IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v281y2021ics0277953621004366.html
   My bibliography  Save this article

Preferences for long-term care insurance in China: Results from a discrete choice experiment

Author

Listed:
  • Wang, Qun
  • Abiiro, Gilbert Abotisem
  • Yang, Jin
  • Li, Peng
  • De Allegri, Manuela

Abstract

Rapid population aging has led countries to consider the introduction of long-term care insurance (LTCI) as an essential component of a comprehensive social health protection package. Limited evidence, however, exists on people's preferences for such insurance products, especially in countries where their availability is still restricted. Using a discrete choice experiment (DCE), we investigated preferences, willingness to pay, and heterogeneity in preferences for attributes of a social LTCI among community members in China. We adopted a multi-methods approach, combining information across different data sources to identify five DCE attributes: individual premium, benefit package, coverage ceiling, government subsidy for participants, and reimbursement of home-based care provided by family caregivers. We constructed our experiment using a D-efficient design and ran the DCE survey among 1067 community members in urban and rural areas in Shenyang and Dalian, Liaoning Province from Dec 2019 to Jan 2020. We relied on a panel mixed logit model to analyze the data. Our findings indicated that people had significantly higher preferences for the LTCI product with a higher coverage ceiling, a lower individual premium, a higher government subsidy, a reimbursement of home-based care provided by family caregivers, and an expansion of the benefit package to also include necessary daily assistance. The coverage ceiling was found to be the most important attribute, followed by the reimbursement of home-based care provided by family caregivers and the individual premium. Our findings also revealed that the area of residence, prior commercial insurance ownership, age, having children, and income were the factors that drove heterogeneity in preferences for LTCIs. These findings bear important policy implications, as they provide clear guidance on product design, enabling decision-makers to increase the attractiveness and sustainability of LTCI.

Suggested Citation

  • Wang, Qun & Abiiro, Gilbert Abotisem & Yang, Jin & Li, Peng & De Allegri, Manuela, 2021. "Preferences for long-term care insurance in China: Results from a discrete choice experiment," Social Science & Medicine, Elsevier, vol. 281(C).
    • Handle: RePEc:eee:socmed:v:281:y:2021:i:c:s0277953621004366
    DOI: 10.1016/j.socscimed.2021.114104
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621004366
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.114104?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 search for a different version of it.

    References listed on IDEAS

    as
    1. Janet Vroomen & Peter Zweifel, 2011. "Preferences for health insurance and health status: does it matter whether you are Dutch or German?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(1), pages 87-95, February.
    2. Chandoevwit, Worawan & Wasi, Nada, 2020. "Incorporating discrete choice experiments into policy decisions: Case of designing public long-term care insurance," Social Science & Medicine, Elsevier, vol. 258(C).
    3. Ameriks, John & Briggs, Joseph & Caplin, Andrew & Shapiro, Matthew D. & Tonetti, Christopher, 2016. "Late-in-Life Risks and the Under-Insurance Puzzle," Research Papers 3485, Stanford University, Graduate School of Business.
    4. Sloan, Frank A & Norton, Edward C, 1997. "Adverse Selection, Bequests, Crowding Out, and Private Demand for Insurance: Evidence from the Long-Term Care Insurance Market," Journal of Risk and Uncertainty, Springer, vol. 15(3), pages 201-219, December.
    5. Lin, Haizhen & Prince, Jeffrey, 2013. "The impact of the partnership long-term care insurance program on private coverage," Journal of Health Economics, Elsevier, vol. 32(6), pages 1205-1213.
    6. Tennyson, Sharon & Yang, Hae Kyung, 2014. "The role of life experience in long-term care insurance decisions," Journal of Economic Psychology, Elsevier, vol. 42(C), pages 175-188.
    7. Courtney Harold Van Houtven & Norma B. Coe & R. Tamara Konetzka, 2015. "Family Structure and Long‐Term Care Insurance Purchase," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 58-73, March.
    8. Rinaldo Brau & Matteo Lippi Bruni, 2008. "Eliciting the demand for long‐term care coverage: a discrete choice modelling analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 411-433, March.
    9. Liangwen Zhang & Yanbing Zeng & Ya Fang, 2017. "The effect of health status and living arrangements on long term care models among older Chinese: A cross-sectional study," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-15, September.
    10. Arne Hole & Julie Kolstad, 2012. "Mixed logit estimation of willingness to pay distributions: a comparison of models in preference and WTP space using data from a health-related choice experiment," Empirical Economics, Springer, vol. 42(2), pages 445-469, April.
    11. Jeffrey R. Brown & Amy Finkelstein, 2009. "The Private Market for Long‐Term Care Insurance in the United States: A Review of the Evidence," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 5-29, March.
    12. Kato, Ryuta Ray, 2018. "The future prospect of the long-term care insurance in Japan," Japan and the World Economy, Elsevier, vol. 47(C), pages 1-17.
    13. Tian Zhou‐Richter & Mark J. Browne & Helmut Gründl, 2010. "Don't They Care? Or, Are They Just Unaware? Risk Perception and the Demand for Long‐Term Care Insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(4), pages 715-747, December.
    14. Arne Risa Hole, 2007. "Fitting mixed logit models by using maximum simulated likelihood," Stata Journal, StataCorp LP, vol. 7(3), pages 388-401, September.
    15. Brian E McGarry & Helena Tempkin-Greener & David C Grabowski & Benjamin P Chapman & Yue Li, 2018. "Consumer Decision-Making Abilities and Long-Term Care Insurance Purchase," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 73(4), pages 1-10.
    16. Yong Li & Gail A. Jensen, 2012. "Why Do People Let Their Long-term Care Insurance Lapse? Evidence from the Health and Retirement Study," Applied Economic Perspectives and Policy, Agricultural and Applied Economics Association, vol. 34(2), pages 220-237.
    17. Lancsar, Emily & Louviere, Jordan & Flynn, Terry, 2007. "Several methods to investigate relative attribute impact in stated preference experiments," Social Science & Medicine, Elsevier, vol. 64(8), pages 1738-1753, April.
    18. Christophe Courbage & Nolwenn Roudaut, 2008. "Empirical Evidence on Long-term Care Insurance Purchase in France*," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 33(4), pages 645-658, October.
    19. He, Alex Jingwei & Qian, Jiwei & Chan, Wai-sum & Chou, Kee-lee, 2021. "Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong," Social Science & Medicine, Elsevier, vol. 270(C).
    20. Abiiro, Gilbert Abotisem & Torbica, Aleksandra & Kwalamasa, Kassim & De Allegri, Manuela, 2014. "Eliciting community preferences for complementary micro health insurance: A discrete choice experiment in rural Malawi," Social Science & Medicine, Elsevier, vol. 120(C), pages 160-168.
    21. Akaichi, Faical & Costa-Font, Joan & Frank, Richard, 2020. "Uninsured by Choice? A choice experiment on long term care insurance," Journal of Economic Behavior & Organization, Elsevier, vol. 173(C), pages 422-434.
    22. Balogh, Péter & Békési, Dániel & Gorton, Matthew & Popp, József & Lengyel, Péter, 2016. "Consumer willingness to pay for traditional food products," Food Policy, Elsevier, vol. 61(C), pages 176-184.
    23. Hensher,David A. & Rose,John M. & Greene,William H., 2015. "Applied Choice Analysis," Cambridge Books, Cambridge University Press, number 9781107465923, September.
    24. Pauly, Mark V, 1990. "The Rational Nonpurchase of Long-term-Care Insurance," Journal of Political Economy, University of Chicago Press, vol. 98(1), pages 153-168, February.
    25. Lei, Xiaoyan & Giles, John & Hu, Yuqing & Park, Albert & Strauss, John & Zhao, Yaohui, 2012. "Patterns and correlates of intergenerational non-time transfers : evidence from CHARLS," Policy Research Working Paper Series 6076, The World Bank.
    26. Yong Li & Gail A. Jensen, 2012. "Why Do People Let Their Long-term Care Insurance Lapse? Evidence from the Health and Retirement Study," Applied Economic Perspectives and Policy, Agricultural and Applied Economics Association, vol. 34(2), pages 220-237.
    27. Yumei Zhu & August Österle, 2019. "China's policy experimentation on long‐term care insurance: Implications for access," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1661-1674, October.
    28. Xiaocang Xu & Linhong Chen, 2019. "Projection of Long-Term Care Costs in China, 2020–2050: Based on the Bayesian Quantile Regression Method," Sustainability, MDPI, vol. 11(13), pages 1-13, June.
    29. Lambregts, Timo R. & Schut, Frederik T., 2020. "Displaced, disliked and misunderstood: A systematic review of the reasons for low uptake of long-term care insurance and life annuities," The Journal of the Economics of Ageing, Elsevier, vol. 17(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. Shang Wu & Hazel Bateman & Ralph Stevens & Susan Thorp, 2022. "Flexible insurance for long‐term care: A study of stated preferences," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(3), pages 823-858, September.
    2. 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.
    3. Eneja Drobež & David Bogataj, 2022. "Legal Aspects of Social Infrastructure for Housing and Care for the Elderly—The Case of Slovenia," Laws, MDPI, vol. 11(2), pages 1-19, February.
    4. Amilon, Anna & Kjær, Agnete Aslaug & Ladenburg, Jacob & Siren, Anu, 2022. "Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark," Social Science & Medicine, Elsevier, vol. 311(C).
    5. Hess, Stephane & Lancsar, Emily & Mariel, Petr & Meyerhoff, Jürgen & Song, Fangqing & van den Broek-Altenburg, Eline & Alaba, Olufunke A. & Amaris, Gloria & Arellana, Julián & Basso, Leonardo J. & Ben, 2022. "The path towards herd immunity: Predicting COVID-19 vaccination uptake through results from a stated choice study across six continents," Social Science & Medicine, Elsevier, vol. 298(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. Lambregts, Timo R. & Schut, Frederik T., 2020. "Displaced, disliked and misunderstood: A systematic review of the reasons for low uptake of long-term care insurance and life annuities," The Journal of the Economics of Ageing, Elsevier, vol. 17(C).
    2. Martin Eling & Omid Ghavibazoo, 2019. "Research on long-term care insurance: status quo and directions for future research," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(2), pages 303-356, April.
    3. M. Martin Boyer & Philippe De Donder & Claude Denys Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2018. "A Canadian Parlor Room-Type Approach to the Long-Term Care Insurance Puzzle," CIRANO Working Papers 2018s-13, CIRANO.
    4. Martin Boyer & Philippe De Donder & Claude Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2017. "Long-Term Care Insurance: Knowledge Barriers, Risk Perception and Adverse Selection," NBER Working Papers 23918, National Bureau of Economic Research, Inc.
    5. M. Martin Boyer & Franca Glenzer, 2021. "Pensions, annuities, and long-term care insurance: on the impact of risk screening," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 46(2), pages 133-174, September.
    6. Łukasz Jurek & Wioletta Wolańska, 2021. "Determinants of Demand for Private Long-Term Care Insurance (Empirical Evidence from Poland)," Risks, MDPI, vol. 9(1), pages 1-15, January.
    7. Cremer, Helmuth & Roeder, Kerstin, 2013. "Long-term care policy, myopia and redistribution," Journal of Public Economics, Elsevier, vol. 108(C), pages 33-43.
    8. Joan Costa-i-Font & Nilesh Raut, 2021. "Long-Term Care Partnership Effects on Medicaid and Private Insurance," CESifo Working Paper Series 9335, CESifo.
    9. M. Martin Boyer & Philippe De Donder & Claude Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2020. "Long-Term Care Insurance: Information Frictions and Selection," American Economic Journal: Economic Policy, American Economic Association, vol. 12(3), pages 134-169, August.
    10. Tennyson, Sharon & Yang, Hae Kyung, 2014. "The role of life experience in long-term care insurance decisions," Journal of Economic Psychology, Elsevier, vol. 42(C), pages 175-188.
    11. Martin Boyer & Philippe Donder & Claude Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2019. "Long-term care risk misperceptions," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(2), pages 183-215, April.
    12. Fels, Markus, 2016. "When the affordable has no value, and the valuable is unaffordable: The U.S. market for long-term care insurance and the role of Medicaid," Working Paper Series in Economics 84, Karlsruhe Institute of Technology (KIT), Department of Economics and Management.
    13. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    14. He, Alex Jingwei & Qian, Jiwei & Chan, Wai-sum & Chou, Kee-lee, 2021. "Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong," Social Science & Medicine, Elsevier, vol. 270(C).
    15. Shang Wu & Hazel Bateman & Ralph Stevens & Susan Thorp, 2022. "Flexible insurance for long‐term care: A study of stated preferences," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(3), pages 823-858, September.
    16. M. Martin Boyer, 2018. "La gestion et le dépistage des risques liés au vieillissement, et le rôle des régimes de retraite dans le marché de l’assurance de soins de longue durée," CIRANO Project Reports 2018rp-03, CIRANO.
    17. Martin Boyer & Franca Glenzer, 2016. "Pensions, annuities, and long-term care insurance: On the impact of risk screening," Cahiers de recherche 1603, Chaire de recherche Industrielle Alliance sur les enjeux économiques des changements démographiques.
    18. de Bresser, Jochem & Knoef, Marike & van Ooijen, Raun, 2022. "Preferences for in-kind and in-cash home care insurance," Journal of Health Economics, Elsevier, vol. 84(C).
    19. Ana I. Sanjuán‐López & Helena Resano‐Ezcaray, 2020. "Labels for a Local Food Speciality Product: The Case of Saffron," Journal of Agricultural Economics, Wiley Blackwell, vol. 71(3), pages 778-797, September.
    20. Justina Klimaviciute & Pierre Pestieau, 2023. "The economics of long‐term care. An overview," Journal of Economic Surveys, Wiley Blackwell, vol. 37(4), pages 1192-1213, September.

    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:socmed:v:281:y:2021:i:c:s0277953621004366. 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/wps/find/journaldescription.cws_home/315/description#description .

    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.