Long-term care insurance and accessibility of home and community-based services for older adults: evidence from China

With population aging, the establishment of universal long-term care insurance (LTCI) has emerged as a critical policy issue. This paper examines the effects of China's LTCI pilots on the physical accessibility of home and community-based services (HCBS) and specific services for older adults. Using three-wave panel data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we analyze the rollout of LTCI pilots across different cities from 2014 to 2021, employing a time-varying difference-in-differences (DID) approach. Our findings indicate that LTCI significantly improves access to HCBS for older adults, particularly in personal daily care. Heterogeneity analysis indicates that LTCI has a stronger positive effect on the accessibility of HCBS for older adults with physical impairment, lower financial transfers from children, or living alone or with a spouse only, and the positive effect is more salient in regions with higher reimbursement for HCBS and more generous coverage. This study provides compelling evidence regarding the pivotal role of institutional design of LTCI in shaping older adults' care-seeking behavior and system-level resource allocation. It offers nuanced insights into the evaluation of differentiated pilot programs across cities, which can inform the development of a uniform national LTCI policy and carry implications for other developing countries.