Assessing the Sustainability of Long-Term Care Insurance Systems Based on a Policy–Population–Economy Complex System: The Case Study of China
Abstract
:1. Introduction
2. Literature Review
3. Characteristics of China’s LTCI Pilot Scheme
4. Materials and Methods
4.1. Study Design
4.1.1. Data Collection
4.1.2. Participants
4.2. Methods
4.2.1. Text Analysis of Pilot Policies
4.2.2. Policy Modeling Consistency (PMC) Index
4.2.3. Coupling Coordination Degree
5. Results
5.1. Descriptions of Policy Documents
5.2. PMC Index and Ranking
5.3. Coupling Coordination Degree
6. Discussion
6.1. Common Characteristics of the LTCI Pilot Cities with a Higher Policy Strength
6.2. Main Weaknesses of LTCI Policy Modeling
6.3. Influencing Aspects on Coupling Coordination Degree
6.4. Policy Implications
7. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
City | Insured Population | Financing Source | Care Provision Place | Care Service | Eligibility |
---|---|---|---|---|---|
Anqing | UE basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies | Medical institution; nursing institution; home | Medical care; daily-life care; rehabilitation care | Disability |
Changchun | UE basic medical insurance participants; urban residents | UE or URR pooled fund | Medical institution; nursing institution | Medical care; daily-life care; preventive care | Disability |
Chende | UE basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies | Nursing institution; community; home | Daily-life care; preventive care; rehabilitation care | Disability |
Chengdu | UE basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies | Medical institution; nursing institution; home | Medical care; daily-life care | Disability; dementia |
Chongqing | UE basic medical insurance participants | UE or URR pooled funds; individual contribution | Medical institution; nursing institution; community; home | Medical care; daily-life care | Disability |
Guangzhou | UE basic medical insurance participants | UE or URR pooled fund | Medical institution; nursing institution; community; home | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling | Disability |
Jingmen | UE or URR basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies | Medical institution; nursing institution; home | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling; hospice care | Disability |
Nantong | UE or URR basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies | Medical institution; nursing institution; community; home | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling | Disability; dementia |
Ningbo | UE basic medical insurance participants | UE or URR pooled fund | Medical institution; nursing institution | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling | Disability; dementia |
Qingdao | UE or URR basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies | Medical institution; nursing institution; community; home | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling; hospice care | Disability; dementia |
Qiqihaer | UE basic medical insurance participants | UE or URR pooled funds; individual contribution | Medical institution; nursing institution; home | Medical care; daily-life care; preventive care; rehabilitation care | Disability |
Shanghai | UE or URR basic medical insurance participants | UE or URR pooled fund | Medical institution; nursing institution; community; home | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling; hospice care | Disability; dementia |
Shangrao | UE or URR basic medical insurance participants | UE or URR pooled funds; individual contribution; government subsidies; employer contribution | Medical institution; nursing institution; home | Medical care; daily-life care; rehabilitation care | Disability |
Suzhou | UE or URR basic medical insurance participants | UE or URR pooled funds; government subsidies | Medical institution; nursing institution; community; home | Medical care; daily-life care; preventive care; rehabilitation care; psychological counseling | Disability |
Appendix B
City | X1 | X2 | X3 | ||||||
---|---|---|---|---|---|---|---|---|---|
X11 | X12 | X13 | X14 | X21 | X22 | X23 | X24 | X31 | |
Anqing | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 |
Changchun | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
Chende | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
Chengdu | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Chongqing | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 |
Guangzhou | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 |
Jingmen | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
Nantong | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Ningbo | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Qingdao | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
Qiqihaer | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Shanghai | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
Shangrao | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 |
Suzhou | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
City | X3 | X4 | X5 | ||||||
X32 | X33 | X41 | X42 | X43 | X44 | X51 | X52 | X53 | |
Anqing | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 0 |
Changchun | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 0 |
Chende | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 1 |
Chengdu | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 0 |
Chongqing | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 1 |
Guangzhou | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 |
Jingmen | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 |
Nantong | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 |
Ningbo | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 0 |
Qingdao | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 |
Qiqihaer | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 0 |
Shanghai | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 |
Shangrao | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 |
Suzhou | 1 | 1 | 1 | 0 | 1 | 0 | 1 | 1 | 1 |
City | X5 | X6 | X7 | ||||||
X54 | X61 | X62 | X63 | X64 | X65 | X66 | X71 | X72 | |
Anqing | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 |
Changchun | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 |
Chende | 1 | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 1 |
Chengdu | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 |
Chongqing | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 |
Guangzhou | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
Jingmen | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Nantong | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
Ningbo | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
Qingdao | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Qiqihaer | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 |
Shanghai | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Shangrao | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 |
Suzhou | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
City | X7 | X8 | X9 | ||||||
X73 | X74 | X75 | X81 | X82 | X83 | X84 | X91 | X92 | |
Anqing | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 |
Changchun | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 0 |
Chende | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 0 |
Chengdu | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Chongqing | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
Guangzhou | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 0 |
Jingmen | 1 | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 1 |
Nantong | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 |
Ningbo | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 |
Qingdao | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Qiqihaer | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 |
Shanghai | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 |
Shangrao | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 |
Suzhou | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 |
Appendix C
City | Top 10 High-Frequency Words |
---|---|
Anqing | long-term care (237); insurance (180); service (149); institution (136); fund (64); the insured (61); benefit (60); standard (45); disability (44); medical insurance (34) |
Changchun | long-term care (340); medical care (241); insurance (135); institution (125); designated (76); insurance (72); population coverage (72); payment (53); contribution (44); fund (42) |
Chende | long-term care (26); insurance (23); institution (21); designated (16); standard (13); service (13); urban and rural residents (7); fund (7); disability (7); health care (6) |
Chengdu | long-term care (489); dementia (233); insurance (139); service (115); institution (109); disability (74); population coverage (74); standard (72); management (63); medical insurance (61) |
Chongqing | long-term care (111); institution (102); service (55); insurance (47); management (30); medical insurance (23); fund (21); disability (18); standard (18); evaluation (15) |
Guangzhou | long-term care (230); institution (214); assessment (195); service (176); population coverage (95); disability (83); designated (61); equipment (59); fund (56); medical care (53) |
Jingmen | long-term care (275); service (183); institution (156); insurance (93); designated (82); medical insurance (58); guarantee (41); fund (39); population coverage (33); management (33) |
Nantong | long-term care (782); service (570); insurance (347); institution (259); designated (158); disability (138); management (93); population coverage (89); appraise (89); the disabled (88) |
Ningbo | service (376); assessment (265); long-term care (172); institution (155); elderly care (148); the elderly (131); insurance (130); home-based (99); management (78); disability (68) |
Qingdao | long-term care (287); institution (198); service (144); assessment (89); designated (80); insurance (70); management (68); evaluation (56); health care (40); medical institution (34) |
Qiqihaer | long-term care (451); insurance (214); service (186); institution (153); population coverage (100); disability (64); fund (61); benefit (53); designated (46); ranking (45) |
Shanghai | service (597); long-term care (560); institution (262); elder care (171); subsidy (158); designated (156); insurance (154); assessment (129); medical insurance (106); the disabled (70) |
Shangrao | long-term care (538); institution (364); service (336); insurance (201); assessment (170); disability (127); designated (120); management (110); fund (86); medical insurance (65) |
Suzhou | long-term care (583); institution (419); service (284); assessment (231); insurance (148); the insured (119); disability (116); commercial insurance (108); home-based (86); management (63) |
Total | long-term care (5226); service (3283); institution (2738); insurance (1965); assessment (1208); designated (967); population coverage (798); disability (854); management (762); fund (629) |
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Main Variables | Sub-Variables | Sub-Variables | |||
---|---|---|---|---|---|
X1 | Policy function | X11 X13 | System innovation Standardized guidance | X12 X14 | Managerial supervision Government support |
X2 | Policy scheme | X21 X23 | Well-founded Clear objective | X22 X24 | Clear responsibility Personnel training |
X3 | Population coverage | X31 X33 | Urban employees Urban and rural residents | X32 | Urban residents |
X4 | Funding source | X41 X43 | Medical insurance fund Financial subsidy | X42 X44 | Individual payment Employer’s subsidy |
X5 | Care setting | X51 X53 | Health care facility Community | X52 X54 | Residential care facility Home |
X6 | Care service | X61 X63 X65 | Medical care Preventive care Psychological counseling | X62 X64 X66 | Daily living care Rehabilitation care Hospice care |
X7 | Long-term care institution | X71 X73 X75 | Hospital Geriatric hospital Daycare facility | X72 X74 | Eldercare facilities Community health service center |
X8 | Payment method | X81 X83 | Fixed payment Paid daily | X82 X84 | Paid proportionally from the fund Paid monthly |
X9 | Benefit eligibility | X91 | Disability | X92 | Dementia |
City | GDP Per Capita (USD) | The Proportion of Older Adults Aged 65+ | Policy Documents | |||
---|---|---|---|---|---|---|
Total Number of Documents | Number of Valid Documents | Number of Invalid Documents | Number of Words | |||
Anqing | 7960.35 | 13.73 | 5 | 4 | 1 | 13,217 |
Changchun | 12,105.00 | 12.63 | 4 | 4 | 0 | 14,456 |
Chende | 6462.59 | 11.73 | 3 | 1 | 2 | 11,789 |
Chengdu | 16,272.96 | 14.27 | 5 | 4 | 1 | 26,825 |
Chongqing | 11,935.33 | 15.34 | 2 | 2 | 0 | 6510 |
Guangzhou | 24,621.61 | 12.57 | 7 | 2 | 5 | 51,012 |
Jingmen | 11,049.95 | 13.07 | 5 | 4 | 1 | 18,663 |
Nantong | 20,182.39 | 24.39 | 14 | 12 | 2 | 40,771 |
Ningbo | 22,532.91 | 16.79 | 6 | 6 | 0 | 24,391 |
Qingdao | 19,561.99 | 13.15 | 17 | 5 | 12 | 64,568 |
Qiqihaer | 3567.79 | 8.14 | 5 | 4 | 1 | 21,430 |
Shanghai | 24,755.71 | 17.86 | 19 | 13 | 6 | 50,440 |
Shangrao | 5798.46 | 11.05 | 6 | 6 | 0 | 26,844 |
Suzhou | 12,293.10 | 17.70 | 10 | 9 | 1 | 30,513 |
Total | — | — | 108 | 76 | 32 | 401,429 |
City | X1 | X2 | X3 | X4 | X5 | X6 | X7 | X8 | X9 | PMC Index | Ranking |
---|---|---|---|---|---|---|---|---|---|---|---|
Anqing | 1.000 | 0.500 | 0.333 | 0.750 | 0.750 | 0.500 | 0.600 | 1.000 | 0.500 | 0.593 | 11 |
Changchun | 0.750 | 0.750 | 0.667 | 0.250 | 0.500 | 0.500 | 0.600 | 0.750 | 0.500 | 0.527 | 14 |
Chengde | 0.750 | 0.750 | 0.333 | 0.750 | 0.750 | 0.500 | 0.800 | 1.000 | 0.500 | 0.613 | 8 |
Chengdu | 0.750 | 1.000 | 0.333 | 0.750 | 0.750 | 0.333 | 0.800 | 0.750 | 1.000 | 0.647 | 6 |
Chongqing | 0.250 | 1.000 | 0.333 | 0.500 | 1.000 | 0.333 | 1.000 | 0.750 | 0.500 | 0.567 | 13 |
Guangzhou | 1.000 | 0.500 | 0.333 | 0.250 | 1.000 | 0.833 | 0.600 | 1.000 | 0.500 | 0.602 | 9 |
Jingmen | 0.250 | 1.000 | 1.000 | 0.750 | 0.750 | 1.000 | 0.800 | 1.000 | 0.500 | 0.705 | 4 |
Nantong | 1.000 | 1.000 | 1.000 | 0.750 | 1.000 | 0.833 | 0.800 | 1.000 | 1.000 | 0.838 | 2 |
Ningbo | 1.000 | 1.000 | 0.333 | 0.250 | 0.500 | 0.833 | 0.600 | 0.500 | 1.000 | 0.602 | 10 |
Qingdao | 0.750 | 1.000 | 1.000 | 0.750 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 0.850 | 1 |
Qiqihaer | 0.750 | 1.000 | 0.333 | 0.500 | 0.750 | 0.500 | 0.600 | 0.750 | 0.500 | 0.568 | 12 |
Shanghai | 1.000 | 0.750 | 1.000 | 0.250 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 0.800 | 3 |
Shangrao | 0.500 | 1.000 | 1.000 | 1.000 | 0.750 | 0.500 | 0.600 | 0.500 | 0.500 | 0.635 | 7 |
Suzhou | 1.000 | 0.750 | 1.000 | 0.500 | 1.000 | 0.833 | 0.800 | 0.500 | 0.500 | 0.688 | 5 |
Mean | 0.768 | 0.857 | 0.643 | 0.571 | 0.821 | 0.679 | 0.757 | 0.821 | 0.679 | ||
Dispersion coefficient | 0.349 | 0.220 | 0.517 | 0.435 | 0.221 | 0.366 | 0.212 | 0.251 | 0.366 |
City | PPE Subsystem Development Level | Coupling Coordination Degree | ||||||
---|---|---|---|---|---|---|---|---|
Policy Subsystem | Population Subsystem | Economy Subsystem | Between Policy and Population | Between Policy and Economy | PPE System | Ranking of PPE System | Coordination Level of PPE System * | |
Anqing | 0.593 | 0.344 | 0.052 | 0.964 | 0.546 | 0.469 | 12 | Low |
Changchun | 0.527 | 0.402 | 0.153 | 0.991 | 0.835 | 0.565 | 10 | Low |
Chengde | 0.613 | 0.310 | 0.037 | 0.945 | 0.461 | 0.437 | 13 | Low |
Chengdu | 0.647 | 0.450 | 0.354 | 0.984 | 0.956 | 0.685 | 7 | Basic |
Chongqing | 0.567 | 0.545 | 0.384 | 1.000 | 0.981 | 0.701 | 5 | Basic |
Guangzhou | 0.602 | 0.209 | 0.719 | 0.875 | 0.996 | 0.670 | 8 | Basic |
Jingmen | 0.705 | 0.399 | 0.132 | 0.961 | 0.729 | 0.578 | 9 | Low |
Nantong | 0.838 | 0.990 | 0.345 | 0.997 | 0.909 | 0.812 | 2 | Good |
Ningbo | 0.602 | 0.503 | 0.543 | 0.996 | 0.999 | 0.740 | 4 | Basic |
Qingdao | 0.850 | 0.334 | 0.408 | 0.900 | 0.936 | 0.698 | 6 | Basic |
Qiqihaer | 0.568 | 0.322 | 0.029 | 0.961 | 0.430 | 0.418 | 14 | Low |
Shanghai | 0.800 | 0.693 | 0.976 | 0.997 | 0.995 | 0.903 | 1 | Excellent |
Shangrao | 0.635 | 0.196 | 0.097 | 0.849 | 0.677 | 0.479 | 11 | Low |
Suzhou | 0.688 | 0.398 | 0.620 | 0.964 | 0.999 | 0.744 | 3 | Basic |
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Peng, R.; Deng, X.; Xia, Y.; Wu, B. Assessing the Sustainability of Long-Term Care Insurance Systems Based on a Policy–Population–Economy Complex System: The Case Study of China. Int. J. Environ. Res. Public Health 2022, 19, 6554. https://doi.org/10.3390/ijerph19116554
Peng R, Deng X, Xia Y, Wu B. Assessing the Sustainability of Long-Term Care Insurance Systems Based on a Policy–Population–Economy Complex System: The Case Study of China. International Journal of Environmental Research and Public Health. 2022; 19(11):6554. https://doi.org/10.3390/ijerph19116554
Chicago/Turabian StylePeng, Rong, Xueqin Deng, Yinghua Xia, and Bei Wu. 2022. "Assessing the Sustainability of Long-Term Care Insurance Systems Based on a Policy–Population–Economy Complex System: The Case Study of China" International Journal of Environmental Research and Public Health 19, no. 11: 6554. https://doi.org/10.3390/ijerph19116554