BackgroundSince the public long-term care insurance (LTCI) system was piloted in Chengdu, China in July 2017, there has been a considerable growth of LTC institutions in China. This study aimed to evaluate the health value effect of LTCI in older patients with severe disabilities in an LTC institution.MethodsThis study was based on data from 985 severe disability patients with or without LTCI from July 2017 to October 2020 in the Eighth People's Hospital, Chengdu, China. The Cox proportional

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... ard model estimated LTCI's health value, including survival probability and risk of pneumonia/pressure ulcers. Subgroup analysis was performed for sex, age, Charlson Comorbidity Index (CCI), and the number of drugs.OutcomeIn the analysis 519 and 466 patients in LTCI and non-LTCI groups, respectively, were included. In adjusted Cox analyses, the LTCI group had a significantly elevated survival rate compared at 12 months (P<0.001, OR=1.758, 95% CI 1.300-2.376). At 40 months, the adjusted survival rate was 62.6% in the LTCI group, which was significantly higher (53.7%; P=0.003, OR=1.438, 95% CI 1.131-1.831). The subgroups of patients aged 60 to 79 years (interaction P=0.007) and CCI≥3 (interaction P=0.026) were more significantly associated with survival improvement than those aged >80 years and CCI< 3. The LTCI group was also at lower risk for hospital-acquired pneumonia (P=0.016, HR 0.622, 95% CI 0.422-0.917) and pressure ulcers (P=0.008, HR 0.695, 95% CI 0.376-0.862). The improved survival of LTCI remained stable in sensitivity analyses.ConclusionFor older patients with severe disabilities, in a long-term care institution, LTCI significantly improved their health profile and longevity after a year, suggesting the large role and development potentiality of institution care in the LTCI system of China.