Can long-term care insurance prevent worsening of frailty among older Chinese adults? A difference-in-differences study based on CHARLS data

Frailty, which is accompanied by negative health outcomes associated with aging, is an increasingly serious public health problem. Long-term care insurance (LTCI) is an effective intervention for frailty in older adults, but few studies have linked LTCI to frailty prevention. This study aimed to determine the role of LTCI in preventing worsening of frailty in older adults. This study used five-wave panel data from the China Health and Retirement Longitudinal Study (CHARLS) 2011 to 2020 to construct an indicator system to assess the frailty index (FI) of surveyed older adults and used a difference-in-differences (DID) method to assess the policy effect of LTCI on frailty among older adults. We found that the full-sample mean of the FI of older adults in China was 0.196, and the implementation of LTCI had a significant negative effect on the FI of older adults. The effect was heterogeneous across sex, age, education and medical insurance groups. LTCI had a more significant negative effect on male group, the middle-aged group, the less educated group, and the URRBMI group, while the effect was less significant for the female and the UEBMI group, and not significant for the more educated and other age groups. That is to say, older Chinese adults are generally frail to different degrees, and the implementation of a LTCI system can prevent worsening of frailty among them, but the effect is not equal across populations. The institutional coverage of LTCI should be further strengthened in the future to slow down the frailty process of the enrollees, so as to promote healthy aging.