Long‐Term Care Insurance and Catastrophic Health Spending at the End of Life Among Older Adults: Evidence From China
利用中国长期护理保险试点政策，研究发现该保险能显著降低老年人临终前5年的灾难性医疗支出概率约36-52个百分点，且不损害健康，通过替代激进治疗为持续护理支持实现。
End-of-life (EOL) health spending imposes catastrophic financial burdens on elderly households, pushing them into poverty without corresponding improvements in health outcomes. Leveraging the quasi-experiment of China's public long-term care insurance (LTCI) pilot program, this study employs data from the China Longitudinal Healthy Longevity Survey to examine the impact of LTCI on catastrophic health spending (CHS) at the end of life. The findings indicate that over the 5-year EOL period, LTCI significantly decreases the probability of CHS by approximately 36.1-52.3 percentage points and reduces out-of-pocket health spending. Furthermore, the study demonstrates that LTCI reduces CHS without compromising EOL health by substituting aggressive medical interventions with sustained long-term care support, which leads to fewer severe-illness episodes, shorter hospital stays, and reduced dependency. These findings provide empirical evidence for the role of LTCI in facilitating value-based healthcare at the end of life, with significant implications for establishing universal LTCI systems in China and other countries.