Wang Jingyi, Guan Jing, Wang Guojun
School of Insurance and Economics, University of International Business and Economics, Beijing, China.
School of Economics, Beijing Technology and Business University, Beijing, China.
Health Econ. 2023 Mar;32(3):558-573. doi: 10.1002/hec.4634. Epub 2022 Nov 20.
With the increase of aging population, long-term care insurance (LTCI) systems have become important for improving individuals' health. However, the effect of LTCI on health is unclear, especially in developing countries, owing to the lack of random policy shocks and comprehensive databases. This study investigates the Chinese LTCI pilot program, using four waves of the China Health and Retirement Longitudinal Study database (sample aged ≥45 years) from 2011 to 2018. The recent difference-in-differences approaches for staggered design, which are capable of dealing with the negative weights issue, are used to investigate changes in health status, measured by self-rated health (SRH), (instrumental) activities of daily living, self-rated depression, and cognition, in pilot and non-pilot cities before and after LTCI implementation. Long-term care insurance has a significant average effect on SRH improvement and a long-term positive effect on cognition for middle-aged and older populations. This study provides the first evaluation of LTCI policy on health outcomes using the recent difference-in-differences approaches. It provides evidence for the overall health improvement achieved through the LTCI and offers positive reinforcement and potential areas for improvement in establishing LTCI worldwide.
随着老龄化人口的增加，长期护理保险（LTCI）制度对于改善个人健康状况变得至关重要。然而，由于缺乏随机政策冲击和全面的数据库，LTCI对健康的影响尚不清楚，尤其是在发展中国家。本研究利用2011年至2018年中国健康与养老追踪调查数据库的四轮数据（样本年龄≥45岁），对中国长期护理保险试点项目进行了调查。采用近期的交错设计双重差分法，该方法能够处理负权重问题，用于研究长期护理保险实施前后试点城市和非试点城市的健康状况变化，健康状况通过自评健康（SRH）、（工具性）日常生活活动、自评抑郁和认知来衡量。长期护理保险对中年及老年人群的自评健康改善有显著的平均效应，对认知有长期的积极影响。本研究首次采用近期的双重差分法对长期护理保险政策的健康结果进行了评估。它为通过长期护理保险实现的整体健康改善提供了证据，并为在全球范围内建立长期护理保险提供了积极的支持和潜在的改进领域。
