Study on the Long-Term Care Service System for Disabled Elderly

People in China

Xiao Tong

†

and Xianping Zheng

School of Economic and Management, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China

Keywords:

Disabled Elderly People, Long-Term Care, Influencing Factors.

Abstract: In this study, the national baseline survey data from CHARLS 2015 and 2018 were selected, the ADL scale

was judged for the elderly disability, and the elderly over 60 years old were selected to analyze the influencing

factors of elderly disability. The results showed that self-rated health, depression, body pains, age, and gender

were important factors affecting disability in the elderly. While the degree of aging is gradually deepening,

the scale of the disabled people is also expanding rapidly, leading to the increasing demand for long-term

care.

1 INTRODUCTION

Population aging is one of the major problems facing

in China's social and economic development, and the

risk pressure of long-term care is increasing. In 1999,

China's population over 60 years of age was about

88.13 million, accounting for 10% of the total

population in the same period, marking China's

official entry into an aging population society. In

recent years, with the change of population size and

structure in China, the degree of population aging is

increasing, and at the same time, the disabled patients

have also increased rapidly. According to the latest

data released by the China Commission on Aging, the

number of disabled and semi-disabled elderly people

in China has exceeded 40 million. The problem of

long-term care guarantee for disabled people is

becoming more and more prominent, and it needs to

be solved urgently. The fourth sampling survey of the

elderly in China shows that the incidence of oral

disability in China is 18.3%.According to a rough

estimate, the number of disabled elderly people in

China will reach 66.3375 million by 2030, an increase

of 26 million compared with 2015.It can be seen that

with the aggravation of the aging population, the

increasing number of disabled elderly people, and the

reduction of family functions, China's long-term care

service demand will increase sharply, and the long-

term care cost sharing and fund raising guarantee

mechanism need to be improved, so the long-term care

insurance system needs to be established and

improved.

As the key guarantee object of long-term care

insurance, the disabled elderly is the core content of

providing high-quality and efficient long-term care

service to that of the disabled elderly, and the

establishment and improvement of the long-term care

service system for the disabled elderly is the meaning

of the problem to deal with the aging problem in

China.

2 RESEARCH ANALYSIS ON

LONG-TERM CARE

INSURANCE AT HOME AND

ABROAD

In recent years, under the background of an aging

society, the long-term care insurance system has been

paid more and more attention in many countries.

According to foreign research, the construction of

long-term care insurance system in developed

countries is relatively earlier, and the relevant

literature research is naturally relatively rich. In

theory, foreign research on the long-term care

insurance system is divided into three modes: the

social insurance model represented by Japan and

Germany, the business operation model represented

by the United States, and the commercial insurance

model supplemented by the UK allowance. As the

Tong, X. and Zheng, X.

Study on the Long-Term Care Service System for Disabled Elderly People in China.

DOI: 10.5220/0012020400003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 319-324

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

319

pioneers of the establishment of the long-term care

insurance system, the Netherlands and Germany have

established a relatively mature long-term care

insurance system and a relatively perfect social

security system (Frederik, 2010). For these developed

countries that have entered the period of development

and reform (Mosca, 2017), foreign scholars have

shifted their research focus to how to control the

service expenditure of long-term care insurance to

establish sustainable development policies (Dai,

2021).

According to domestic research, due to the

different national conditions, social culture,

population aging degree and social system, China's

long-term care insurance system started relatively

late, and it is still in the pilot stage. Many scholars

take this as the starting point to study the pilot

situation of Chinese long-term care insurance system,

mainly focusing on the following three aspects: one

is to explore the local long-term care insurance

system suitable for China based on the dialectical

study of foreign experience; the second is to analyze

the current situation and problems of the existing pilot

cities and make targeted suggestions; the third is the

disability scale measurement and demand analysis.

Although domestic scholars have made

corresponding results in studying the long-term care

insurance system, there are still two deficiencies.

First, the adopted data lag behind and lack timeliness,

and it is difficult to meet the latest policy and social

development situation. The second is to be limited to

regional data research, while ignoring the nature of

long-term care socialization, and the lack of

systematic and holistic research, but this also leaves

room and possibility for this study. Based on the

existing research results, this paper uses the national

data provided by CHARLS to explore the influencing

factors of the elderly oral disability in China (Yang,

2016), so as to provide a reference for improving the

long-term care service system of the disabled elderly

population.

3 DATA PROCESSING AND

VARIABLE SETTINGS

3.1 Data Processing

This article selects the China Health and Retirement

Longitudinal Study data (CHARLS), The project was

officially launched in 2011 and was presided over by

the China Economic Research Center of the National

Academy of Development of Peking University. It

mainly collects micro data on individual and family

collection of middle-aged and above in China. It is a

set of representative and high-quality database. The

CHARLS database covers a wide range and has

strong tracking ability, involving 28 provinces, cities,

autonomous regions, 150 counties and 450 villages,

and more than 20,000 middle-aged and elderly

respondents, tracked every two to three years (Wang,

2020).

This paper uses the panel data of "CHARLS" in

2015 and 2018 for empirical analysis to explore the

status and influencing factors of elderly disability in

China. Under this study topic, the latest two-phase

data samples were screened to retain the disabled

elderly samples. Since the study subjects were

disabled elderly, this paper judged whether the

elderly are disabled according to the ten questions

about the daily activities (ADL) in the CHARLS

questionnaire. At the same time, drawing on the age

classification standard of the elderly in China, the

elderly population over 60 was selected, and the final

remaining sample was 2,492 people.

3.2 Variable Settings

In the whole sample, 565 disabled people and 1,927

nondisabled people, accounting for 22.67% and

77.33% of the total sample number, respectively. The

number of men was 1,191, representing 47.79% of the

total sample population, with a mean age of 68.93

years. the number of women was 1,301, representing

52.21% of the total sample population, with a mean

age of 68.76 years.80.30% of the elderly were

married or cohabiting, and the remaining 19.70%

were unmarried, separated, divorced, and widowed.

The elderly generally have low education. About

80.14% of the elderly have education below primary

school, 11.24% of primary school education, 5.54%

of junior high school education, and 3.09% of high

school education or above. On the basis of the

relevant domestic study, nine variables including

disability, self-rated health, depression, body pains,

chronic diseases, age, marry, gender, education were

selected in combination with this study topic, See

Table 1 for details.

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320

Table 1: Variable-definition.

Variables Assignment description Obs Mean

Std.

Dev.

Min Max

disability 1=Disability, 0=Non-disabled 2492 0.226 0.418 0 1

self-rated health -1=Poor, 0=Fair, 1=Good 2442 -0.208 0.600 -1 1

depression

The difference is 0-30, the

higher the worse

2174 8.599 6.737 0 3

body pains 1=Yes, 0=No 2440 0.347 0.476 0 1

chronic diseases

Number of chronic diseases

affected in individuals

2492 0.113 0.515 0 6

age Individual age 2492 68.846 6.396 61 101

marry

1=Married, 0= Not in

marriage

2492 0.802 0.397 0 1

gender 1=Male, 2=Female 2492 1.522 0.499 1 2

education

1=Elementary school below,

2=Elementary school, 3=

Middle school, 4= High

school and above

2492 0.828 1.034 0 4

3.3 Model Construction

This paper uses the fixed effect model as the

benchmark regression to identify the influencing

factors of oral disability in China. The model is set as

follows:

Ypt=β0+β1Xpt+μt+αp+εpt

Among them, the explained variable Y

is the

elderly disability status, p represents the province,

and t represents the time. Disabled judgment criteria

is according to the CHARLS questionnaire ADL

scale, specific problems including the elderly in

clothes, bath, eat, get up or out of bed, go to the toilet,

control defecation, do housework, cooking, to buy

grocery, take medicine ten daily life difficulties, and

according to the completion of the above activities

will be divided into mild, moderate, severe. Based on

existing studies, self-rated health status, depression,

body pains, number of chronic diseases, age, marry,

gender, and education level were selected as the

explanatory variable X

, β

represents the coefficient

of the explanatory variable, and β

represents the

constant term. The μ

indicates time fixed effect, α

indicates province fixed effect and ε

indicates

random error.

4 INTERPRETATION OF

RESULT

4.1 Regression Analysis

The results of Table 2 show that self-rated health,

depression, body pains, age, and gender were factors

affecting elderly disability and were statistically

significant (P<0.01). When older elderly self-rated

health, the lower the likelihood of disability. With the

deepening of the degree of depression, the incidence

of disability in the elderly is also getting higher and

higher. It can be seen that psychological factors also

affect the physical health status of the elderly. We

should also pay attention to the psychological status

when providing long-term care services to the elderly.

The increased degree of physical pain is positively

associated with the incidence of disability in the

elderly, the more likely disability when physical pain

is felt in the elderly, otherwise the opposite. While the

elderly age increases, the physical function keeps

deteriorating, and the physical health degree also

gradually decreases, so the incidence of disability

also gradually increases. Furthermore, the incidence

of disability was relatively higher in women than in

men. When the elderly improve their health, the lower

the probability of disability; the increase of

depression, physical pain, and age, and women are

higher than men.

Study on the Long-Term Care Service System for Disabled Elderly People in China

321

Table 2: Variable-definition.

Variables Coef. Std.

err.

t P>|t| [95%Conf.

Interval]

self-rated

health

-0.096 0.015 -6.13 0.000 -.0126 -0.065

depression

0.010 0.001 7.12 0.000 0.007 0.013

body pains

0.080 0.021 3.74 0.000 0.038 0.122

chronic

diseases

-0.001 0.019 -0.09 0.926 -0.040 0.037

e 0.008 0.001 5.59 0.000 0.005 0.011

marry

0.015 0.024 0.63 0.532 -0.032 0.063

ende

0.072 0.016 4.55 0.000 0.041 0.104

education

0.004 0.007 0.56 0.575 -0.010 0.018

_cons -0.659 0.123 -5.34 0.000 -0.902 -0.416

Note: *** p<0.01, ** p<0.05, * p<0.1

4.2 Robustness Test

To ensure the robustness of the results, this study was

retested by controlling only province fixed effects

(Table 3) or only control year fixed effects (Table 4),

and the results are shown in Table 3, and self-rated

health, depression, body pains, age, and gender

remained significant by the sequential increase of

control variables, still significant at the 1% level.

Table 3: Robustness analysis of fixed effects in controlled provinces based on disability status.

Variables disability

self-rated health -0.0996***

(0.0162)

depression 0.0109***

(0.00140)

body pains 0.0815***

(0.0219)

age 0.00952***

(0.00154)

gender 0.0680***

(0.0163)

chronic diseases -0.0115

(0.0168)

marry 0.0152

(0.0243)

education -0.000106

(0.00697)

_cons -0.705***

(0.122)

N 2,171

Adjusted R-squared 0.150

Note: *** p<0.01, ** p<0.05, * p<0.1

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Table 4: Robustness analysis based on the fixed effects of years of disability status control.

Variables disabilit

self-rated health -0.0960***

(

0.0157

)

depression 0.0104***

(

0.00146

)

ody pains 0.0803***

(

0.0215

)

age 0.00875***

(

0.00156

)

gende

0.0728***

(

0.0160

)

chronic diseases -0.00185

(

0.0198

)

marr

0.0153

(

0.0244

)

education 0.00404

(

0.00720

)

cons -0.660***

(

0.124

)

N 2,172

Adjusted R-square

0.137

Note: *** p<0.01, ** p<0.05, * p<0.1

5 CONCLUSIONS AND

SUGGESTIONS

In this paper, we analyzed the factors affecting

disability in the elderly empirically using two panel

data from CHARLS 2015 and 2018.The results of this

study showed that self-rated health, depression, body

pains, age, and gender are the factors affecting

disability in the elderly group. As the degree of aging

deepens and the increase of disabled elderly, the

demand for long-term care will increase. In this

regard, this paper summarizes the policies issued by

China at the present stage and puts forward the

following suggestions based on the above analysis,

hoping to provide reference significance for

improving the long-term care service system for the

disabled elderly people in China:

In the early stage of the system development, it is

necessary and urgent to give priority to solving the

long-term nursing support needs for severely disabled

personnel. We should improve the assessment

standards for disability and dementia as soon as

possible. First, based on the existing assessment

standards, actively summarize the assessment

experience of moderate, mild disabled and dementia

personnel, introduce unified assessment standards,

disability assessment scales and assessment tools

adapted to China’s national conditions as soon as

possible, and improve the recruitment and

supervision mechanism, form an authoritative,

unified and professional assessment system; second,

appropriately increase the guarantee strength, expand

the scope of guarantee objects, pay attention to the

guarantee of different age levels, prevent individual

disability, and realize accurate assessment and

accurate guarantee as soon as possible.

The proportion of the elderly popu”atio’ In rural

areas of China accounts for 45.97% of the national

elderly population. The disability rate and disability

scale of the rural elderly are also higher than that of

cities (Dai, 2018). The long-term care demand for the

rural elderly is greater and more urgent. So, we should

expand the scope of population coverage. First,

Study on the Long-Term Care Service System for Disabled Elderly People in China

323

explore the rural care service plan as soon as possible,

strengthen the construction of rural nursing service

capacity, narrow the gap between urban and rural

areas, and ensure the nursing needs of rural disabled

people; second, based on the theory of large number

rule, the more the insured number, the better the long-

term care risk sharing effect. Based on this, on the

basis of meeting the basic guarantee needs of long-

term care insurance, a multi-level security system can

be adopted according to different income levels to

solve the nursing needs of the insured objects (Han,

2020).

At present, the long-term care service system

mainly includes the basic life care and related medical

care services, and mainly provides the basic level

guarantee (Yang, 2020). However, in addition to the

needs of physical care, the disabled elderly also need

psychological comfort. However, there are few areas

with spiritual support and cover few projects. We will

expand payment projects. First, divide

responsibilities between medical care services and

life care related nursing services to prevent

unreasonable expenses and reduce unreasonable

expenses of long-term care insurance fund. Second,

pilot cities can, appropriately, phased, focus, and

increase psychological care, health care, care and

hospice care., and can guarantee the disabled elderly.

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