The Influence Of Long-term Care Insurance On Home Care Services

Since China entered the aging society in 2000,the aging process has been accelerating.Against the backdrop of the continuous expansion of the elderly population and the deepening of aging,the issue of disability among the elderly population has received widespread attention from society.Overall,the care mode for disabled individuals can be divided into two types: home care and institutional care.Because the disabled elderly group is more dependent on the family,home care is the current main care mode choice.Due to the higher dependence of disabled elderly individuals on their families,home care is currently the main choice of care mode.Whether choosing institutional care or home care,disabled families bear a relatively heavy burden of care,and the social pension security system established in China in the past cannot effectively meet the long-term care needs of disabled individuals and their families.In order to cope with the increasing demands and challenges of long-term care,in June 2016,China launched the first pilot work of long-term care insurance in 15 cities.In the pilot work,most pilot cities adopt the method of purchasing nursing services from institutions,and the long-term care insurance policy implemented by Chengdu not only provides treatment subsidies for institutional care,but also provides economic subsidies for people who provide informal care services at home,which has become a characteristic of Chengdu.Based on the pilot practice in Chengdu,this paper uses the micro return visit data(including application information)of long-term care insurance applicants in Chengdu to evaluate the impact of long-term care insurance policies on home care services by using the differences-in-differences method.Home care services refers to the informal care of relatives and the formal care at home.In this paper,the possibility of relatives participating in care and the intensity of relatives’ care are used to measure the informal care of relatives,and whether the formal care service at home is used to measure the formal home care services.The study found that although the implementation of the policy had no significant impact on whether relatives participated in care,it reduced the number of days of weekly care for relatives,and greatly increased the probability of disabled families using formal home care services.Due to the difference in the amount of subsidies for formal home care services provided by long-term care insurance for urban workers and rural residents,this paper further analyzes the heterogeneity of urban workers and rural residents,and finds that compared with urban residents,rural residents are more likely to choose to use formal home care services after obtaining the long-term care insurance benefits qualification.In home care,the informal care services provided by relatives,mainly children and spouses,are the main care for disabled people.Relatives need to reduce working hours or even give up work opportunities,resulting in a certain opportunity cost.This paper also focuses on the economic compensation impact of long-term care insurance on family caregivers.By gender,age,education level and other human capital characteristics,we make a detailed classification of relatives for caring for family members,and combine the China Household Finance Survey(CHFS)data to calculate the opportunity cost.By comparing the opportunity cost with the payment standard of long-term care insurance fund for family caregivers,it is found that the economic subsidy of the long-term care insurance fund compensates the opportunity cost of family members to a large extent.The specific impact of the long-term care insurance policy on the well-being of the disabled elderly and their family members is of great significance to the path choice of improving the social pension service system.Based on the pilot experience in Chengdu and the research results of this paper,the following suggestions are proposed: 1.The design of long-term care insurance policy needs to reflect the principle of home care orientation;2.Pay attention to the labor value and service quality of informal caregivers at home;3.Give full play to the complementary power of social door-to-door support services;4.Strengthen the rational allocation of long-term care resources;5.Do a good job in supporting and linking policies,and build a complete long-term care security system step by step.