Study finds a higher care-gap share in China's care insurance pilots

Adoption of China's long-term care insurance pilots was associated with a higher severe care-gap proxy by 2020, according to a study published July 21 in BMC Geriatrics by Hongwei Zheng and Wanping Chen of Quanzhou Medical College. Using the China Health and Retirement Longitudinal Study from 2011 to 2020, and a staggered difference-in-differences model comparing early-adopter pilot cities with never-pilot cities among respondents aged 60 years or older at first observation, the authors report an ATT of 0.023, with a 95% confidence interval of 0.001–0.045.

The proxy counts an older adult who reports difficulty with activities of daily living or instrumental activities of daily living and receives no help. Zheng and Chen report that estimates were directionally larger in cities whose policy texts did not explicitly include in-kind home- and community-based services — delivered services such as home-visit provision, rather than a benefit named on paper — and that formal and community home-based care did not measurably expand over the same period. They bound the result tightly: the estimand describes care-gap trajectories among older adults with functional limitations, not effects among confirmed beneficiaries or formally eligible disabled older adults, and they write that pandemic disruption, measurement differences, attrition, and compositional shifts may have contributed to the 2020 pattern. The proxy showed high specificity and positive predictive value but limited sensitivity.

Medicare covers home health only for people who are homebound and need part-time or intermittent skilled care, and it does not pay for custodial or personal care with daily living when that is the only care needed. AARP's Public Policy Institute counted 59 million family caregivers of adults providing 49.5 billion hours of care in 2024, an economic value exceeding $1 trillion. CDC, which counts over 53 million unpaid caregivers, states that unpaid caregiving can reduce the need for paid services from many sectors; nearly 2 in 10 employed caregivers report having to stop working entirely, and 4 in 10 have had to reduce their working hours.