Rapid population aging has led countries to consider the introduction of long-term care insurance (LTCI) as an essential component of a comprehensive social health protection package. Limited evidence, however, exists on people's preferences for such insurance products, especially in countries where their availability is still restricted. Using a discrete choice experiment (DCE), we investigated preferences, willingness to pay, and heterogeneity in preferences for attributes of a social LTCI among community members in China. We adopted a multi-methods approach, combining information across different data sources to identify five DCE attributes: individual premium, benefit package, coverage ceiling, government subsidy for participants, and reimbursement of home-based care provided by family caregivers. We constructed our experiment using a D-efficient design and ran the DCE survey among 1067 community members in urban and rural areas in Shenyang and Dalian, Liaoning Province from Dec 2019 to Jan 2020. We relied on a panel mixed logit model to analyze the data. Our findings indicated that people had significantly higher preferences for the LTCI product with a higher coverage ceiling, a lower individual premium, a higher government subsidy, a reimbursement of home-based care provided by family caregivers, and an expansion of the benefit package to also include necessary daily assistance. The coverage ceiling was found to be the most important attribute, followed by the reimbursement of home-based care provided by family caregivers and the individual premium. Our findings also revealed that the area of residence, prior commercial insurance ownership, age, having children, and income were the factors that drove heterogeneity in preferences for LTCIs. These findings bear important policy implications, as they provide clear guidance on product design, enabling decision-makers to increase the attractiveness and sustainability of LTCI.

Evidence from population-based studies on the economic burden imposed by chronic non-communicable diseases (CNCDs) is still sparse in Sub-Saharan Africa. Our study aimed to fill this existing gap in knowledge by estimating both the household direct, indirect, and total costs incurred due to CNCDs and the economic burden households bear as a result of these costs in Malawi. The study used data from the first round of a longitudinal household health survey conducted in 2012 in three rural districts in Malawi. A cost-of-illness method was applied to estimate the economic burden of CNCDs. Indicators of catastrophic spending and impoverishment were used to estimate the economic burden imposed by CNCDs on households. A total 475 out of 5643 interviewed individuals reported suffering from CNCDs. Mean total costs of all reported CNCDs were 1,040.82 MWK, of which 56.8 % was contributed by direct costs. Individuals affected by chronic cardiovascular conditions and chronic neuropsychiatric conditions bore the highest levels of direct, indirect, and total costs. Using a threshold of 10 % of household non-food expenditure, 21.3 % of all households with at least one household member reporting a CNCD and seeking care for such a condition incurred catastrophic spending due to CNCDs. The poorest households were more likely to incur catastrophic spending due to CNCDs. An additional 1.7 % of households reporting a CNCD fell under the international poverty line once considering direct costs due to CNCDs. Our study showed that the economic burden of CNCDs is high, causes catastrophic spending, and aggravates poverty in rural Malawi, a country where in principle basic care for CNCDs should be offered free of charge at point of use through the provision of an Essential Health Package (EHP). Our findings further indicated that particularly high direct, indirect, and total costs were linked to specific diagnoses, although costs were high even for conditions targeted by the EHP. Our findings point at clear gaps in coverage in the current Malawian health system and call for further investments to ensure adequate affordable care for people suffering from CNCDs.

The aim of this study was to estimate willingness to pay (WTP) for long-term care insurance (LTCI) and to explore the determinants of demand for LTCI in China. We collected data from a household survey conducted in Qinghai and Zhejiang on a sample of 1842 households. We relied on contingent valuation methods to elicit the demand for LTCI and random effects logistic regression to analyze the factors associated with the demand for LTCI. Complementarily, we used document analysis to compare the LTCI designed in this study and the current LTCI policies in the pilot cities. More than 90% of the respondents expressed their willingness to buy LTCI. The median WTP for LTCI was estimated at 370.14 RMB/year, accounting for 2.29% of average annual per capita disposable income. Price, age, education status, and income were significantly associated with demand for LTCI. Most pilot cities were found to mainly rely on Urban Employees Basic Medical Insurance funds as the financing source for LTCI. Considering that financing is one of the greatest challenges in the development of China’s LTCI, we suggest that policy makers consider individual contribution as an important and possible option as a source of financing for LTCI.

Home and community care is an important way to actively respond to population aging and to promote healthy aging. This study aims to estimate the effect of using home and community care services on the multidimensional health of older adults. We used data from the China Health and Retirement Longitudinal Study conducted in 2018 and relied mainly on the propensity score matching method for data analysis. The results showed that using home and community care increased the probability of maintaining and improving physical health by 2.9%, decreased the score of depression by 0.471, and improved the score of cognitive function by 0.704. Using home and community care also increased the probability of actively participating in life by 4.1% and elevated the score of life satisfaction by 0.088. The heterogeneity analysis showed that the use of home and community care had a significant effect on promoting all health indicators in rural older adults and a more obvious promoting effect on the social adaptation of urban older adults. Using home and community care significantly promoted the multidimensional health of people aged 60 to 79 years but had no impact among people aged ≥ 80 years. The use of home and community care significantly improved all health indicators in non-disabled older adults. Whereas, it only improved the levels of cognitive function and life satisfaction in disabled older people. Using this form of care significantly improved all health indicators in those with low socio-economic status, but it only had a partial positive effect on the multidimensional health of those with high socio-economic status. Our results are of importance to the government as they may be used to further improve the quality of home and community care services for the targeted older population.

Exploring the influence of farmland transfer on poverty among the mid-aged and elderly rural households is of great value in preventing them from returning to poverty and in solving the problem of rural poverty. Based on the propensity score matching with differences in differences approach, this paper measures and compares the effects of farmland transfer-in and transfer-out on the vulnerability to poverty of the mid-aged and elderly rural households by using the tracking survey of China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. The findings reveal that: (1) The anti-poverty effect of farmland transfer is “asymmetric”. Farmland transfer-in can significantly reduce the vulnerability to poverty of the lessee households, but farmland transfer-out has no such effect. (2) Obvious regional and household differences exist in the anti-poverty effect of farmland transfer. The anti-poverty effects of farmland transfer-in in the eastern and central regions are higher than in other regions. The greater vulnerability to poverty is associated with the more obvious anti-poverty effect of farmland transfer-in. These results benefit the government to strengthen the reforms related to farmland transfer and anti-poverty.