Table 4 The Influence of public LTCI

 1

Buscher,et al. (2010) [22]

ZEITSCHRIFT FUR GERONTOLOGIE UND GERIATRIE

Germany

Qualitative research

qualitative interviews were conducted with family caregivers and on the general performance of the visits, the perception of care recipients and their family members, and from the perspective of the nursing services.

Based on the findings, a family-oriented approach for home care counseling was developed and evaluated in 80 home care arrangements. The physical health of the beneficiaries of the public LTCI has improved significantly for the most part, especially those receiving good home care.

 2

Olivares-Tirado et al. (2012) [31]

BMC HEALTH SERVICES RESEARCH

Japan

Quantitative research

This paper discussed the effect of LTCI services on the progression of recipient disability in Japan since 2000.

1.women had a significantly greater probability of improving their functional status during all phases of the observation period. 2.disability transition as a measure of disability progression may not be specific enough to assess changes in functional status of LTCI recipients.

 3

Ohwaki, et al. (2009) [17]

AGING CLINICAL AND EXPERIMENTAL RESEARCH

Japan

Quantitative research

This study was to examine the impact of social engagement and other predictive factors, including disability, household composition, and formal services, on continuity in home care of the elderly.

Participants who lived alone or with a spouse were less likely to continue to receive home care compared with those who lived with others. Having friends was a significant predictor of continuity in home care. The promotion of social engagement may be important in preventing institutionalization.

 4

Chen et al. (2013) [34]

GERIATRICS & GERONTOLOGY INTERNATIONAL

Japan

Quantitative research

This study show which dimensions of functions differ among community-dwelling elderly participants in four different certification levels of the current long-term care insurance system (LTCI) in Japan.

Exercise and drinking habits were significantly less common in support- or care-level elderly than in specified or uncertified elderly. The prevalence of taking antihypertensive, antihyperlipidemic, antidepressant or sleeping medications was significantly higher in the support- or care-level elderly than in uncertified or specified elderly people. Support- or care-level elderly also had a significantly higher prevalence of past medical histories of stroke, bone fractures, osteoarthropathy, heart disease and cancer than uncertified or specified elderly people.

 5

Lee et al. (2014) [40]

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY

Korea

Quantitative research

This paper examined the effect of LTCI service type on the cognitive function, behavioral symptoms, and physical function.

There were significant differences in cognitive function, behavioral symptoms, and physical function at baseline between individuals receiving the three LTCI service type (HC, IC, CC) and overall improvements in those outcomes over 2 years in the three groups.

 6

Sohn et al. (2020) [66]

SOCIAL SCIENCE & MEDICINE

Korea

Quantitative research

This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea.

1.the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. 2.Ensuring a “continuum of care” through education for service providers and stronger relationships with the recipients’ families could improve overall quality.

 7

Zuchandke et al. (2010) [25]

GENEVA PAPERS ON RISK AND INSURANCE-ISSUES AND PRACTICE

Germany

Quantitative research

This paper analyses the effect of the introduction of compulsory long-term care insurance in 1995 in Germany on the perception of financial security when needing long-term care.

Experience with long-term care had no significant effect before the introduction but a positive effect afterwards. Also, the perception of financial security is found to be increasing with income at both times with similar magnitudes.

 8

Schwarzkopf, et al. (2012) [30]

BMC HEALTH SERVICES RESEARCH

Germany

Quantitative research

This study quantified the additional yearly expenditures per dementia patient for various health and long-term care services.

1.male and female dementia patients incurred comparable total costs. However, women accounted for significantly lower health and significantly higher long-term care expenditures. 2.Long-term care spending increased in older age, whereupon health care spending decreased. Thus, at more advanced ages, women incurred greater costs than men of the same age.

 9

Yamada et al. (2009) [16]

PSYCHOLOGY HEALTH & MEDICINE

Japan

Quantitative research

This paper evaluated how care manager support (‘social talk,’ ‘information giving’ and ‘reassurance’) affects the burden of family caregivers categorised by caregiver gender and living arrangement.

Care manager support is only effective for female caregivers living with elderly relatives, and is ineffective or works poorly for female caregivers living separately and male caregivers living with elderly relatives.

 10

Iwamoto et al. (2010) [21]

JOURNAL OF THE JAPANESE AND INTERNATIONAL ECONOMIES

Japan

Quantitative research

This paper evaluates the role of the public long-term care insurance scheme implemented in Japan in April 2000 on the welfare losses measured in terms of consumption.

1.when households include a disabled family member, household consumption net of long-term care costs do not decrease as much as before the introduction of long-term care insurance. 2.The introduction of social insurance in 2000 helped Japanese households to reduce the welfare losses associated with a disabled family member.

 11

Washio et al. (2012) [32]

INTERNATIONAL MEDICAL JOURNAL

Japan

Qualitative research

This paper studies on the care burden among caregivers before and after the introduction of long term care insurance system since 2000 in Japan.

1.Neither the rate of depressive caregivers nor time spent on caregiving decreased under the LTCI. Although the elderly and their caregivers have right to use services under the LTCI, they use only small part of these services which they had the right to use.

2.municipal services and/or informal services should be provided when the elderly and their caregivers cannot afford to use social service under the LTCI.

 12

Kim& Lim (2015) [45]

JOURNAL OF PUBLIC ECONOMICS

Korea

Quantitative research

This paper provides empirical evidence on the short-run impact of government subsidies of long-term care.

1.the first-year impact of subsidies for formal home lead to increases in formal long-term care utilization, even when accounting for crowd out of private spending. 2.publicly financed home care may have limited impact among the more able, but that it may be both more cost-effective and beneficial than institutional care for the least able.

 13

Choi et al. (2018) [60]

GERIATRICS & GERONTOLOGY INTERNATIONAL

Korea

Quantitative research

This paper examined whether long-term care insurance (LTCI) reduces medical utilization and the burden of medical costs of beneficiaries.

The burden of medical costs for LTCI beneficiaries were significantly reduced compared with non-beneficiaries, despite the rise in medical costs among older adults. The positive effect of LTCI supports continuous implementation and expansion of the LTCI service for non-beneficiaries who require care assistance.

 14

Feng et al. (2020) [71]

SOCIAL SCIENCE & MEDICINE

China

Quantitative research

This study examines the effect of long-term care insurance (LTCI) on hospital utilization and expenditures among the elderly in China.

The introduction of LTCI significantly reduces the length of stay, inpatient expenditures, and health insurance expenditures in tertiary hospitals by 41.0, 17.7, and 11.4%, respectively. Cost-effectiveness analysis indicates that every extra 1 yuan spent in LTCI will generate a decrease of 8.6 yuan in health insurance expenditures.

 15

Geyer&Korfhage (2015) [48]

HEALTH ECONOMICS

Germany

Quantitative research

This paper discussed the labor supply decision of family carers and the incentives set by the long-term care insurance.

Estimated a structural model of labor supply and the choice of benefits of family carers. We find that benefits in kind have small positive effects on labor supply. Labor supply elasticities of cash benefits are larger and negative. If both types of benefits increase, negative labor supply effects are offset to a large extent.

 16

Geyer, et al. (2017) [53]

FISCAL STUDIES

Germany

Quantitative research

This paper use a structural model of labour supply and the choice of care arrangement to quantify these indirect fiscal effects of informal care.

Informal care by close family members is the main pillar of most long-term care systems. However, due to demographic ageing, the need for long-term care is expected to increase while the informal care potential is expected to decline.

 17

Umegaki et al. (2014) [38]

ARCHIVES OF GERONTOLOGY AND GERIATRICS

Japan

Quantitative research

This paper surveyed the care burden of family caregivers, their satisfaction with the services, and whether their care burden was reduced by the introduction of the LTCI care services.

A lower age of caregivers, a more advanced need classification level, and more satisfaction with the services were independently associated with a reduction of the care burden. In Japanese LTCI, the overall satisfaction of the caregivers appears to be relatively high and is associated with the reduction of the care burden.

 18

Fu et al. (2017) [54]

JOURNAL OF HEALTH ECONOMICS

Japan

Quantitative research

this paper investigated the spillover effect in two periods: before and after the introduction of the LTCI in 2000 and before and after its major amendment in 2006.

The LTCI introduction has significant and positive spillover effects on family caregivers’ labor force participation and the effects vary by gender and age. In contrast, the LTCI amendment is found to have generally negative spillover effects on their labor force participation.

 19

Kondo (2019) [64]

JOURNAL OF THE JAPANESE AND INTERNATIONAL ECONOMIES

Japan

Quantitative research

This paper examines the effect of raising Long-term care insurance (LTCI) payments on employment and wages of workers in the long-term care (LTC) industry.

No increase in the number of employees in the establishments, registered under the LTCI scheme, in municipalities where the regional premium increased. The earnings and working hours of LTC workers did not increase, either.

 20

Strier,& Werner (2016) [50]

JOURNAL OF AGING & SOCIAL POLICY

Israel

Qualitative research

This article uses a methodology of personal in-depth and focus group triangulation, by which the views of three groups of stakeholders are explored and compared: persons with AD, relatives, and professionals.

The presence of stigmatic self-images among persons with AD or other types of dementia and the absence of such images in relatives’ and professionals’ views of them and of LTCI. However, treatment stigma was found to be primarily associated with eligibility determination procedures. The study concludes that LTCI, even when mandated and almost universal, may also generate welfare stigma due to the ways in which it is implemented.

 21

Bascans et al. (2017) [52]

INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT

France

Qualitative research

This paper investigates theoretically how the structure of means-tested public long-term care (LTC) support influences the relationship between LTC insurance and informal care.

The optimal levels of insurance and informal care as well as their relationship are strongly influenced by the waysmeans-tested public support for LTC is structured, which have important implications in terms of public policy for the financing of LTC needs.

 22

Tomita et al. (2010) [27]

BMC HEALTH SERVICES RESEARCH

Japan

Quantitative research

This study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits.

1. Users of home and community-based services were less likely than non-users to be hospitalised or institutionalised. 2. For those with relatively light needs, users of day care were also less likely to be hospitalised or institutionalized than non-users. 3.Respite care, rental services for assistive devices and day care are effective in preventing hospitalisation and institutionalisation. 4.home and community-based services contribute to the goal of the LTCI system of encouraging individuals certified as needing long-term care to live independently at home for as long as possible.

 23

Seok (2010) [20]

SOCIAL WORK IN PUBLIC HEALTH

Korea

Qualitative research

This paper examines the radical change and impacts on service financing, provision, and governance from the introduction of the long-term care insurance for the elderly in Korea.

1.The long-term care service has transformed from the very selective service applicable only to low-income groups to a universal service for all income groups. 2.The service provision method has been changed from the provision by nonprofit organizations entrusted by the state under a monopolistic commission arrangement in the past to a new open-service provision arrangement in which free competition among service providers in service market and consumers’ choice will be emphasized.

 24

Kim et al. (2013) [37]

HEALTH POLICY

Korea

Quantitative research

This study examined the patterns of and factors associated with public long-term care (LTC) utilization among older LTCI beneficiaries in Korea, with special attention to the policy for subsidizing the co-payments of lower income populations.

About 5.48% of older adults in 2010 utilized the LTC provided under the Korean public LTCI among which about 26.1% received a subsidy. The findings imply the subsidy policy promotes equity of access to public LTC services. Further evaluation is necessary on the impact of the policy on the effectiveness of LTC utilization by socially marginalized populations.

 25

Hyun et al. (2014) [43]

BMC HEALTH SERVICES RESEARCH.

Korea

Quantitative research

This study examines the effects of long-term care insurance (LTCI) on the length of stay (LoS) of senior citizens under the national health insurance of Korea.

the LoS of LTCI users is 1.27 days greater than that of non-LTCI users, but the LoS of level 1 and level 2 beneficiaries decreases by 8.35 and 2.84 days, respectively, whereas the LTCI does not reduce the LoS of level 3 beneficiaries. Thus, recommend a modification in the LTCI system that facilitates the use of long-term care institutional services by level 3 beneficiaries to promote home-based care services instead of the institutional care services.

 26

Kim et al. (2019) [62]

JOURNAL OF AGING & SOCIAL POLICY

Korea

Quantitative research

This study analyzed the association between living arrangement and caregiver type with institutionalization in different LTCI grade beneficiaries using from 2008 to 2013.

Higher likelihoods of institutionalization were found in individuals living with a non-family member compared to individuals living with their spouses. Individuals without a caregiver or with a paid caregiver were also more likely to experience institutionalization than individuals with a spouse primary caregiver.

 27

Zhang&Yu (2019) [65]

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH

China

Quantitative research

This paper explored the outcomes and evaluate the performance of the LTCI policy in the Chinese pilot cities

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.