Assessing the Alignment of Long-Term Care Insurance Benefits and Service Provision: Evidence from Shandong, China and...

This study assesses the alignment between Long-Term Care Insurance (LTCI) benefit levels and service supply across 16 prefecture-level cities in Shandong Province, China. This study aims to identify whether mismatches exist between LTCI benefits and long-term care service supply across cities in Shandong Province.

Drawing on field investigations and administrative-institutional data (2023-2024), we developed a composite indicator system covering three dimensions of LTCI benefits, namely benefit breadth, benefit depth, and benefit sustainability, as well as two dimensions of service supply, including institutional capacity and human resources. Entropy weighted TOPSIS was used to derive subsystem scores for benefit level (F1) and service supply (F2). The coupling coordination degree model (CCDM) was then applied to evaluate the quality of alignment, and an obstacle degree model was used to identify key barriers.

Substantial intercity disparities were observed in both LTCI benefit levels (F1: 0.237-0.798) and service supply (F2: 0.049-0.695). Only one city achieved a well-coordinated status (D = 0.863), while most remained at primary or lower coordination stages. Distinct structural patterns emerged, including benefit-led, service-led, and dual-low development types. Obstacle analysis identified human resource capacity (accounting for 36.9% of obstacles in leading cities) and insufficient payment standards as the dominant barriers to coordination.

The LTCI system in Shandong is characterized by significant intercity heterogeneity and structural mismatches between policy design and service delivery. Our analysis identifies human resource capacity and payment standards as the dominant obstacles that hinder the effective translation of insurance funding into accessible care. Policy efforts should prioritize integrated coordination through dynamic payment adjustments and human resource stabilization to ensure the long-term sustainability and equity of the system.