IDEAS home Printed from https://ideas.repec.org/p/mhe/chemon/2024-13.html
   My bibliography  Save this paper

Services and Cash: How Long-term Care Insurance Benefit Design Affects Household Behavior in China

Author

Listed:
  • Miao Guo

    (Hunan University)

  • Yang Li

    (University of Nottingham Ningbo China)

  • Minghao Wu

    (China Life Insurance Company Ltd.)

  • Terence C. Cheng

    (Harvard T.H. Chan School of Public Health & Monash University)

Abstract

This study analyzes the effects of China’s long-term care insurance (LTCI) benefit design on household consumption and intergenerational support. The program provides two benefit options: in-kind benefits (or services) and cash allowances. We introduce a conceptual framework to analyze economic decision making under the two types of LTCI benefits. Using an empirical framework that exploits variations in LTCI benefit designs across China’s pilot cities, we find that both types of LTCI benefits increase household consumption and reduce medical expenditure. Specifically, ‘mixed’ benefits households – those with a choice between in-kind and cash benefits – significantly increase spending on food and housing, while households receiving services spend more on housing, transport, and clothing. Additionally, in-kind benefit recipients report receiving lower informal care from their children, implying a substitution with formal care. Households with mixed benefits experience a decline in financial support from children, suggesting a crowding-out of intergenerational transfers. Finally, we estimate income and sub-stitution effects that are implicit in recipients’ behavior to analyze welfare implications under China’s LTCI.

Suggested Citation

  • Miao Guo & Yang Li & Minghao Wu & Terence C. Cheng, 2024. "Services and Cash: How Long-term Care Insurance Benefit Design Affects Household Behavior in China," Papers 2024-13, Centre for Health Economics, Monash University.
  • Handle: RePEc:mhe:chemon:2024-13
    as

    Download full text from publisher

    File URL: http://monash-ch-econ-wps.s3-ap-southeast-2.amazonaws.com/RePEc/mhe/chemon/2024-13.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Costa-Font, Joan & Jiménez-Martín, Sergi & Vilaplana-Prieto, Cristina, 2022. "Do Public Caregiving Subsidies and Supports affect the Provision of Care and Transfers?," Journal of Health Economics, Elsevier, vol. 84(C).
    2. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    3. Asako Ohinata & Matteo Picchio, 2020. "Financial support for long-term elderly care and household saving behaviour," Oxford Economic Papers, Oxford University Press, vol. 72(1), pages 247-268.
    4. Lei, Xiaoyan & Bai, Chen & Hong, Jingpeng & Liu, Hong, 2022. "Long-term care insurance and the well-being of older adults and their families: Evidence from China," Social Science & Medicine, Elsevier, vol. 296(C).
    5. Costa-Font, Joan & Jimenez-Martin, Sergi & Vilaplana, Cristina, 2018. "Does long-term care subsidization reduce hospital admissions and utilization?," Journal of Health Economics, Elsevier, vol. 58(C), pages 43-66.
    6. Christophe Courbage & Guillem Montoliu-Montes & Joël Wagner, 2020. "The effect of long-term care public benefits and insurance on informal care from outside the household: empirical evidence from Italy and Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1131-1147, November.
    7. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    8. Kim, Hyuncheol Bryant & Lim, Wilfredo, 2015. "Long-term care insurance, informal care, and medical expenditures," Journal of Public Economics, Elsevier, vol. 125(C), pages 128-142.
    9. Fu, Rong & Noguchi, Haruko & Kawamura, Akira & Takahashi, Hideto & Tamiya, Nanako, 2017. "Spillover effect of Japanese long-term care insurance as an employment promotion policy for family caregivers," Journal of Health Economics, Elsevier, vol. 56(C), pages 103-112.
    10. Liu, Hong & Ma, Jinqiu & Zhao, Liqiu, 2023. "Public long-term care insurance and consumption of elderly households: Evidence from China," Journal of Health Economics, Elsevier, vol. 90(C).
    11. Courbage, Christophe & Eeckhoudt, Louis, 2012. "On insuring and caring for parents’ long-term care needs," Journal of Health Economics, Elsevier, vol. 31(6), pages 842-850.
    12. Wang, Qun & Abiiro, Gilbert Abotisem & Yang, Jin & Li, Peng & De Allegri, Manuela, 2021. "Preferences for long-term care insurance in China: Results from a discrete choice experiment," Social Science & Medicine, Elsevier, vol. 281(C).
    13. Feng, Jin & Wang, Zhen & Yu, Yangyang, 2020. "Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China," Social Science & Medicine, Elsevier, vol. 258(C).
    14. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Liu, Hong & Ma, Jinqiu & Zhao, Liqiu, 2023. "Public long-term care insurance and consumption of elderly households: Evidence from China," Journal of Health Economics, Elsevier, vol. 90(C).
    2. Ai, Jingyi & Feng, Jin & Zhang, Xiaohan, 2024. "Long-term care insurance coverage and labor force participation of older people: Evidence from China," China Economic Review, Elsevier, vol. 86(C).
    3. Jiayi Wen & Xiaoqing Yu, 2024. "Insuring Long-Term Care in Developing Countries: The Interaction between Formal and Informal Insurance," Papers 2408.14243, arXiv.org.
    4. Costa-Font, Joan & Jiménez-Martín, Sergi & Vilaplana-Prieto, Cristina, 2022. "Do Public Caregiving Subsidies and Supports affect the Provision of Care and Transfers?," Journal of Health Economics, Elsevier, vol. 84(C).
    5. Luo, Yanan & Yuan, Kexin & Li, Yuxiao & Liu, Yating & Pan, Yao, 2024. "The “spillover effect” of long-term care insurance in China on spouses’ health and well-being," Social Science & Medicine, Elsevier, vol. 340(C).
    6. Hollingsworth, Bruce & Ohinata, Asako & Picchio, Matteo & Walker, Ian, 2022. "Does It Matter Who Cares for You? The Effect of Substituting Informal with Formal Personal Care on the Care Recipients' Health," IZA Discussion Papers 15457, Institute of Labor Economics (IZA).
    7. Bas Scheer & Wiljan van den Berge & Maarten Goos & Alan Manning & Anna Salomons, 2022. "Alternative Work Arrangements and Worker Outcomes: Evidence from Payrolling," CPB Discussion Paper 435, CPB Netherlands Bureau for Economic Policy Analysis.
    8. Alex Hollingsworth & Krzysztof Karbownik & Melissa A. Thomasson & Anthony Wray, 2024. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," American Economic Review, American Economic Association, vol. 114(7), pages 2201-2238, July.
    9. Jack (Peiyao) Ma & Andrea Mantovani & Carlo Reggiani & Annette Broocks & Néstor Duch-Brown, 2024. "The Price Effects of Prohibiting Price Parity Clauses: Evidence from International Hotel Groups," Economics Series Working Papers 1043, University of Oxford, Department of Economics.
    10. Luo, Lianfa & Cheng, Zhiming & Ye, Qingqing & Cheng, Yanjun & Smyth, Russell & Yang, Zhiqing & Zhang, Le, 2024. "Nonmonetary awards and innovation: Evidence from winning China's Top Brand Contest," China Economic Review, Elsevier, vol. 86(C).
    11. Hashida, Yukiko & Dundas, Steven J., 2023. "The effects of a voluntary property buyout and acquisition program on coastal housing markets: Evidence from New York," Journal of Environmental Economics and Management, Elsevier, vol. 121(C).
    12. Jaraitė, Jūratė & Kurtyka, Oliwia & Ollivier, Hélène, 2022. "Take a ride on the (not so) green side: How do CDM projects affect Indian manufacturing firms’ environmental performance?," Journal of Environmental Economics and Management, Elsevier, vol. 114(C).
    13. Xin Nie & Jianxian Wu & Han Wang & Weijuan Li & Chengdao Huang & Lihua Li, 2022. "Contributing to carbon peak: Estimating the causal impact of eco‐industrial parks on low‐carbon development in China," Journal of Industrial Ecology, Yale University, vol. 26(4), pages 1578-1593, August.
    14. Kristensen, Frederikke Frehr & Sharp, Paul, 2021. "Disease Surveillance, Mortality and Race: The Case of HIV/AIDS in the United States," CAGE Online Working Paper Series 553, Competitive Advantage in the Global Economy (CAGE).
    15. Cl'ement de Chaisemartin & Xavier D'Haultf{oe}uille, 2020. "Difference-in-Differences Estimators of Intertemporal Treatment Effects," Papers 2007.04267, arXiv.org, revised Dec 2024.
    16. Qi, Yu & Yin, Aoxue & Chen, Jianwei & Yang, Chunfei & Zhan, Pengyu, 2024. "Motivating for environmental protection: Evidence from county officials in China," World Development, Elsevier, vol. 184(C).
    17. Simon Freyaldenhoven & Christian Hansen & Jorge Perez Perez & Jesse Shapiro, 2021. "Visualization, Identification, and stimation in the Linear Panel Event-Study Design," Working Papers 21-44, Federal Reserve Bank of Philadelphia.
    18. Mikhail Mamonov & Anna Pestova & Steven Ongena, 2023. "“Crime and Punishment”? How Banks Anticipate and Propagate Global Financial Sanctions," CERGE-EI Working Papers wp753, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
    19. Li, Daiyue & Jin, Yanhong & Cheng, Mingwang, 2024. "Unleashing the power of industrial robotics on firm productivity: Evidence from China," Journal of Economic Behavior & Organization, Elsevier, vol. 224(C), pages 500-520.
    20. Timothy K. M. Beatty & Joakim A. Weill, 2024. "Social Security and High-Frequency Labor Supply: Evidence from Uber Drivers," Finance and Economics Discussion Series 2024-079, Board of Governors of the Federal Reserve System (U.S.).

    More about this item

    Keywords

    Long-term Care Insurance; Benefit Design; In-kind Benefits; Cash Benefits; Household Consumption;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D10 - Microeconomics - - Household Behavior - - - General

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:mhe:chemon:2024-13. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Johannes Kunz (email available below). General contact details of provider: https://edirc.repec.org/data/dxmonau.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.