Does long-term care insurance promote assistive device utilization? Evidence from pilot regions in China

BACKGROUND: As China's population aging rapidly, long-term care insurance (LTCI) has emerged as a critical policy instrument to address the care needs of older adults. While previous studies have examined the effects of LTCI on service utilization, less is known about its effect on assistive device utilization-a key component in supporting functional independence and reducing caregiver burden. This study examines the association between LTCI benefit design and assistive device use among older adults in China. METHODS: We use cross-sectional data from 1,460 older adults residing in elderly care institutions located in non-pilot areas, general LTCI pilot areas (covering care services only), and special LTCI pilot areas (covering both care services and assistive devices). Logistic regression models were used to estimate the associations between LTCI benefit types and assistive device use. Robustness checks were conducted using propensity score matching (PSM), and subgroup analyses were performed by age, education, and household registration. RESULTS: General LTCI programs that cover care service only were significantly associated with a lower probability of assistive device use, consistent with a potential substitution effect in which subsidized formal care services may replace the need for assistive devices. In contrast, LTCI programs that explicitly include assistive device benefits were associated with a higher probability of assistive device use. These associations were more pronounced among the oldest-old, individuals with urban household registration, and those with lower education levels. Additional analyses indicate that the observed associations are primarily driven by mobility-related devices, whereas estimates for ADL-related devices and total device counts are not statistically significant. CONCLUSION: The findings suggest that the design of LTCI benefit packages may influence older adults' care choices and technology adoption. While causal interpretation remains limited, the results highlight the potential role of benefit design in shaping the balance between formal care services and assistive technology use. Expanding assistive device coverage and improving accessibility may help support functional independence among older adults in ageing societies, particularly in underserved rural regions.