Becoming eligible for long-term care insurance in China brought more ageing at home: evidence from a pilot city.

Abstract

Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people's choice of place of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries' choice of place of ageing-institution or home-before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person's probability of choosing home as her place of ageing even before she received any benefit by ∼16%, and this positive impact was larger for those insured, of higher education level, or of higher disability grade. By bringing more ageing in place, LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program, such as who could receive subsidies, family values, and family members' engagement in the labor market, could all work together to shape the substitution pattern between home and institutional care.