Research On U.S.Long-Term Care Service Supply For The Elderly

With the aggravation of population aging around the world,most developed economies have regarded that increasing the supply of long-term care services for the elderly as one of the important means to meet the challenge of population aging.At present,China is in the transition period of aging society towards aged society and about to enter the toughest period of dealing with the problem of population aging.Against this background,actively coping with population aging has become China’s national strategy in 2020.In order to deal with this challenge,China is now exploring the establishment of long-term care service supply system for the elderly including building long-term care insurance system,with 49 pilot cities across the country.Entering the aging society in the 1940 s,the United States was one of the countries who paid attention to the aging problem once upon a time.After decades of development,the United States has been able to provide relatively rich long-term care services for the elderly.However,with the aging of the “baby boomers” after World War II,the United States is in the historical stage of accelerating from an aged society to a super-aged society.Against this background,influenced by external shocks such as the COVID-19 pandemic at the same time,the United States is facing problems such as shortages of labor and capital supplies of long-term care services for the elderly.In order to deal with these problems,the U.S.government is making efforts to improve the supply level of long-term care services for the elderly by institutional supply.Based on theories such as mixed economy theory of welfare,production factors theory,hierarchy of needs theory,lemon market theory and government regulation theory,this paper constructs a four-dimensional research framework of "product supply-labor supply-capital supply-institutional supply" from the perspective of economics,regarding long-term care service for the elderly as a product,focusing on two core factors of production---labor and capital,and introducing institutional supply as the exogenous variable.Under this four-dimensional research framework,this paper adopts a combination of qualitative and quantitative methods to conduct a comprehensive study of U.S.long-term care services supply for the elderly.First of all,the United States has built a relatively complete and diversified longterm care service supply system for the elderly,but the relationship between the internal components of the system has been unbalanced for a long time.In order to meet the market demand,the diversified participants,mainly profit-making institutions,constantly enrich the supply of long-term care services for the elderly and meet the multi-level long-term care needs of the elderly through diverse product supplies including living care services,medical care services and hospice care services.However,the supplies of labor and capital for long-term care services are in a bottleneck state,which would hinder the good operation of the long-term care system for the elderly in the United States.The shortage of labor force results in the price of long-term care services for the elderly keeping high,and causes the sellers’ slow response to the market price,leading to the failure of the reverse regulation of price to supply.The longterm shortage of supply eventually forms a sellers’ market,which would not only weaken the sellers’ motivation to reduce costs,but also seriously hinder their efforts to improve quality.The U.S.long-term care service capital supply system for the elderly is mainly based on commercial long-term care insurance and underfunded by social insurance.Due to the lemon market effects of itself and the crowding-out effects from social insurance,commercial long-term care insurance has not been able to play a role as the core pillar.In consequence,originally set as the social safety net,social longterm care insurance has become the main source of capital supply,posing serious financial sustainability risks to both federal and state governments.Therefore,the U.S.government tries to realize the multi-dimensional linkage mechanism among product supply,factor supply and institutional supply by providing appropriate regulations,so that the supply of long-term care services for the elderly could develop in the direction of higher availability,lower cost and better quality.In addition,this paper improves the reliability of the above conclusions by the application of econometric models.Firstly,based on U.S.social long-term care insurance data,commercial insurance data and other related industry data from 1998 to2019,this paper verifies the existence of crowding-out effects from social insurance to commercial insurance and reveals the inner mechanism of the impacts on system operation from the capital supply system by constructing Moran index and Doberman spatial model.The empirical results show that the social insurance has a negative effect on the supply system while the commercial insurance has a positive effect.The internal reasons for this result are as follows: First of all,there would be heavier burden of capital supply in a district with higher proportion of social insurance expenditure.Then,the higher proportion of social insurance expenditure in GDP means the higher cost of long-term care services for the elderly in a region,and the worse process of changing the supply system from an institutional mode to a home-and-community based mode.Finally,due to the profit-seeking motivation,commercial insurance companies keep improving the efficiency of resource allocation in the service network to expand the profit space,which is also the fundamental reason for the federal government to implement the privatization of long-term care service reform of social security.Secondly,based on the "multi-input and multi-output" data envelopment analysis method,this paper constructs the Malmquist index model consisting of institution numbers,expense,employment,industrial output and other indicators to evaluate the supply system comprehensively.On the one hand,this paper verifies that the multidimensional supply linkage mechanism of "product supply--labor supply--capital supply--institutional supply" is the fundamental reason for the continuous Pareto improvement of supply system by tracking the changing trends of efficiency improvement index,technology improvement index and total index of decomposition index.On the other hand,the decisive role of the multi-dimensional supply linkage mechanism is further verified by comprehensively analyzing the clustering results of states based on Malmquist index,the enrollment of Medicaid MLTSS programs in states across the United States,and the distribution of AARP livable communities for the elderly.Finally,this paper summarizes the practical experience and lessons from U.S.long-term care service supply for the elderly,and puts forward the enlightenments for China.Multiple subjects’ collaborative involvement based on market mechanism can effectively improve the toughness of U.S.long-term care services supply for the elderly,which is helpful in protecting the elderly rights through relatively perfect institutional supply.However,the shortage of labor supply continues to intensify,which leads to the uncertainty of service supply.Moreover,due to the structure feature of complete replenishment,the capital supply of long-term care services in the United States is not sustainable.Therefore,China should encourage public and private multi-subjects to participate in the supply of long-term care services for the elderly through thorough institutional supply,improve labor supply efficiency by increasing the labor supply reserve and optimizing the labor supply structure,and construct a multi-level capital supply system with moderate inclusive benefits and complementary features to maximize the use of social resources,improve the accuracy and scope of protection,and provide the basic security for the vast majority of citizens,underprivileged security for the poor and self-financing security for the rich.