Moving long-term care insurance upstream: A geriatric-syndrome-oriented framework for healthy aging in China

Long-term care insurance (LTCI) is commonly understood as a social insurance mechanism that compensates care-related costs after disability has occurred. This compensation function remains essential, but it is insufficient in the context of rapid population aging, multimorbidity, cognitive impairment, and long-term family caregiving burden. In older adults, disability often emerges from the cumulative interaction of geriatric syndromes, including frailty, recurrent falls, cognitive decline, malnutrition, depressive symptoms, pressure injuries, together with multimorbidity, environmental vulnerability, and caregiver burden. This article argues that the next stage of LTCI reform should not simply expand coverage or reimbursement, but should incorporate earlier identification of functional risk, comprehensive geriatric assessment, continuous care, caregiver support, and functional outcome evaluation. Existing quasi-experimental studies from China suggest that current LTCI pilots are associated with partial benefits in cognitive and psychological outcomes, changes in healthcare utilization including reduced hospitalization in some studies, modest improvements in health-related quality of life, and favorable frailty-related outcomes. However, these studies do not establish the effectiveness or added value of a geriatric-syndrome-oriented LTCI model. We therefore distinguish between the current evidence base and a proposed reform model, outline potential pathways linking LTCI to healthy aging, and propose operational priorities for future evaluation.