Long Chengxu, Yang Wei, Glaser Karen
Department of Global Health and Social Medicine, King's College London, London, England, UK.
Eur J Ageing. 2025 Jun 3;22(1):25. doi: 10.1007/s10433-025-00861-1.
Older adults with cognitive and/or physical limitations often face excessive health and long-term care (LTC) costs, which significantly affect their living standards. However, current measures of catastrophic health expenditure primarily focus on healthcare costs, overlooking the substantial burden of LTC costs. Our study is among the first to introduce the concept of catastrophic health and long-term care expenditures (CHLTCE) to comprehensively capture the economic burden of health and LTC costs associated with functional limitations. Drawing data from 2011, 2013, 2015, and 2018 waves of China Health and Retirement Longitudinal Study, we employed a staggered difference-in-differences approach to assess the impact of long-term care insurance (LTCI) on alleviating CHLTCE. We found that after accounting for LTC costs, both total health and LTC expenditures and CHLTCE risk significantly increased compared to when only healthcare costs were considered. Furthermore, LTCI coverage significantly reduced CHLTCE risks among older adults with cognitive and/or physical limitations. This effect was more pronounced among those with severe cognitive impairments and those with physical limitations and chronic diseases. In addition, its effectiveness in reducing CHLTCE risks for individuals with complex care needs was observed only at the high threshold, but not at lower thresholds. Our findings offer empirical contributions by incorporating both health and LTC costs into catastrophic expenditures analysis. We recommend that policymakers refine LTCI eligibility criteria and implement tiered coverage options based on various levels and dimensions of cognitive and physical function-beyond activities of daily living-to offer targeted protection for individuals with complex care needs.
认知和/或身体有局限的老年人往往面临过高的医疗和长期护理（LTC）费用，这严重影响了他们的生活水平。然而，目前灾难性医疗支出的衡量标准主要集中在医疗费用上，忽视了长期护理费用的巨大负担。我们的研究是首批引入灾难性医疗和长期护理支出（CHLTCE）概念的研究之一，以全面捕捉与功能受限相关的医疗和长期护理费用的经济负担。我们利用中国健康与养老追踪调查2011年、2013年、2015年和2018年的数据，采用交错差分法评估长期护理保险（LTCI）对减轻灾难性医疗和长期护理支出的影响。我们发现，在考虑长期护理费用后，与仅考虑医疗费用时相比，医疗和长期护理总支出以及灾难性医疗和长期护理支出风险均显著增加。此外，长期护理保险覆盖显著降低了认知和/或身体有局限的老年人的灾难性医疗和长期护理支出风险。这种影响在严重认知障碍者以及有身体局限和慢性病的人群中更为明显。此外，仅在高门槛水平上观察到其对有复杂护理需求者降低灾难性医疗和长期护理支出风险的有效性，在低门槛水平则未观察到。我们的研究结果通过将医疗和长期护理费用纳入灾难性支出分析做出了实证贡献。我们建议政策制定者完善长期护理保险资格标准，并根据认知和身体功能的不同水平和维度——而非仅限于日常生活活动——实施分层覆盖选项，为有复杂护理需求的个人提供有针对性的保护。
