School of Public Administration, Zhongnan University of Economics and Law, 182 Nanhu Road, Guanshan Street, Hongshan District, Wuhan, China.
School of Public Administration, Yanshan University, Qinhuangdao, China.
BMC Geriatr. 2023 Oct 19;23(1):679. doi: 10.1186/s12877-023-04344-9.
It is still uncertain whether and how formal long-term care (LTC) systems affect the health status of family members. This paper examines the health effects of long-term care insurance (LTCI) on spouses of disabled people in China.
The data is from China Health and Retirement Longitudinal Survey (CHARLS), a longitudinal survey of a nationally representative sample of Chinese residents aged 45 or older and their spouses, and China City Statistical Yearbook. Exploiting the regional variation in the implementation of LTCI in the first round of pilot cities in China, a difference-in-difference (DID) strategy is applied to identify the causal effects of LTCI on the health status of spouses of disabled people. We carefully identify the causal effects by controlling for city-level covariates, testing common trends between the treatment and control groups, combining propensity score matching (PSM) with DID, selecting the second round of pilot cities as the control group, controlling for city fixed effects (FE) instead of individual FE, and evaluating selection bias from omitted observable and unobservable factors.
The introduction of LTCI in China reduces the number of painful body parts and the self-reported health score significantly, indicating that spouses of disabled people get physical health benefits from LTCI coverage. However, the impact of LTCI on the depression index remains ambiguous and needs to be analyzed further. LTCI improves the physical health status of spouses of disabled individuals mainly through the time reallocation channel, while the impact of the consumption promotion channel has not been verified. Furthermore, the beneficial effects of LTCI on physical health are stronger for spouse caregivers and spouses with lower-level education and lower household income.
These findings demonstrate that LTCI not only improves the health status of family caregivers by reducing their caregiving burden but also has beneficial health effects on non-caregiver family members. Policy designs of LTCI should emphasize the orientation of home and community-based care services (HCBS), which can not only satisfy the care preferences of disabled individuals, reduce the care burden on family caregivers, promote the health of all family members, but also prevent a large number of disabled individuals from choosing high-cost institutional care and reduce the financial burden of the LTCI Fund.
长期护理保险（LTCI）对家庭成员的健康状况的影响及其程度仍不确定。本文考察了中国残疾人配偶的长期护理保险（LTCI）对其健康状况的影响。
本研究数据来自中国健康与养老追踪调查（CHARLS），这是一项针对中国 45 岁及以上居民及其配偶的全国代表性样本的纵向调查，以及中国城市统计年鉴。利用中国首轮试点城市 LTCI 实施的区域差异，采用双重差分（DID）策略来识别 LTCI 对残疾人配偶健康状况的因果效应。我们通过控制城市层面的协变量、检验处理组和对照组之间的共同趋势、将倾向评分匹配（PSM）与 DID 相结合、选择第二轮试点城市作为对照组、控制城市固定效应（FE）而不是个体 FE、以及评估遗漏可观测和不可观测因素的选择偏差，仔细识别因果效应。
中国 LTCI 的引入显著减少了残疾配偶疼痛身体部位的数量和自报健康评分，表明残疾人配偶从 LTCI 覆盖中获得了身体健康收益。然而，LTCI 对抑郁指数的影响仍不明确，需要进一步分析。LTCI 主要通过时间再分配渠道改善残疾配偶的身体健康状况，而消费促进渠道的影响尚未得到验证。此外，LTCI 对身体健康的有益影响在配偶照顾者和教育程度较低、家庭收入较低的配偶中更强。
这些发现表明，LTCI 不仅通过减轻照顾者的照顾负担来改善家庭照顾者的健康状况，而且对非照顾家庭成员也有有益的健康影响。LTCI 的政策设计应强调家庭和社区为基础的护理服务（HCBS）的定位，这不仅可以满足残疾人士的护理偏好，减轻家庭照顾者的照顾负担，促进所有家庭成员的健康，还可以防止大量残疾人士选择高成本的机构护理，减轻 LTCI 基金的财务负担。
