Journal

Health Policy and Planning

Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries, provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.

Specific objectives are to:

• Attract high quality research papers, reviews and debates on topics relevant to health policies in low- and middle-income countries;

• Ensure wide geographical coverage of papers including coverage of the poorest countries and those in transition;

• Encourage and support researchers from low- and middle-income countries to publish in HPP ;

• Ensure papers reflect a broad range of disciplines, methodologies and topics;

• Ensure that papers are clearly explained and accessible to readers from the range of disciplines used to analyse health policies; and

• Provide a fair, supportive and high-quality peer review process.

Article

He Chen , Jing Ning, The impacts of long-term care insurance on health care utilization and expenditure: evidence from China, Health Policy and Planning, Volume 37, Issue 6, June 2022, Pages 717–727

Author

He Chen, Associate Professor, School of Public Administration and Policy, RUC

Abstract

Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure (OOP) in China. The Propensity Score Matching with difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study. Our findings indicate that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (P < 0.05), the number of hospitalizations by 0.158 times (P < 0.01) and the length of inpatient stay during last year by 1.441 days (P < 0.01). In the aspect of OOP, we found that LTCI significantly reduced the inpatient OOP during last year by 533.47 yuan (P < 0.01), but it did not exhibit an impact on the outpatient OOP during last year. LTCI also had a significantly negative impact on the total OOP by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and OOP, the expansion of LTCI could help reduce the needs for health care services and contain the increases in OOP in China.

Keywords

Public long-term care insurance, policy experimentation, health care utilization, out-of-pocket health expenditure, China

Key messages

We evaluated the impacts of long-term care insurance (LTCI) on health care utilization and expenditure in China by employing a quasi-experiment design.

LTCI significantly reduced the number of outpatient visits during last month, the number of hospitalizations during last year and the length of inpatient stay during last year.

LTCI had a significant negative impact on the inpatient out-of-pocket expenditure and total out-of-pocket expenditure, but we did not find such impact on outpatient out-of-pocket expenditure.

To expand LTCI could help reduce the needs for health care services and contain the increases in health care expenditure.

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