ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1616761
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health Welfare, Volume IIView all 3 articles
Impact of long-term care insurance on health out-of-pocket expenditure ratios for older adults
Provisionally accepted
- 1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- 2School of Foreign Languages, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- 3The School of Nursing,Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hebei Province, China
- 4The School of Sociology,Nankai University, Tianjin, China
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Background: China's rapidly aging population has intensified the demand for long-term care (LTC), resulting in higher out-of-pocket expenditure (OOPE) ratios and financial strain among older adults. To mitigate these burdens, Long-Term Care Insurance (LTCI) has been piloted across selected cities. However, its effectiveness in reducing financial burden-particularly OOPE ratios-remains insufficiently evaluated. This study assesses the causal impact of LTCI on OOPE ratios and explores subgroup heterogeneity.We used panel data from the China Health and Retirement Longitudinal Study (CHARLS, 2015(CHARLS, -2020)), applying difference-in-differences (DID), dynamic DID, and propensity score matching DID (PSM-DID) approaches. The treatment group consisted of older adults living in 12 LTCI pilot cities, while controls were drawn from non-pilot areas. We adjusted for socio-demographic and health covariates and conducted robustness and parallel trend tests.Results: DID results show that LTCI significantly reduced OOPE ratios (coefficient = -0.035, p < 0.01), with dynamic DID confirming a 5.6% reduction in the post-treatment period. PSM-DID estimates remained consistent (coefficient = -0.019, p < 0.05). Subgroup analysis revealed stronger effects among the younger elderly (70-79), rural residents, and individuals with lower education or chronic conditions.In contrast, minimal impact was observed among those aged ≥80 and highly educated individuals. Notably, OOPE ratios continued to increase over time, indicating that inflation and systemic cost pressures may offset policy gains.-3 -Conclusions: While LTCI has demonstrable short-term benefits in reducing OOPE ratios and improving equity, long-term sustainability remains at risk due to persistent cost escalation. Targeted policy design and enhanced integration with broader health financing mechanisms are needed to strengthen its long-term impact.
Keywords: Long-Term Care, long-term care insurance, Health expenditure, out-of-pocket expenditure, China
Received: 23 Apr 2025; Accepted: 26 Jun 2025.
Copyright: © 2025 Liu, Shi, Jiang, Tang, Qiu and Yao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zenghui Qiu, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
Lan Yao, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
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