ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1619791
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 73 articles
Improving Healthcare Efficiency through Long-Term Care Insurance (LTCI): A Super-SBM and DID Analysis of 291 Chinese Cities
Provisionally accepted
- 1Law School of Shanxi University of Finance and Economics, 太原市, China
- 2Xinjiang Agricultural University, Urumqi, China, Urumqi, China, China
- 3Xinjiang Agricultural University, Urumqi, Xinjiang, China
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The intensification of population aging has exacerbated the strain on medical resources.Long-term care insurance (LTCI) influences healthcare efficiency by redefining the boundaries between medical and care services. However, its mechanisms and effectiveness in developing countries remain underexplored. This study investigates the impact pathways and heterogeneous characteristics of the effects of LTCI on regional healthcare efficiency in China, providing evidence for policy optimization.Methods: Using panel data from 291 prefecture-level cities in China from 2010-2021, healthcare efficiency was measured via the slack-based measure super efficiency (Super-SBM) model. The difference-in-differences (DID) method was employed to evaluate the policy effects of LTCI.Bootstrap-based mediation models were used to examine the transmission mechanisms of hospitalization volume, average length of stay, and the number of care institutions. Regional heterogeneity was also analyzed.Results: LTCI significantly improved regional healthcare efficiency (β=0.071, P<0.01). Mechanism analysis identified three effective pathways: (1) Reducing hospitalization demand ( λ = -0.419, P < 0.01) freed up medical resources, contributing 3.42% of the efficiency gains; (2) Shortening length of hospital stay (λ = -0.326, P < 0.01) accelerated bed turnover, accounting for 47.6% of the total effect, making it the dominant pathway; (3) Expanding institutional care supply ( λ = 0.330, P < 0.05) diverted patient flows, explaining 9.23% of the improvement. Heterogeneity analysis indicated that the policy effects were more pronounced in the eastern and central regions and new first-and thirdtier cities.
Keywords: long-term care insurance, Healthcare efficiency, Super-SBM model, Difference-indifferences, Population aging
Received: 28 Apr 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Jin and Halili. 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: Ayitijiang • Halili, Xinjiang Agricultural University, Urumqi, China, Urumqi, China, China
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