The Inequality Of Opportunity Of The Utilization Of Long-term Care Of The Elderly With Disability In China

PurposeBy systematically sorting out the long-term care service models in various pilot areas in China,combining the academic communities’ and the media’s the evaluation of the development status,selecting appropriate evaluation indicators,using the relevant information of the disabled elderly in the CLHLS database and the method in econometrics to measure the inequality of opportunity of the utilization of long-term care services in China,to determine whether there are inequality of opportunities that due to external factors such as economic and social environment and system design.If such inequalities exist,further Identify the influencing factors,measure the contribution of these influencing factors to the overall inequality,and then make targeted suggestions.MethodsThis study uses the "Chinese Longitudinal Healthy Longevity Survey "（CLHLS）as the data source,takes the cost of long-term care services for the disabled elderly as the "advantage" variable,takes the household registration system as the environmental variable,and further divides the effort variable into e1 variables and e2 variables,e1 variables include education level,region,socio-economic status,family income,e2 variables include gender,age,marital status,disability（disability or not in bathing,dressing,toilet,indoor transfer,continence,eating）.Then we use the analysis framework of inequality of opportunity proposed by Roemer,the concept of "fairness gap" and the Oaxaca-Blinder decomposition method to construct the counterfactual regression equation to analyze the inequality of opportunity of long-term care services between urban and rural area in China.Then we use quantile regression to further explore the relationship between family income and long-term care service utilization.ResultsLong-term care services utilization of the elderly with disability in urban areas in 2011 and 2014 was higher than that in rural areas,the former’s average long-term care costs in urban areas were 430.31 yuan and 2285.30 yuan,respectively,while the later’s average costs were 209.03 yuan and 1384.18 yuan,respectively;the long-term care expenses of the disabled elderly in the eastern region are the highest（474.70 yuan and 2260.64 yuan,respectively）;the long-term care service costs of the disabled with higher economic status are the highest（925.01 yuan and 1927.57 yuan,respectively）;people with a high family income level also have a higher level of care expenses.Among them,those with a family income level of more than 8,000 yuan have the highest expenditure levels,which are 661.51 yuan and 4913.30 yuan,respectively.In terms of influencing factors,the household registration system（2011 β=0.069,p<0.05;2014 β=0.308,p<0.05）,region（2011,β=-0.015,p<0.05;2014 β=-0.054,p<0.05）,economic status（2011 β=-0.532,p<0.05;2014 β =-0.176,p<0.01）,and household income（2011 β=0.410,p<0.05;2014 β=0.2858,p<0.05）have significant influence on the utilization of long-term care services utilization,while gender,marital status,years of education,and disability have no significant influence on the utilization of long-term care services.There was inequality of opportunity in the utilization of long-term care services for the disabled elderly between urban and rural areas in China,which had led to a gradually increasing "justice gap" between urban and rural areas（（-221.52）and（-903.01）in 2011 and 2014,respectively）.In the Oaxaca-Blinder decomposition of inequality of opportunities,"environmental e1 coefficient effect" and "e2 coefficient effect" represent direct unfairness caused by the environment,which led to contribution rates to the "fairness gap" with 95.36% and 87.16%,respectively.The "e2 coefficient effect" contributed the most to the overall fairness gap in 2011 and 2014,in which age played an important role（Contribution rate in 2011 and 2014 were 65.66% and 21.84%,respectively）,and the contribution of disability to the "justice gap" had increased compared to the previous period.The “environment e1 characteristic effect” had a relatively small contribution to the fairness gap,and its contribution to the fairness gap had increased compared with the previous period（contribution rates were 4.64% and 12.04% respectively）,among which family income contributed the most to the “justice gap” in urban and rural areas（contribution rates were 1.89% and 8.03%,respectively）.The "environment e1 coefficient effect" had the smallest contribution to the justice gap,and its contribution to the "justice gap" had increased compared to the previous period（the contribution rates were 4.23% and 6.08%,respectively）.In terms of quantile regression,the willingness to pay for long-term care services for the elderly will gradually decline as income levels increase both in urban or rural areas,and the willingness to pay in 2014 was lower than in 2011 on the same quintile of income.ConclusionThe area,household registration,socioeconomic status,and family income have an impact on the expenditure of disability elderly’s long-term care utilization with significance,but age,gender,and education level have no effect on it.There are significant differences in the expenditures of long-term care utilization between urban and rural areas in China,and inequality of opportunity plays an important role in this.Besides,the gap of expenditures between urban and rural areas caused by inequality of opportunities is gradually increasing.Family income contributes the most to the inequality of opportunity of long-term care utilization in China,and plays an increasingly important role;as family income increase,the willingness to pay for the expenditure of long-term care utilization in urban and rural areas is gradually decreasing.The "environment e1 coefficient effect" had the smallest contribution to the fairness gap,and its share of the fairness gap was reduced compared to the previous period.