses’ health and well-being," Social Science & Medicine, Elsevier, vol. 340(C).
    6. Xueqin Deng & Jiaxin Liao & Rong Peng & Jiahao Chen, 2022. "The Impact of Long-Term Care Insurance on Medical Utilization and Expenditures: Evidence from Jingmen, China," IJERPH, MDPI, vol. 19(19), pages 1-18, September.
    7. Guo, Miao & Li, Yang & Zhang, Wendan, 2025. "Supply expansion of Long-Term Services & Supports: Evidence from China’s long-term care insurance pilot," Journal of Economic Behavior & Organization, Elsevier, vol. 239(C).
    8. Rapp, Thomas & Ronchetti, Jérome & Sicsic, Jonathan, 2022. "Impact of formal care consumption on informal care use in Europe: What is happening at the beginning of dependency?," Health Policy, Elsevier, vol. 126(7), pages 632-642.
    9. Jiayi Wen & Xiaoqing Yu, 2024. "Insuring Long-Term Care in Developing Countries: The Interaction between Formal and Informal Insurance," Papers 2408.14243, arXiv.org.
    10. repec:wly:hlthec:v:33:y:2024:i:12:p:2778-2797 is not listed on IDEAS
    11. Lin, Lin & He, Min & Nie, Peng, 2025. "Direct and spillover effects of long-term care insurance on Chinese elderly frailty," The Journal of the Economics of Ageing, Elsevier, vol. 31(C).
    12. Miao Guo & Yang Li & Minghao Wu & Terence C. Cheng, 2024. "Services and Cash: How Long-term Care Insurance Benefit Design Affects Household Behavior in China," Papers 2024-13, Centre for Health Economics, Monash University.
    13. Marie Blaise & Laetitia Dillenseger, 2023. "Informal Caregivers and Life Satisfaction: Empirical Evidence from the Netherlands," Journal of Happiness Studies, Springer, vol. 24(6), pages 1883-1930, August.
    14. Liangwen Zhang & Jinghong Dong & Sicheng Li & Ya Fang, 2026. "The effect of long-term care insurance on labor force participation among informal caregivers: evidence from China," Humanities and Social Sciences Communications, Palgrave Macmillan, vol. 13(1), pages 1-11, December.
    15. Hollingsworth, Bruce & Ohinata, Asako & Picchio, Matteo & Walker, Ian, 2022. "Does It Matter Who Cares for You? The Effect of Substituting Informal with Formal Personal Care on the Care Recipients' Health," IZA Discussion Papers 15457, IZA Network @ LISER.
    16. Kim, Seung Hoon & Park, Eun-Cheol & Jang, Suk-Yong, 2023. "Impact of long-term care insurance on medical costs and utilization by patients with Parkinson's disease," Social Science & Medicine, Elsevier, vol. 317(C).
    17. Huan Liu, 2021. "Formal and Informal Care: Complementary or Substitutes in Care for Elderly People? Empirical Evidence From China," SAGE Open, , vol. 11(2), pages 21582440211, May.
    18. Liu, Hong & Ma, Jinqiu & Zhao, Liqiu, 2023. "Public long-term care insurance and consumption of elderly households: Evidence from China," Journal of Health Economics, Elsevier, vol. 90(C).
    19. Ren, Junqiushi & Xiong, Deyin, 2023. "Do social assistance programs promote the use of clean cooking fuels? Evidence from China's new rural pension scheme," Energy Policy, Elsevier, vol. 182(C).
    20. Christophe Courbage & Guillem Montoliu-Montes & Joël Wagner, 2023. "On children’s motives to influence parents’ long-term care insurance purchase: evidence from Switzerland," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 48(1), pages 102-129, January.
    21. Sean Urwin & Yiu‐Shing Lau & Gunn Grande & Matt Sutton, 2023. "Informal caregiving, time use and experienced wellbeing," Health Economics, John Wiley & Sons, Ltd., vol. 32(2), pages 356-374, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ijhplm:v:40:y:2025:i:3:p:646-654. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0749-6753 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.