Research on the Impact of Long Term Care Insurance on Family Medical Expenditure: Empirical Evidence Based on CHARLS Data from 2011 to 2020

Churui Yan; Rongxin Li; Xunwen Zheng

doi:10.62177/apemr.v3i2.1261

Authors

Churui Yan Beihang University
Rongxin Li Renmin University of China
Xunwen Zheng Kyoto University

DOI:

https://doi.org/10.62177/apemr.v3i2.1261

Keywords:

Long Term Care Insurance, Medical Expenses, Double Difference Model

Abstract

In recent years, the long-term care insurance system has played an important role in the social security system under the background of population aging. Different from previous studies that focused on the improvement effect of policies on the health status of the elderly, the evaluation of policy effects, and the limitations of data lag, this study adopts the latest CHARLS data from 2011 to 2020 and uses a difference in differences model to explore the impact of long-term care insurance policies on family medical expenditures, and deeply analyzes the mediating and moderating effects. Research has found that long-term care insurance can significantly reduce household medical expenses; Mechanism analysis shows that this policy improves the physical health status of disabled elderly people by providing professional nursing services, thereby achieving a decrease in family medical expenses; The number of children has a negative moderating effect on the effectiveness of policies; Heterogeneity analysis shows that long-term care insurance has a more prominent effect on reducing medical expenses for families of chronic disease patients and highly educated families. Based on the above conclusions, it is recommended to adopt a gradual promotion strategy, gradually expand the coverage and guarantee objects of the pilot program, develop personalized service plans based on differences in disability level, economic status, etc., strengthen the professional training of nursing talents, and establish a multidimensional evaluation mechanism to regularly monitor the effectiveness of policy implementation and dynamically adjust the implementation plan.

Downloads

Download data is not yet available.

References

Cheng, Q., Lu, J. H., & Zheng, B. F. (2023). The impact of long-term care insurance system on middle-aged and elderly consumption: Evidence from CHARLS panel data. Chinese Journal of Population Science, 37(3), 82–96.

Liu, Y., Xu, W., Yang, Z., et al. (2025). Caregiving experiences of family caregivers of disabled middle-aged and older adults enrolled in long-term care insurance: A qualitative study. BMC Nursing, 24(1), 67. https://doi.org/10.1186/s12912-025-01281-9

Zhao, M., Zhao, Z. T., She, Z. X., et al. (2025). Long-term care insurance, end-of-life medical expenses, and value-based healthcare effects. Insurance Studies, (1), 68–80.

Ma, C., Yu, Q. W., Song, Z., et al. (2019). Long-term care insurance, medical cost control, and value-based healthcare. China Industrial Economics, (12), 42–59.

Zhu, M. L., & He, M. (2021). Does long-term care insurance crowd out family care? An empirical analysis based on CHARLS data from 2011 to 2018. Insurance Studies, (12), 21–38.

Zhou, B. W., & Zang, X. H. (2024). The impact of long-term care insurance on the financial vulnerability of elderly households: An empirical analysis based on CHARLS data. Economic Perspectives, (12), 111–127.

Chen, F., & Wang, R. T. (2024). Common prosperity effects of the long-term care insurance system: From the perspective of care decisions and risk sharing. The Journal of World Economy, 47(4), 154–183.

Chen, Q., & Liu, W. (2014). The impact of health expenditure on residents' asset allocation behavior: A discussion based on the homogeneity and heterogeneity debate. Shanghai Journal of Economics, (6), 111–118.

Costa, B. N., Shah, G. G., & Von Hinke, H. C. (2023). Family spillovers and long-term care insurance. Journal of Health Economics, 90, 102781. https://doi.org/10.1016/j.jhealeco.2023.102781

Kim, S., & Yoo, J. (2025). Effects of copayment reduction in long-term care insurance on medical utilization in South Korea. Journal of Aging & Social Policy, 37(3), 1–21. https://doi.org/10.1080/08959420.2025.2321245

Vanella, P., Wilke, B. C., & Heß, M. (2024). Long-term care in Germany in the context of the demographic transition—An outlook for the expenses of long-term care insurance through 2050. Econometrics, 12(4), 28. https://doi.org/10.3390/econometrics12040028

Huang, J. M., & Yu, X. L. (2025). Can long-term care insurance promote household consumption? A micro-perspective based on relative deprivation. Collected Essays on Finance and Economics, 1(13). Advance online publication.

Shu, Z., & Han, Y. (2022). The impact of long-term care insurance on intergenerational support among families of disabled elderly. Population and Development, 28(4), 143–154, 117.

Zhu, Z. Y. (2023). The impact of long-term care insurance on elderly family care. Chinese Journal of Population Science, 37(3), 97–114.

Xie, M. M., Yang, J., & Xie, X. (2024). The impact of long-term care insurance on catastrophic health expenditure among the elderly. Population and Development, 30(4), 156–166.

Zhu, J., Li, W., & Li, Z. F. (2024). The impact of long-term care insurance on rural household consumption levels: An empirical analysis based on CHARLS data. The Theory and Practice of Finance and Economics, 45(2), 104–111.

Yue, W., Wang, X., & Zhang, Q. (2021). Health risk, medical insurance, and household financial vulnerability. China Industrial Economics, (10), 175–192.

Xie, Y. F., & Feng, J. (2022). Has long-term care insurance narrowed the health gap among disabled elderly?. Insurance Studies, (10), 19–33.

Li, S., Zhang, L., & Fang, Y. (2024). Does social support alleviate the caregiving burden of adult children? Evidence from Chinese long-term care insurance pilot program. Journal of Aging & Social Policy, 37(3), 11–16. https://doi.org/10.1080/08959420.2024.2321244

Wang, Z., & Feng, J. (2021). The substitution effect of long-term care insurance on medical expenses and a comparison of different compensation models. China Economic Quarterly, 21(2), 557–576.

Chen, J., & Sun, P. (2020). The impact of population aging on household health expenditure in China: An analysis based on microdata. Productivity Research, (11), 114–118.

Ke, J., & Sun, F. (2025). Long-term care insurance and health inequality: Evidence from China. The International Journal of Health Planning and Management, 40(3), 594–606. https://doi.org/10.1002/hpm.3512

Zhang, K., Liu, Y., & Hu, H. (2024). Multidimensional poverty and disability of older adults in China: Will long-term care insurance make a difference? Applied Research in Quality of Life, 19(6), 1–24. https://doi.org/10.1007/s11482-024-10281-9

Sun, Z., Li, Y., & Gao, S. (2024). Residents’ cognition, attitudes, and intentions to participate in long-term care insurance: Moderating effect of policy support. Behavioral Sciences, 14(10), 895. https://doi.org/10.3390/bs14100895

Yin, M., & Hu, M. Y. (2016). Government health expenditure, economic development, and residents' health expenditure: An empirical test based on a panel threshold model. Taxation and Economy, (6), 30–36.

Xue, H. Y., & Zhang, Y. G. (2025). The impact of long-term care insurance on the health of the elderly: An empirical analysis based on CHARLS data. Journal of Guizhou University of Finance and Economics, (3), 20–30.