Long-term care insurance and health outcomes among older adults with disabilities: evidence from a support system reconfiguration perspective.
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BACKGROUND: Population ageing and weakening family support systems pose major public health challenges in China and worldwide. Long-term care insurance (LTCI) has emerged as a key policy response; however, evidence on its effectiveness in improving health outcomes among older adults with disabilities remains limited. This study examined whether, and through which pathways, LTCI affects health outcomes by reconfiguring support systems. METHODS: Guided by a support system reconfiguration perspective, we conceptualised LTCI as a formal intervention that interacts with existing informal support networks. Using five waves (2011–2020) of the China Health and Retirement Longitudinal Study, we applied a difference-in-differences design to estimate the effects of LTCI on symptom burden, psychological burden, and a composite health outcome index among older adults with disabilities. We assessed robustness using parallel-trends tests, placebo tests, and propensity score matching. RESULTS: LTCI implementation was associated with significant reductions in symptom burden (β = −0.595, p < 0.01), psychological burden (β = −0.732, p < 0.05), and overall adverse health outcomes (β = −0.172, p < 0.01). Effects were strongest among non-cancer patients, individuals with medium socioeconomic status, and those living with children. No significant effects were observed among cancer patients or those with very high or very low socioeconomic status. Benefits emerged approximately one year after implementation and persisted over time. CONCLUSIONS: LTCI appears to improve health outcomes by reconfiguring—rather than replacing—existing support systems, with effectiveness depending on alignment with underlying care needs and available resources. The policy performs best when it complements family-based care and targets populations with moderate resources. These findings can inform the design of integrated long-term care policies that address heterogeneous needs in ageing societies while strengthening existing support networks.