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Leveraging the quasi\u2010experiment of China's public long\u2010term care insurance (LTCI) pilot program, this study employs data from the China Longitudinal Healthy Longevity Survey to examine the impact of LTCI on catastrophic health spending (CHS) at the end of life. The findings indicate that over the 5\u2010year EOL period, LTCI significantly decreases the probability of CHS by approximately 36.1\u201352.3 percentage points and reduces out\u2010of\u2010pocket health spending. Furthermore, the study demonstrates that LTCI reduces CHS without compromising EOL health by substituting aggressive medical interventions with sustained long\u2010term care support, which leads to fewer severe\u2010illness episodes, shorter hospital stays, and reduced dependency. These findings provide empirical evidence for the role of LTCI in facilitating value\u2010based healthcare at the end of life, with significant implications for establishing universal LTCI systems in China and other countries.<\/jats:p>","DOI":"10.1002\/hec.70099","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T07:01:16Z","timestamp":1775631676000},"page":"947-959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long\u2010Term Care Insurance and Catastrophic Health Spending at the End of Life Among Older Adults: Evidence From China"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2315-5947","authenticated-orcid":false,"given":"Zhenyu","family":"Zhu","sequence":"first","affiliation":[{"name":"School of Sociology | Elder Service Research Center Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Bai","sequence":"additional","affiliation":[{"name":"School of Labor and Human Resources Renmin University of China  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeconom.2020.12.001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2024.102921"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czac003"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.14080"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2016.03.013"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.08.019"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3982\/ecta15022"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2020.113081"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(20)32136\u2010x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0174"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2017.09.011"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909087"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","unstructured":"Glinskaya E. 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