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. 2024 Dec 24;24(1):1646.
doi: 10.1186/s12913-024-12126-1.

Why are people with dementia overlooked in long-term care insurance policy in Guangzhou, China?

Bei Ye #  1   2   3 , Yingxin Xu #  1   2 , Wing Kit Chan  4   5 , Zhongyan Zhang  4   5 , Sophia Lobanov-Rostovsky  6 , Natasha Curry  7 , Eric John Brunner  6 , Jing Liao  8   9
Affiliations

Why are people with dementia overlooked in long-term care insurance policy in Guangzhou, China?

Bei Ye et al. BMC Health Serv Res. .

Abstract

Background and objectives: There is a growing demand for dementia care to be funded by long-term care insurance (LTCI). However, evidence indicates that people with dementia are overlooked in China's LTCI policy and empirical research on this issue is notably scarce. Among the first seven LTCI pilot cities that officially enrolled people with dementia, Guangzhou is unique for roll-back LTCI policies related to eligibility criteria and benefits. This study aims to explore why people with dementia are overlooked in China's LTCI policy, using Guangzhou as a case study.

Methods: Semi-structured interviews were conducted with stakeholders involved in LTCI need assessment and care delivery in Guangzhou. Eight LTCI assessment specialists, 22 formal caregivers, and six informal caregivers were interviewed from December 2021 to October 2022. Data was analyzed using NVivo 11.0 software and the Gilbert welfare framework to identify themes.

Results: Interviewees reported that need assessment lacked a clear definition, were poorly supervised, and had high moral hazards. Challenges to care delivery included unprofessionalism of formal caregivers, shortage of resources, unprepared informal caregivers, a lack of a supportive environment and the negative impact of COVID-19. DISCUSSION AND IMPLICATIONS: People with dementia are overlooked in LTCI policy which may result from difficulties in implementing dementia-related assessment criteria, and hampered service delivery due to a shortage of skilled caregivers. These issues need to be carefully considered before scaling up the coverage of LTCI policy nationwide.

Keywords: China; Dementia; Long-term care; Long-term care insurance.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was granted by the Institutional Review Board of Sun Yat-sen University (IRB Approval no. 2019–124) and UCL Research Ethics Committee (REC Approval no. 21679.001). Informed consent was obtained from all study participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The national two-round long-term care insurance policy corresponds to Guangzhou three-round long-term care insurance policy
Fig. 2
Fig. 2
Stakeholder relationship map for dementia care in long-term care insurance policy. Note. LTCI = long-term care insurance; PwDs = people with dementia. Assessment specialist: These professionals work in tertiary hospitals or commercial insurance companies, and are trained by the Guangzhou Healthcare Security Administration. They have qualifications to assess LTCI level. Formal caregivers: Formal caregivers are caregivers who work for care agencies and can provide care in both institutional and home settings. Informal caregivers: Beneficiaries’ family members or domestic helpers may apply as informal caregivers for in-home care only. They provide care services for older individuals under the management of care agencies and receive wages
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