Research on the income and expenditure forecast of long-term care insurance fund in Shihezi City based on community care.

Objective: This study forecasts the income and expenditures of the long-term care insurance fund, provides a basis for formulating the raising standard of the long-term care insurance fund, and explores the measures to improve the pilot work of long-term care insurance. Methods: By using the exponential smoothing and ARIMA models to forecast the income and expenditure of the old-age care insurance fund in 2022, the problems existing in the operation of the long-term care insurance fund are discussed. Results: In 2022, the income of the old-age insurance fund was 28.8934 million yuan, and the fund compensation expenditure was 28.4070 million yuan, with a slight balance of the fund. The highest relative errors of income and expenditure forecast models are -2.03% and - 2.76%, respectively. According to the results of fund expenditure, the annual financing standard should be 132.93 yuan/person, and the individual financing standard should be 66.47 yuan/person. Conclusion: Through the integration of personal payment, welfare, sports lottery public welfare income, social donations, and other ways, we can gradually establish a multi-channel risk-sharing financing. We will appropriately raise the standard for individual financing and the annual contribution standard for individuals from 50 yuan to 66.47 yuan. This will promote sustainable development of long-term insurance system.

Characteristics of first-time users of the nursing small-scale multifunctional home care service: a pooled cross-sectional study using Japanese long-term care insurance claims data from 2012 to 2019.

OBJECTIVES: In April 2012, the Japanese government launched a new nursing service called the nursing small-scale multifunctional home care (NSMHC) to meet the nursing care demands of individuals with moderate-to-severe activities of daily living (ADLs) dysfunction and who require medical care, thereby allowing them to continue living in the community. We aimed to preliminarily analyse the characteristics of first-time users of NSMHC service. DESIGN: This pooled cross-sectional study used the Japanese long-term care insurance (LTCI) claims data from the users' first use of NSMHC (from April 2012 to December 2019). SETTING: NSMHC includes nursing home visits, home care, daycare, overnight stays and medical treatment. PARTICIPANTS: The study population included LTCI beneficiaries who received their first long-term care requirement certification in Japan from April 2012 onwards, died between April 2012 and December 2019, and used any LTCI service at least once. RESULTS: Among the 836 563 individuals who used any LTCI service at least once, 3957 (0.47%) used NSMHC. We analysed 3634 individuals without any missing data regarding long-term care requirement certification. Most individuals were aged 80 years or older, with 64.3% requiring care level 3 or above, indicating complete assistance with ADLs. Regarding ADLs in individuals with dementia, 70.6% were at level 2 or below, indicating they can live almost independently even with dementia. A large proportion of NSMHC users availed the service approximately 6 months before death, with no prior use of any LTCI services; they continued using the service for around 4 months, although some people continued to use NSMHC until their month of death. CONCLUSIONS: Using individual data on nationwide LTCI, we described the characteristics of first-time users of NSMHC among those who died within 7.5 years from the first certification of care needs. Further studies are needed to investigate the effect of NSMHC use on user outcomes.

Long-term care needs and hospitalization costs with long-term care insurance: a mixed-sectional study.

Background: With the rapid aging of the population, the health needs of the older adult have increased significantly, resulting in the frequent occurrence of the "social hospitalization" problem, which has led to a rapid increase in hospitalization costs. This study investigates whether the "social hospitalization problem" arising from the long-term care needs can be solved through the implementation of long-term care insurance, thereby improving the overall health of the older adults and controlling the unreasonable increase in hospitalization costs. Methods: The entropy theory was used as a conceptual model, based on data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. The least-squares method was used to examine the relationship between long-term care needs and hospitalization costs, and the role that long-term care insurance implementation plays in its path of influence. Results: The results of this study indicated that long-term care needs would increase hospitalization cost, which remained stable after a series of tests, such as replacing the core explanatory variables and introducing fixed effects. Through the intermediary effect test and mediated adjustment effect test, we found the action path of long-term care needs on hospitalization costs. Long-term care needs increases hospitalization costs through more hospitalizations. Long-term care insurance reduces hospitalization costs. Its specific action path makes long-term care insurance reduce hospitalization costs through a negative adjustment of the number of hospitalizations. Conclusion: To achieve fair and sustainable development of long-term care insurance, the following points should be achieved: First, long-term care insurance should consider the prevention in advance and expand the scope of participation and coverage; Second, long-term care insurance should consider the control in the event and set moderate levels of treatment payments; Third, long-term care insurance should consider post-supervision and explore appropriate payment methods.

Enhancing Older Household Consumption: The Impact of Long-Term Care Insurance in China.

OBJECTIVES: Household consumption significantly affects the quality of life and successful aging of older adults. However, prior research has often overlooked the connection between household consumption and long-term care insurance (LTCI). This study aims to investigate the influence of LTCI on consumption patterns within older Chinese households. METHODS: We used harmonized data from the China Health and Retirement Longitudinal Study and merged it with data from cities that implemented LTCI in China. We analyzed a total of 6,494 households consisting of individuals who were 60 years of age or older. To ensure accurate and stable research findings, we employed a series of difference-in-differences models. RESULTS: We found that LTCI has a significant impact on consumption levels, including total and per capita consumption within older households. Furthermore, our research demonstrates that LTCI significantly enhances enjoyable consumption across the consumption types. Through a heterogeneous analysis, it is shown that LTCI has a unique effect on both the total and enjoyable consumption of urban older households and also promotes comprehensive consumption improvements in older rural and disabled households. DISCUSSION: These findings highlight the crucial role of LTCI in improving the financial security and well-being of older households. They also have considerable policy implications for dealing with the challenges of an aging population.

Low educational level increases functional disability risk subsequent to heart failure in Japan: On behalf of the Iwate KENCO study group.

OBJECTIVES: The risk factors that contribute to future functional disability after heart failure (HF) are poorly understood. The aim of this study was to determine potential risk factors to future functional disability after HF in the general older adult population in Japan. METHODS: The subjects who were community-dwelling older adults aged 65 or older without a history of cardiovascular diseases and functional disability were followed in this prospective study for 11 years. Two case groups were determined from the 4,644 subjects: no long-term care insurance (LTCI) after HF (n = 52) and LTCI after HF (n = 44). We selected the controls by randomly matching each case of HF with three of the remaining 4,548 subjects who were event-free during the period: those with no LTCI and no HF with age +/-1 years and of the same sex, control for the no LTCI after HF group (n = 156), and control for the LTCI after HF group (n = 132). HF was diagnosed according to the Framingham diagnostic criteria. Individuals with a functional disability were those who had been newly certified by the LTCI during the observation period. Objective data including blood samples and several socioeconomic items in the baseline survey were assessed using a self-reported questionnaire. RESULTS: Significantly associated risk factors were lower educational levels (odds ratio (OR) [95% confidence interval (CI)]: 3.72 [1.63-8.48]) in the LTCI after HF group and hypertension (2.20 [1.10-4.43]) in no LTCI after HF group. Regular alcohol consumption and unmarried status were marginally significantly associated with LTCI after HF (OR [95% CI]; drinker = 2.69 [0.95-7.66]; P = 0.063; unmarried status = 2.54 [0.91-7.15]; P = 0.076). CONCLUSION: Preventive measures must be taken to protect older adults with unfavorable social factors from disability after HF via a multidisciplinary approach.

[Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching].

Objectives　To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults.Methods　Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1 : 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model).Results　The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio=0.51, 95% confidence interval [CI]=0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio=0.36, 95%CI=0.11-1.21, P=0.099; LTC cost per unit follow-up period: cost ratio=0.36, 95%CI=0.11-1.12, P=0.076).Conclusions　These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.

Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge.

BACKGROUND: The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. METHODS: This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. RESULTS: The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. CONCLUSION: Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

Impact of home- and community-based services in the long-term care insurance system on outcomes of patients with acute heart failure: Insights from the Kitakawachi Clinical Background and Outcome of Heart Failure Registry.

AIM: In Japan, the long-term care insurance (LTCI) system is important for elderly people living at home; however, no clinical studies have revealed a relationship between home- or community-based services and outcomes in patients with acute heart failure (AHF). METHODS: This was a prospective multicenter cohort study of patients with AHF enrolled between April 2015 and August 2017. Patients aged ≥65 years with LTCI were divided into those receiving home- and community-based services (service users) and without home and community-based services (service non-users). The endpoint was defined as a composite endpoint, which included all-cause mortality and hospitalization for heart failure after discharge. Subgroup analyses were performed for elderly patients (<85 years) or super-elderly patients (≥85 years). RESULTS: The study participants were eligible for LTCI two times more than community-dwelling people were. At the 1-year follow-up period, the rate of the composite endpoint showed no significant difference between service users and service non-users among all patients or super-elderly patients. However, in elderly patients, the rate of the composite endpoint was significantly lower among service users than service non-users. The difference was independently maintained even after adjustments for differences in comorbidities or in social backgrounds (adjusted hazard ratio 0.62; 95% confidence interval 0.38-0.99, and adjusted hazard ratio 0.57; 95% confidence interval 0.35-0.90, respectively). CONCLUSIONS: In this study, adverse events following discharge of patients with AHF who used home- and community-based services were prevented only in elderly patients, not in super-elderly patients. Geriatr Gerontol Int 2020; 20: 967-973.

Effectiveness of Hospital Discharge Support by Medical and Nursing Care Workers in Reducing Readmission Rates of Patients in Long-Term Care Wards: An Observation Study in Japan.

For increasing medical care demand by aging population, the Japanese government is shifting to home medical care for treatments that do not necessarily require hospitalization. It is therefore essential to identify factors involved in improving the quality and outcomes of home medical care. This study examined the effect of hospital discharge support in long-term care wards on readmission rates. We used medical insurance and the Long-Term Care Insurance data of patients aged ≥ 65. Participants were patients who discharged between April 2012 and March 2016 from long-term care wards that did not require 24-hour monitoring and had no specific incurable diseases. Participants were divided into two groups according to hospital discharge support, defined by medical fee incentives for discharge planning and coordination of medical and nursing services after discharge. We explored the association between hospital discharge support and risk-adjusted readmission based on patient characteristics for one year beginning the month after patient discharge. This study involved a total of 10,998 patients: 2,563 patients with hospital discharge support and 8,435 patients without relevant support. In the group with hospital discharge support, there was a significant reduction in readmission rates. When examined by patients' characteristics, this association was significant in groups with age ≥ 85, care needs levels 1 to 2 (conditions requiring partial care for daily living), dementia or fracture. Our results suggest that hospital discharge support by medical and nursing care workers is effective in reducing readmission rates. Moreover, patients' age, care needs, and underlying disease should be considered.

[Life prognosis of persons with dementia: Observation of persons registered for long-term care insurance in a community in Japan].

Objectives　This study aimed to observe the life prognosis of persons with dementia during the first five years after registering for long-term care insurance, and to determine the factors affecting their prognosis.Methods　A total of 556 persons, aged 65 years or older newly registered for long-term care insurance in a city in Japan, were observed. The life prognosis of the registered persons was determined using standardized mortality ratio (SMR) with the general population as a standard, and relevant factors were observed in terms of dependence indices of dementia and disability.Results　The mean age of persons newly registered for long-term care insurance was 81.6 years and 63% of them were females. Mortality during the first 4.5 years after registration was 16.7% p.a., with males and those of older age having higher rates. The SMR was 1.80 for all individuals, with males and those of younger age having a higher SMR. The SMR increased with the severity of the disability (higher classes on the disability dependence index) at the time of the registration, while no significant trend was seen in SMR with the dementia dependence index. Multivariate analysis revealed that mortality was dependent on sex (male>female), age (older>younger), disability dependence indices (higher classes>lower classes), and current place of residence (home>facility), while there were no significant trends found in mortality with degree of severity on the dementia dependence indices. The adjusted odds ratios of dying from respective factors were as follow: from sex (male/female, with male as a standard) 0.35 (95% confidence interval 0.24-0.51), from age group (65-74 years/75-84/85+, stepwise with 65-74 years as a standard) 1.84 (1.39-2.47), from disability dependence index (normal/I/Ⅱa/Ⅱb..., stepwise with "normal" as standard) 1.38 (1.21-1.58), and from place of residence (home/facility, with home as a standard) 0.64 (0.42-0.99). When limited to only the elderly with dementia dependence indices of Ⅱa-Ⅳ, the analysis showed similar results.Conclusion　Elderly persons registered for long-term care insurance had higher mortality rates than the general population that was dependent on the disability dependence index, but not on the dementia dependent index. Further studies are therefore necessary to elucidate the factors relevant to the study's finding.

The effects of raising the long-term care insurance co-payment rate on the utilization of long-term care services.

AIM: The effect of raising insurance co-payment rates on healthcare service utilization in Japan remains unclear. In this study, we utilized patient-level long-term care (LTC) insurance claims data to analyze these effects. METHODS: Claims data were obtained on individuals certified as requiring LTC in City A and City B, Fukuoka Prefecture, Japan during August 2014-July 2016. Individuals whose LTC insurance co-payment rate increased from 10% to 20% in August 2015 were regarded as high-income individuals; individuals whose co-payment rate remained at 10% were regarded as non-high-income individuals. We examined the changes in LTC service utilization between high-income individuals and non-high-income individuals during the study period. Monthly LTC insurance charges were analyzed to evaluate service utilization. We created monthly panel data for the study participants, and quantified the differences in LTC service utilization before and after August 2015 between the high-income and non-high-income groups. Care needs levels and age were included as covariates in a fixed-effects model. RESULTS: The sample comprised 7711 individuals (1000 high-income individuals and 6711 non-high-income individuals) in City A and 647 individuals (84 high-income individuals and 563 non-high-income individuals) in City B. After adjusting for care needs levels and age, the co-payment rate increase was associated with reductions in monthly LTC insurance charges of $34.3 (P < 0.001) in City A and $91.0 (P = 0.022) in City B. CONCLUSION: The increase in co-payment rate for high-income individuals in August 2015 negatively affected their utilization of LTC services. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; ••: ••-••.

Association of long-term care needs, approaching death and age with medical and long-term care expenditures in the last year of life: An analysis of insurance claims data.

AIM: This study aimed to examine whether long-term care needs, approaching death and age were associated with the use of medical and long-term care resources (care/service use and expenditures) in the last year of life among older Japanese individuals. METHODS: Using data on insurance claims and death certificates, we described the use of medical and long-term care resources in the last year of life by residents of Soma City in Japan aged ≥65 years who died between September 2006 and October 2009. Using a generalized estimating equation, we examined whether long-term care needs, approaching death and age were associated with resource use during each 3-month period in the last year of life. RESULTS: Resource use in medical and long-term care among 882 non-survivors and 8504 survivors were analyzed. Analyses for the non-survivors showed statistically significant associations between: (i) severe long-term care needs and greater service use in outpatient care, higher expenditures for outpatient care and higher expenditures for in-home/facility services; (ii) approaching death and greater use in both inpatient care and facility services; and (iii) being aged 65-74 years and greater service use in outpatient/in-hospital care and in-home/facility services, higher expenditures in outpatient/inpatient care, and lower expenditures for in-home/facility services. CONCLUSIONS: The present study showed that severe long-term care needs and approaching death, rather than advancing age, were significantly and independently associated with greater use of resources in both medical and long-term care services. Geriatr Gerontol Int 2020; 20: 277-284.

The effect of severity of white matter hyperintensities on loss of functional independency in patients with mild cognitive impairment: A CREDOS-LTCI (clinical research center for dementia of South Korea-long term card insurance) study.

OBJECTIVE: By combining data from the Clinical Research Center for Dementia of South Korea(CREDOS) study and long-term care insurance(LTCI), we aimed to assess whether the severity of white matter hyperintensity(WMH) predicted functional decline in cases of amnestic mild cognitive impairment(MCI). METHODS: WMH was evaluated in 3,569 patients with amnestic MCI using the visual rating scale developed for the CREDOS study. The participants were classified as having amnestic MCI with minimal WMH change(aMCI), with moderate WMH change(maMCI) and with severe WMH change(saMCI) according to the severity of the WMH measurements. A Kaplan-Meier survival probability estimate was used to compute median time from the diagnosis of MCI to LTCI enrollment for the three MCI groups. The effect of various risk factors of LTCI enrollment was evaluated using Cox's proportional hazards model, adjusted for covariates. RESULTS: As compared with aMCI cases, maMCI and saMCI patients required help with daily activities of living at a younger age. The saMCI and maMCI patients had higher risk of LTCI enrollment as compared with that of the aMCI patients. Younger patients(≤ 65y) with MCI had a 3.201 times higher risk of early LTCI enrollment than older patients(> 65y) did. High clinical dementia rating score and female sex were also risk factors of early LTCI enrollment. CONCLUSIONS: WMH predicted the rate of global functional decline and loss of independence in patients with MCI. The findings support the use of neuroimaging of WMH, in conjunction with biomarkers, as a tool in predicting functional decline in patients with MCI.

Sociopsychological characteristics of late nonagenarians in Japan: the protocol of the Arakawa 95+ study.

AIM: The aim of this study was to examine sociopsychological characteristics of the oldest old in Japan. We conducted a baseline survey of a community-based cohort of persons aged 95 or older. METHODS: Participants were aged 95+ years and resided in Arakawa Ward in Tokyo on 1 January 2016. We mailed a questionnaire to these individuals to assess their physical, mental, and social status. Subsequently, if respondents agreed, we conducted in-home interviews and examined their physical and cognitive function. Also, we mailed non-respondents a simplified version of full questionnaire. Additionally, we examined the basic registered data of the study population and the status of their Long-term Care Insurance. Data at baseline and 1-year follow-up were compared. RESULTS: With regard to Long-term Care Insurance, 423 residents aged 95+ years (78.0%) were on long-term care level, 35 (6.5%) were on support level, and 84 (15.5%) did not require support. At the 1-year follow-up, 275 (50.7%) had the same care level, 107 (19.7%) required a greater level of care, and 131 had died (annual death rate: 24.2%). Compared to the simplified questionnaire group (n = 128) and the full questionnaire-only group (n = 14), a higher proportion of respondents who had completed the full questionnaire and had in-home interviews (n = 26) were men, lived only with a spouse, had higher activities of daily living, and reported more positive feelings and well-being. CONCLUSIONS: In the late nonagenarian population, the annual death rate was high, and care needs increased rapidly. However, some persons maintained the same care level or even showed improvement and successful ageing.

Factors associated with changes of care needs level in disabled older adults receiving home medical care: Prospective observational study by Osaka Home Care Registry (OHCARE).

AIM: To clarify factors associated with changes in care needs level and mortality among disabled older people receiving home medical care over a period of 2.5 years. METHODS: The study included 179 participants, aged ≥65 years, receiving home medical care, who consented to join the Osaka Home Care Registry study. The main outcome was changes in the care needs level of participants eligible for the long-term care insurance system. We investigated the association of changes in care needs level with basic characteristics and care-receiving status. RESULTS: At the 2.5-year follow up, 20.0% of participants showed deteriorated levels, and 41.8% of participants died. In multiple logistic regression, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.00-1.21; P = 0.051) and bone joint diseases (OR 0.34, CI 0.09-1.22; P = 0.098) were possible risks associated with deterioration of the care needs level. Male sex (OR 3.28, CI 0.91-11.74; P = 0.068) was a possible risk factor for mortality, and lower serum albumin (OR 0.22, CI 0.07-0.73) was a significant risk factor for mortality. CONCLUSIONS: We clarified the different factors associated with deterioration of the care needs level and mortality among disabled older people. Old age and bone joint diseases might be predictive factors for the further deterioration of independence of physical activity, and a low serum albumin level is considered to be strongly associated with increased mortality. Geriatr Gerontol Int 2019; 19: 1198-1205.

Evaluation of Long-Term Care Insurance Policy in Chinese Pilot Cities.

Since 2016, 15 pilot cities in China have implemented a long-term care insurance (LTCI) policy. The aim of this research was to explore the outcomes and evaluate the performance of the LTCI policy in the Chinese pilot cities and estimate the willingness of Chinese citizens to expand the formal implementation of LTCI policy in China. We gathered data from 1500 elderly people aged over 60 years in 15 pilot cities (100 surveys for each city) and the effective response rate was 77.8% (1167/1500). We relied on statistical analysis to elicit the outcomes and performance of LTCI implementation and an ordinal logit regression to analyze the factors associated with the extension of the LTCI policy. We examined factors associated with the perception according to sex, age, degree of disability, choices of care, living location, number of children, and monthly income. Among these factors, the relationship between living location and number of children of the family and the outcomes and performance of the LTCI policy in the pilot cities was significant. The rest of the factors showed no significance with the implementation of the LTCI in Chinese pilot cities. This study is among the first to explore the attitudes of Chinese citizens among those who have benefited from the LTCI policy in the pilot cities and contributes to identifying the outcomes of the LTCI in pilot cities to assist policymakers in their further implementation in China.

Perceived Discrimination and Stigma in the Context of the Long-Term Care Insurance Law from the Perspectives of Arabs and the Jews in the North of Israel.

The Long-Term Care Insurance Law provides support to older Israelis who wish to remain in their home. The present study evaluated the experience of perceived discrimination and stigma in the context of the law among Arab older adults, their family members, and their paid home care workers. For triangulation purposes, we interviewed 15 National Insurance Institute workers (NII; responsible for implementing the law; 47% Arab), 31 older adults (81% Arab), 31 family members (87% Arab), and six paid home care workers (83% Arab) in the north of Israel. Respondents were queried about their home care experience and their encounter with the NII. Thematic analysis was conducted. Four main themes emerged: (a) a strong sense of perceived discrimination among Arab interviewees, (b) reports suggesting the internalization of stigma and the adoption of negative views regarding the Arab population by some Arab respondents, (c) implicit stigma manifested in claims concerning the Arab population (primarily) as "cheating" the system, and (d) the negation of discrimination of Arabs as reported by Jewish interviewees and NII workers. The findings show that a sense of perceived discrimination is common and colors the experience of service seeking among Arabs. On the other hand, the Jewish interviewees in this study completely negated any discrimination or stigma directed toward Arabs. The findings point to the importance of group affiliation (e.g., minority vs. majority) in interpreting the existence of discrimination. The findings likely have major implications for both service providers and policy-makers and legislators.

China's policy experimentation on long-term care insurance: Implications for access.

China's population is aging rapidly, while the traditional long-term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long-term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural-urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.