Evaluating the impact of long-term care insurance reform on health-related quality of life and inequality among older adults in China: A quasi-experimental analysis

Less is known about whether and to what extent Long-Term Care Insurance (LTCI) promotes the Health-Related Quality of Life (HRQoL) of older individuals, a vital health outcome for healthy aging. This study utilizes longitudinal data from CHARLS and employs the widely-used EQ-5D-3L method to measure HRQoL. Using the LTCI pilot-which has been implemented in a staggered manner since 2012-as a quasi-experiment, we apply a difference-in-differences approach and find that LTCI increases the HRQoL of older adults aged 60 and older by 1.5%-2% and those aged 70+ by 3.3%. These results suggest that the public LTCI reform in China enhances the HRQoL for the older individuals but only to a relatively modest degree. This minor improvement in HRQoL is primarily driven by increased utilization of formal care, reduced financial strain due to decreased medical expenses, and increased psychological well-being. However, we also find that the current LTCI reform, which mainly targets urban employees and residents, inadvertently exacerbates the urban-rural disparity in HRQoL of older adults.