중국의 장기요양보험이 중·장년 우울감과 생활만족도에 미치는 영향

다국어 초록 (Multilingual Abstract)

China’s Long-Term Care Insurance (LTCI) pilot policy, introduced in 2016, has emerged as a key institutional response to accelerating population aging and the rising care needs of middle-aged and older adults. While existing studies have discussed the system’s financing mechanisms, coverage expansion, and service provision, relatively few empirical analyses have examined the policy’s effect on older adults’ subjective well-being and mental health—two dimensions that directly reflect long-term welfare and quality of life. Given China’s rapid demographic transition, increasing chronic disease burden, and growing policy attention toward psychological health, an empirical evaluation of LTCI’s welfare impact is both timely and necessary. This dissertation employs five waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020) and treats the staggered introduction of LTCI pilot cities as a quasi-natural experiment. A time-varying difference-in-differences (DID) model is used to estimate the causal impact of LTCI on life satisfaction and depressive symptoms (CES-D index). To ensure the reliability of the empirical findings, multiple robustness checks—including parallel trend tests, placebo tests, and PSM-DID estimations—are conducted. The empirical results demonstrate that the implementation of LTCI significantly enhances the life satisfaction of middle-aged and older adults while reducing their depressive symptoms. These effects remain stable across various robustness procedures, confirming the validity of the findings. In addition, the study conducts heterogeneity analyses to examine how policy impacts differ across individual characteristics. The results show that the positive effects of LTCI are more pronounced among individuals with higher educational attainment, those with fewer children and lower caregiving burdens, and individuals with chronic health conditions, who may have greater dependence on formal care services. Overall, this dissertation provides rigorous empirical evidence that China’s LTCI pilot policy plays a meaningful role in improving subjective well-being and psychological health among older adults. The findings underscore the importance of expanding accessible care services, improving benefit adequacy, and strengthening the integration of psychological health within long-term care policy design. As China advances toward establishing a more equitable and sustainable long-term care security system, the results of this study offer valuable implications for refining policy implementation and enhancing the welfare of the aging population.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 　1. 연구 배경과 목적 1
• 2. 논문의 구성과 내용 5
• Ⅱ. 선행연구와 가설 6
• 1. 장기요양보험과 노인 주관적 행복의 개념적 틀 6
• 　　1) 장기요양과 장기요양보험의 개념 6
• 　　2) 노인 주관적 복지의 개념 8
• 2. 이론적 배경 9
• 1) 매슬로우의 욕구단계 이론 9
• 2) 사회적지지 이론 10
• 3) 역량접근 이론 13
• 　3. 선행실증 연구 14
• 　　 1) 장기요양보험 관련 연구 14
• 　　　(1) 국제 장기요양보험 제도의 유형 14
• 　　　(2) 중국의 장기요양보험 제도 17
• 　　2) 주관적 행복감에 영향요인에 관한 연구 19
• 　　3) 사회보험제도가 노인 행복에 미치는 영향 관련 연구 20
• 4. 연구문제 및 가설 22
• 　　1) 연구의 접근 논리 22
• 　　2) 연구가설 23
• 　
• Ⅲ. 제도적 배경 26
• 1. 중국의 장기요양보험 제도 현황 26
• 2. 장기요양보험의 실태 및 평가체계 27
• 　　3. 재원조달 방식의 다양화와 지역 간 차이 27
• 　　4. 서비스 제공 형태와 급여 수준 28
• Ⅳ. 분석 방법 30
• 1. 변수의 측정과 기초통계 30
• 　　1) 데이터 출처 30
• 　　2) 변수 설정 32
• 　　　(1) 종속변수 32
• 　　　(2) 설명변수 33
• 　　　(3) 통제변수 35
• 　　3) 기초통계분석 39
• 　2. 모형 설정 40
• 　　1) 이중차분모형 40
• 　　2) 성향점수매칭-이중차분모형 41
• Ⅴ. 분석 결과 42
• 　1. 평행추세 검정 42
• 　2. 기준 회귀분석 45
• 　3. 강건성 검정 49
• 　　1) 위약검정 49
• 　　2) PSM-DID 검정 51
• 　　3) 추가적 분석 결과 56
• 　4. 이질성 분석 59
• 1) 소득수준별 59
• 　　2) 만성질환 여부별 63
• 3) 자녀 수별 66
• 4) 교육수준별 69
• Ⅵ. 결론 73
• 　1. 연구결과 요약 73
• 　2. 정책적 시사점 74
• 　3. 연구의 한계와 향후 연구 방향 76