IDEAS home Printed from https://ideas.repec.org/a/eee/ehbiol/v58y2025ics1570677x25000280.html

Evaluating the impact of long-term care insurance reform on health-related quality of life and inequality among older adults in China: A quasi-experimental analysis

Author

Listed:
  • Lin, Lin
  • He, Min
  • Zai, Xianhua

Abstract

Less is known about whether and to what extent Long-Term Care Insurance (LTCI) promotes the Health-Related Quality of Life (HRQoL) of older individuals, a vital health outcome for healthy aging. This study utilizes longitudinal data from CHARLS and employs the widely-used EQ-5D-3L method to measure HRQoL. Using the LTCI pilot-which has been implemented in a staggered manner since 2012-as a quasi-experiment, we apply a difference-in-differences approach and find that LTCI increases the HRQoL of older adults aged 60 and older by 1.5%–2% and those aged 70+ by 3.3%. These results suggest that the public LTCI reform in China enhances the HRQoL for the older individuals but only to a relatively modest degree. This minor improvement in HRQoL is primarily driven by increased utilization of formal care, reduced financial strain due to decreased medical expenses, and increased psychological well-being. However, we also find that the current LTCI reform, which mainly targets urban employees and residents, inadvertently exacerbates the urban-rural disparity in HRQoL of older adults.

Suggested Citation

  • Lin, Lin & He, Min & Zai, Xianhua, 2025. "Evaluating the impact of long-term care insurance reform on health-related quality of life and inequality among older adults in China: A quasi-experimental analysis," Economics & Human Biology, Elsevier, vol. 58(C).
    • Handle: RePEc:eee:ehbiol:v:58:y:2025:i:c:s1570677x25000280
    DOI: 10.1016/j.ehb.2025.101495
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S1570677X25000280
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.ehb.2025.101495?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
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Pieter Bakx & Claudine de Meijer & Frederik Schut & Eddy van Doorslaer, 2015. "Going Formal or Informal, Who Cares? The Influence of Public Long‐Term Care Insurance," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 631-643, June.
    2. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    3. Masaki Takahashi, 2023. "Insurance coverage, long-term care utilization, and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(8), pages 1383-1397, November.
    4. Hilary Hoynes & Doug Miller & David Simon, 2015. "Income, the Earned Income Tax Credit, and Infant Health," American Economic Journal: Economic Policy, American Economic Association, vol. 7(1), pages 172-211, February.
    5. Manasi Deshpande & Yue Li, 2019. "Who Is Screened Out? Application Costs and the Targeting of Disability Programs," American Economic Journal: Economic Policy, American Economic Association, vol. 11(4), pages 213-248, November.
    6. Jingyi Wang & Jing Guan & Guojun Wang, 2023. "Impact of long‐term care insurance on the health status of middle‐aged and older adults," Health Economics, John Wiley & Sons, Ltd., vol. 32(3), pages 558-573, March.
    7. Kim, Hoolda & Mitra, Sophie, 2022. "The Economic and Health Effects of Long-Term Care Insurance: New Evidence from Korea," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    8. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    9. Doruk Cengiz & Arindrajit Dube & Attila Lindner & Ben Zipperer, 2019. "The Effect of Minimum Wages on Low-Wage Jobs," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(3), pages 1405-1454.
    10. Suzi Claflin & Julie A. Campbell & Richard Norman & Deborah F. Mason & Tomas Kalincik & Steve Simpson-Yap & Helmut Butzkueven & William M. Carroll & Andrew J. Palmer & C. Leigh Blizzard & Ingrid van d, 2023. "Using the EQ-5D-5L to investigate quality-of-life impacts of disease-modifying therapy policies for people with multiple sclerosis (MS) in New Zealand," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 939-950, August.
    11. 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).
    12. Martha J. Bailey & Andrew Goodman-Bacon, 2015. "The War on Poverty's Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans," American Economic Review, American Economic Association, vol. 105(3), pages 1067-1104, March.
    13. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    14. Cl'ement de Chaisemartin & Xavier D'Haultf{oe}uille, 2020. "Difference-in-Differences Estimators of Intertemporal Treatment Effects," Papers 2007.04267, arXiv.org, revised May 2026.
    15. 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).
    16. Korfhage, Thorben & Fischer-Weckemann, Björn, 2024. "Long-run consequences of informal elderly care and implications of public long-term care insurance," Journal of Health Economics, Elsevier, vol. 96(C).
    17. He, Min & Lin, Lin, 2024. "China’s public long-term care insurance and risky asset allocation among elderly households," The Journal of the Economics of Ageing, Elsevier, vol. 29(C).
    18. Milad Karimi & John Brazier, 2016. "Health, Health-Related Quality of Life, and Quality of Life: What is the Difference?," PharmacoEconomics, Springer, vol. 34(7), pages 645-649, July.
    19. Xingtong Pei & Wei Yang & Mingming Xu & Markus Schafer, 2024. "Examining the Impact of Long-Term Care Insurance on the Care Burden and Labor Market Participation of Informal Carers: A Quasi-Experimental Study in China," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 79(5), pages 151-161.
    20. Andrew Goodman-Bacon, 2018. "Public Insurance and Mortality: Evidence from Medicaid Implementation," Journal of Political Economy, University of Chicago Press, vol. 126(1), pages 216-262.
    21. Coe, Norma B. & Goda, Gopi Shah & Van Houtven, Courtney Harold, 2023. "Family spillovers and long-term care insurance," Journal of Health Economics, Elsevier, vol. 90(C).
    22. Nancy J. Devlin & Koonal K. Shah & Yan Feng & Brendan Mulhern & Ben van Hout, 2018. "Valuing health‐related quality of life: An EQ‐5D‐5L value set for England," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 7-22, January.
    23. Guangbo Ma & Kun Xu, 2022. "Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health," IJERPH, MDPI, vol. 20(1), pages 1-20, December.
    24. Otto Lenhart, 2019. "The effects of income on health: new evidence from the Earned Income Tax Credit," Review of Economics of the Household, Springer, vol. 17(2), pages 377-410, June.
    25. İmrohoroğlu, Ayşe & Zhao, Kai, 2018. "The chinese saving rate: Long-term care risks, family insurance, and demographics," Journal of Monetary Economics, Elsevier, vol. 96(C), pages 33-52.
    26. James J. Heckman & Hidehiko Ichimura & Petra Todd, 1998. "Matching As An Econometric Evaluation Estimator," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 65(2), pages 261-294.
    27. Makai, Peter & Brouwer, Werner B.F. & Koopmanschap, Marc A. & Stolk, Elly A. & Nieboer, Anna P., 2014. "Quality of life instruments for economic evaluations in health and social care for older people: A systematic review," Social Science & Medicine, Elsevier, vol. 102(C), pages 83-93.
    28. 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).
    29. Finch, Aureliano Paolo & Mulhern, Brendan, 2022. "Where do measures of health, social care and wellbeing fit within a wider measurement framework? Implications for the measurement of quality of life and the identification of bolt-ons," Social Science & Medicine, Elsevier, vol. 313(C).
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lin, Lin & He, Min & Sun, Wenkai, 2025. "Security fosters generosity: Social security protection and charitable giving," World Development, Elsevier, vol. 196(C).

    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. Lin, Lin & He, Min & Sun, Wenkai, 2025. "Security fosters generosity: Social security protection and charitable giving," World Development, Elsevier, vol. 196(C).
    2. He, Min & Lin, Lin, 2024. "China’s public long-term care insurance and risky asset allocation among elderly households," The Journal of the Economics of Ageing, Elsevier, vol. 29(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. Ai, Jingyi & Feng, Jin & Zhang, Xiaohan, 2024. "Long-term care insurance coverage and labor force participation of older people: Evidence from China," China Economic Review, Elsevier, vol. 86(C).
    5. Brehm, Johannes & Pestel, Nico & Schaffner, Sandra & Schmitz, Laura, 2025. "From Low Emission Zone to academic track: Environmental policy effects on educational achievement in elementary school," Journal of Environmental Economics and Management, Elsevier, vol. 132(C).
    6. 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).
    7. Marchesi, Silvia & Marcolongo, Giovanna, 2025. "Knockin’ on H(e)aven’s door. Financial crises and offshore wealth," Journal of International Economics, Elsevier, vol. 158(C).
    8. Jiayi Wen & Xiaoqing Yu, 2024. "Insuring Long-Term Care in Developing Countries: The Interaction between Formal and Informal Insurance," Papers 2408.14243, arXiv.org.
    9. Bas Scheer & Wiljan van den Berge & Maarten Goos & Alan Manning & Anna Salomons, 2022. "Alternative Work Arrangements and Worker Outcomes: Evidence from Payrolling," CPB Discussion Paper 435, CPB Netherlands Bureau for Economic Policy Analysis.
    10. 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).
    11. Antonin Bergeaud & Clement Malgouyres & Clement Mazet-Sonilhac & Sara Signorelli, 2021. "Technological change and domestic outsourcing," CEP Discussion Papers dp1784, Centre for Economic Performance, LSE.
    12. Yang, Tianli & Zhao, Zhong, 2025. "Long-term care insurance policy and the development of elderly care enterprises in China," China Economic Review, Elsevier, vol. 94(PB).
    13. 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.
    14. Li, Pei & Liu, Kaihao & Lu, Yi & Peng, Lu, 2025. "Organizing regulatory structure and local air quality: Evidence from the environmental vertical management reform in China," Journal of Comparative Economics, Elsevier, vol. 53(1), pages 139-164.
    15. Chen, Jidong & Shi, Xinzheng & Zhang, Ming-ang & Zhang, Sihan, 2024. "Centralization of environmental administration and air pollution: Evidence from China," Journal of Environmental Economics and Management, Elsevier, vol. 126(C).
    16. Robinson, Sarah & Tazhitdinova, Alisa, 2025. "One hundred years of U.S. state taxation," Journal of Public Economics, Elsevier, vol. 241(C).
    17. Brülhart, Marius & Klinke, Gian-Paolo & Marcucci, Andrea & Rohner, Dominic & Thoenig, Mathias, 2023. "Price and Prejudice: Housing Rents Reveal Racial Animus," CEPR Discussion Papers 18050, Centre for Economic Policy Research.
    18. Castelnovo, Paolo & Clò, Stefano & Florio, Massimo, 2023. "A quasi-experimental design to assess the innovative impact of public procurement: An application to the Italian space industry," Technovation, Elsevier, vol. 121(C).
    19. Byrski, Dennis & Wang, Lucy Xiaolu, 2025. "Marketing authorization and strategic patenting: Evidence from pharmaceuticals," Journal of Public Economics, Elsevier, vol. 247(C).
    20. Balia, S.; & Brau, R.; & Pau, S.;, 2025. "One plus one makes less than two? Consolidation policies and mortality in the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 25/02, HEDG, c/o Department of Economics, University of York.

    More about this item

    Keywords

    ;
    ;
    ;
    ;

    JEL classification:

    • D10 - Microeconomics - - Household Behavior - - - General
    • D64 - Microeconomics - - Welfare Economics - - - Altruism; Philanthropy; Intergenerational Transfers
    • I10 - Health, Education, and Welfare - - Health - - - General

    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:eee:ehbiol:v:58:y:2025:i:c:s1570677x25000280. 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: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/622964 .

    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.