Changes of filial responsibility norms under public long-term care insurance in China

Abstract

Aim: The public long-term care insurance (LTCI) scheme offers a potential solution to growing long-term care needs. This study investigated its effects on perceived filial responsibility norms and evaluated the heterogeneity of these effects. Methods: Using data from the 2014, 2016, 2018, and 2020 waves of the China Longitudinal Aging Social Survey, we focused on 10 042 older adults aged 60 and above living in communities. The quasi-experimental design of staggered difference-in-differences analyses with propensity score matching was employed to assess the policy effects. Results: The LTCI scheme significantly influenced perceived filial responsibility norms, reducing the likelihood of older adults believing that children should bear primary responsibility for their care by 6%. This effect was more pronounced among older adults who were more educated, lived with their children, or were in better health. Conclusion: The implementation of the public LTCI scheme has had a negative impact on traditional filial piety in China. These findings highlight the importance for countries adopting LTCI or similar policies to develop strategies that prevent the excessive erosion of this cultural value. Geriatr Gerontol Int 2025; 25: 606–619.