The impact of long-term care insurance on family care for older adults: The mediating role of intergenerational financial support

Lianjie Wang; Jing Liu

doi:10.1371/journal.pone.0299974

Peer Review History

Original SubmissionAugust 15, 2023
8 Nov 2023 Decision Letter - Yuxia Wang, Editor PONE-D-23-25847The Impact of Long-term Care Insurance on Family Care for Older Adults: Evidence from a Quasi-Natural Experiment in ChinaPLOS ONE Dear Dr. wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 23 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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During revision, please pay attention to the suggestion and comments of the Reviewer #2. Please note that your revised version will be further assessed by external reviewers. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study examines how the introduction of long-term care insurance in China has affected the amount of family care provided to older adults using a difference-in-differences analysis approach, taking into account the heterogeneity of the subjects. The results show that the introduction of long-term care insurance leads to a decrease in family care. They also show that the impact of insurance varies depending on the attributes of the target population. The authors demonstrate the effectiveness of long-term care insurance. This paper provides important insights into how to support family caregiving for older adults in an aging society. The hypothesis is clearly presented, the analysis is well designed, and the results are interesting. However, as interesting as the study is, it is very disappointing that the authors disregard the journal's author guidelines. In addition, the validity of the data used is unclear and there seems to be insufficient consideration of limitations. I hope you will take the following points into consideration. Major comments 1. The author guidelines contribute to readability, so the authors should be divided accordingly into Introduction, Materials and Methods, Results, Discussion, and Conclusions. I understand that Results and Discussion are sometimes written together in economics and policy studies, but at least in 4.4.2, 4.5, and Table 8, analyses not described in Methods should not be started in the Results and Discussion sections. The Methods section should include a description of the analyses for all robustness checks and heterogeneity analyses, as well as the analyses that accompany them (e.g., balance test). The Vancouver method should also be used for references in accordance with the guidelines. 2. 2.1 Policy background: Please consider adding a description of the system (e.g., delivery system, support system, etc.) for medical care and long-term care for older people in China before the intervention begins. My concern is that when financial support is provided through long-term care insurance, residents will not be able to use them if the local service delivery system is not adequate. Also, the medical care delivery system could complement long-term care services. 3. 2.1 Policy background: Please consider specifying the differences between medical care and long-term care in the Chinese system. In particular, it would be helpful to explain the differences in financing, payment, service delivery systems, and service content. 4. Figure 1: It would be easier to understand if you could visualize which regions are starting to introduce the system and from which survey year. I am not familiar with Chinese place names, so I have difficulty understanding the text and figures; I suggest numbering the pilot areas and indicating the place names with notes. Also, please let me confirm what is the difference between the pilots by the local government and the officially announced 15 pilots. 5. 2.2 Literature Review: Prior studies have been properly reviewed, but it would help the reader's understanding by specifying which country the study is from. 6. 3.1 Data: CHARLS data is insufficiently detailed. At the least, the survey's subject and target sampling methods, survey methodology, geographic areas included, response rates, and dropout rates are important for bias and interpretation of the results. Please consider providing explanations in the text and supporting materials or citing articles that describe them. 7. please specify how many subjects were excluded in each of the two stages of the selection process. 8. Were there any missing data? If so, how were they addressed? 9. 3.3.1: Individuals are nested in cities. Therefore, I am concerned that each observation is not independent over time and that there is a city-level autocorrelation. For example, have you considered using city cluster standard errors or using city random effects? 10. 3.3.2: Did the authors use "nearest neighbor matching within caliper"? Please provide more clarification on the matching method. 11. 3.3: Did they use linear regression for all analyses? 12. Table 1: Considering the DID, it would be easier to understand the changes if you show the mean values before and after the intervention for each group, respectively. 13. Figure 2: Does "current" on the horizontal axis indicate the time of intervention? How is it taken into account in this analysis if there is only one time point before the intervention or one time point after the intervention? 14. 4.4.1: Was the overlap of the propensity score values sufficient? 15.Line 608: What do the authors consider the validity of the common shocks assumption for DID in this study? 16. Policy Implications: We should limit ourselves to suggestions that can be made based on the results analyzed in this study. Some of the suggestions seem to be overstated. Minor comments 1. 3.3.3: Equations 7 and 8 are missing. 2. Table 4: seems to contain Chinese characters. 3. Line 594: Table 9 is missing. Reviewer #2: 1.There is much room for modification in the language, typesetting and grammatical methods of the article. 2.Please strengthen introduction section to highlight the value of this study. Besides, Each paragraph in the introduction seems to be unrelated to the previous paragraph. 3.There is an expression mistake, not '家庭照料' but 'family care'. 4.Regarding sample selection, to enhance the reliability of research conclusions, the author needs to accurately match pilot samples. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
12 Dec 2023 Author Response Response to Reviewers Dear Editor and Reviewers, We would like to express our gratitude for your professional suggestions and constructive comments, which are essential for improving the quality of our research paper. We have carefully considered and addressed each point raised by the reviewers, and we believe that our revised manuscript is now significantly improved. Please find below a detailed response to each of the reviewers' comments. Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting _sample_title_authors_affiliations.pdf. Response: Thank you for the suggestions provided by the journal. We have made modifications to the format of this article according to the requirements of the two documents, making the manuscript more in line with the journal’s requirements. 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Response: Thank you for your reminder. We have carefully checked and corrected the funding detail. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. Response: Thank you so much for this kind reminder. The data we used in this article is secondary data, which is openly available to the public. If you need anything else from us, we will be more than happy to provide 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. Response: Thank you for your comment. We have added the "Ethics statement" in the "Methods" section of this paper on page 11. 5. We note that Figure 1 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright. Response: Thank you so much. Figure 1 was drawn by the authors, therefore, the authors own the copyright of Figure 1. The authors grant permission for the open-access journal PLOS ONE to publish Figure 1 under the Creative Commons Attribution License (CCAL) CC BY 4.0. Reviewer #1: This study examines how the introduction of long-term care insurance in China has affected the amount of family care provided to older adults using a difference-in-differences analysis approach, taking into account the heterogeneity of the subjects. The results show that the introduction of long-term care insurance leads to a decrease in family care. They also show that the impact of insurance varies depending on the attributes of the target population. The authors demonstrate the effectiveness of long-term care insurance. This paper provides important insights into how to support family caregiving for older adults in an aging society. The hypothesis is clearly presented, the analysis is well designed, and the results are interesting. However, as interesting as the study is, it is very disappointing that the authors disregard the journal's author guidelines. In addition, the validity of the data used is unclear and there seems to be insufficient consideration of limitations. I hope you will take the following points into consideration. Major comments 1. The author guidelines contribute to readability, so the authors should be divided accordingly into Introduction, Materials and Methods, Results, Discussion, and Conclusions. I understand that Results and Discussion are sometimes written together in economics and policy studies, but at least in 4.4.2, 4.5, and Table 8, analyses not described in Methods should not be started in the Results and Discussion sections. The Methods section should include a description of the analyses for all robustness checks and heterogeneity analyses, as well as the analyses that accompany them (e.g., balance test). The Vancouver method should also be used for references in accordance with the guidelines. Response: Thank you for your suggestions. We have revised the manuscript as follows: Firstly, according to the author's guidelines, we have revised the article structure into following 6 sections: Introduction, Policy background and research hypothesis, Materials and methods, Results, Discussion, Conclusions and policy implications. Based on the original manuscript, we also added a section named "Policy background and research hypotheses" to introduce more details of the pilot long-term care insurance policies in China. We hope that’ll help provide more background information for readers. Secondly, we have revised the structure of the methods, results and discussion sections. In the "methods" section, we have presented an overview of all the primary research methods conducted in this study. We have consolidated all the empirical analysis in the "results" section. Through these modifications, we have ensured that the "methods," "discussion," and "results" sections are more in line with the basic requirements of the journal. 2. 2.1 Policy background: Please consider adding a description of the system (e.g., delivery system, support system, etc.) for medical care and long-term care for older people in China before the intervention begins. My concern is that when financial support is provided through long-term care insurance, residents will not be able to use them if the local service delivery system is not adequate. Also, the medical care delivery system could complement long-term care services. Response: Thank you so much for this valuable comments. We have rewritten the entire "policy background" section. Please see from page 3 to page 5. In the revised version, we introduced the system in two sub-sections: the first primarily analyzes the differences between China's medical care and long-term care insurance, while the second provides a brief overview of the development and basic situation of long-term care insurance. In China, Long-term care insurance is composed of separately established healthcare institutions that introduce market entities such as nursing homes and medical institutions to provide services. Based on our research in various regions, it is observed that older adults who qualify for long-term care insurance can generally receive comprehensive and qualified nursing services. In addition, medical care covers expenses related to the prevention and treatment of chronic diseases and illnesses in older adults, while long-term care insurance primarily provides service support for disabled older adults. 3. 2.1 Policy background: Please consider specifying the differences between medical care and long-term care in the Chinese system. In particular, it would be helpful to explain the differences in financing, payment, service delivery systems, and service content. Response: Thank you for your suggestion. We have discussed the differences between China’s medical insurance and long-term care insurance in the policy background section on page 3 and 4. 4. Figure 1: It would be easier to understand if you could visualize which regions are starting to introduce the system and from which survey year. I am not familiar with Chinese place names, so I have difficulty understanding the text and figures; I suggest numbering the pilot areas and indicating the place names with notes. Also, please let me confirm what is the difference between the pilots by the local government and the officially announced 15 pilots. Response: Thank you for your suggestions. I have made the following revisions to the manuscript: Firstly, Figure 1 presents the basic situation of the pilot program for the long-term care insurance in China. The subsequent research in the manuscript is based on the treatment groups annotated in the CHARLS data from the regions depicted in Figure 1. We totally agree with you that adding the specific policy implementation year for each pilot city will make more sense for the readers while reading this paper. We have added detailed policy implementation years for all the pilot cities in the "Note" section of Figure 1. Secondly, the officially announced 15 pilot cities are national-level pilot cities that have been determined by the central government through the issued documents. They are part of a formal national policy promoted by the central government. On the other hand, local government pilots are initiated by the local governments themselves and are local policies undertaken to address the long-term care needs of older adults. The general pattern of institutional development in China is to first select representative regions for regional pilots, gradually expand the scope of the pilot program, and eventually implement it nationwide. We really appreciated the suggestion of numbering the pilot cities to help readers distinguish different cities. But after careful consideration, we did not number the pilot cities in this revised version, instead, we added the specific policy implementation year for each city to help readers distinguish the pilot cities. 5. 2.2 Literature Review: Prior studies have been properly reviewed, but it would help the reader's understanding by specifying which country the study is from. Response: Thank you for your suggestion. It is indeed important to acknowledge that different scholars’ perspectives are based on different countries and regions. We have made efforts to indicate the countries associated with different viewpoints as much as possible, so that readers can have a clearer understanding of this. 6. 3.1 Data: CHARLS data is insufficiently detailed. At the least, the survey's subject and target sampling methods, survey methodology, geographic areas included, response rates, and dropout rates are important for bias and interpretation of the results. Please consider providing explanations in the text and supporting materials or citing articles that describe them. Response: Thank you for your comments. Our description of the data source is primarily based on the official website of CHARLS, which can be found at http://charls.pku.edu.cn/gy/gyxm.htm. In response to your suggestion, we have added additional detailed information in the data section (page 8) to provide more detailed information about the data. This ensures that our data contains sufficient details. The followings are the data details we added in this revision: (1) Sponsor of the data Project: Peking University National Development Research Institute, Peking University China Social Science Survey Center, and Peking University Youth League Committee. (2) Start time and frequency of follow-up surveys: The survey started in 2011, and three follow-up surveys were conducted in 2013, 2015, and 2018. (3) Coverage: The survey covers 28 provinces in China and includes nearly 20,000 respondents from 450 communities nationwide (Excluding Hong Kong, Macau and Taiwan Province). (4) Main methodology: The questionnaire design drew on international experiences, including the Health and Retirement Study (HRS) in the United States, the English Longitudinal Study of Aging (ELSA), and the Survey of Health, Aging, and Retirement in Europe (SHARE), among others. The project employed a multi-stage sampling approach, with the use of probability proportional to size (PPS) sampling at both the county/district and village levels. CHARLS pioneered the use of electronic mapping software (CHARLS-GIS) technology to create village-level sampling frames using a mapping method. (5) We also added the detailed description of the two reasons, process, and results of using CHARLS in this study. Unfortunately, CHARLS did not disclose response rates, therefore we were not able to talk about it in the article. But we made sure that we include detailed sample and variable information in the descriptive statistics section. Thank you for your understanding and support. 7. please specify how many subjects were excluded in each of the two stages of the selection process. Response: Thank you for your suggestion. I have added the number of lost samples during the two stages of processing on page 8. 8. Were there any missing data? If so, how were they addressed? Response: Thank you for your comments. Yes, there were missing data in the variables "Upward" economic support and "Downward" economic support. Since these two variables are continuous, we used the interpolation method to handle missing values by predicting them based on neighboring observations. Taking your advice into consideration, we have added supplementary explanations in the note section of Table (page 13). 9. 3.3.1: Individuals are nested in cities. Therefore, I am concerned that each observation is not independent over time and that there is a city-level autocorrelation. For example, have you considered using city cluster standard errors or using city random effects? Response: Thank you for your comment. We greatly agree with your point of view. In the basic regression, we only controlled for time and individual fixed effects, without considering city random effects. Therefore, we have made modifications in the "robustness test" section. In this section, we have added city and province fixed effects, as well as some interaction terms. We hope that this approach will help address the issue. 10. 3.3.2: Did the authors use "nearest neighbor matching within caliper"? Please provide more clarification on the matching method. Response: Thank you for your suggestion. The standalone PSM method provides multiple matching methods, and the PSM-DID model typically uses default kernel matching for estimation. In accordance with your suggestion, we have made modifications to the corresponding section and explained the method we used. 11. 3.3: Did they use linear regression for all analyses? Response: Thank you for your comment. The dependent variable in this study is a continuous variable, and the data used is panel data. Therefore, the main research method employed is the linear regression method (“xtreg”). In the mechanism analysis, intergenerational economic support is also a continuous variable. Therefore, it is mostly analyzed using the linear regression method, unless otherwise specified. 12. Table 1: Considering the DID, it would be easier to understand the changes if you show the mean values before and after the intervention for each group, respectively. Response: Thank you for your comment. We have made supplementary modifications to Table 1, adding the mean and SD before and after intervention. 13. Figure 2: Does "current" on the horizontal axis indicate the time of intervention? How is it taken into account in this analysis if there is only one time point before the intervention or one time point after the intervention? Response: Thank you for your comment. We have made mod Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0299974.r002
31 Jan 2024 Decision Letter - Yuxia Wang, Editor PONE-D-23-25847R1The impact of long-term care insurance on family care for older adults: quasi-experimental evidence from ChinaPLOS ONE Dear Dr. wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 16 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Yuxia Wang Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I would like to express my gratitude to the authors for sincerely addressing the comments and making the necessary amendments. These changes have improved the quality of the manuscript. However, it seems that the description in the Methods section remains insufficient. According to the STROBE guideline, the methods for all sensitivity analyses must also be included in the Methods section. Please consider adding details about Robustness tests, Heterogeneity analysis, and Further analysis in the Methods section. It is better to refrain from presenting additional analytical methods in the results section. Another concern is the lack of published response rates for the CHARLS data. This omission could potentially introduce a significant bias in the results, so I recommend acknowledging this as a limitation. Overall, nice work. I hope this research contributes to the development of China's long-term care insurance system. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0299974.r003
Revision 2
3 Feb 2024 Author Response Response to Minor Revision Dear Editor and Reviewers, We would like to express our gratitude for your professional suggestions and constructive comments, which are essential for improving the quality of our research paper. We also greatly appreciate your recognition and acceptance of our paper. Based on some suggestions for minor revisions, we have made the following modifications to our paper: Reviewer #1: I would like to express my gratitude to the authors for sincerely addressing the comments and making the necessary amendments. These changes have improved the quality of the manuscript. However, it seems that the description in the Methods section remains insufficient. According to the STROBE guideline, the methods for all sensitivity analyses must also be included in the Methods section. Please consider adding details about Robustness tests, Heterogeneity analysis, and Further analysis in the Methods section. It is better to refrain from presenting additional analytical methods in the results section. Another concern is the lack of published response rates for the CHARLS data. This omission could potentially introduce a significant bias in the results, so I recommend acknowledging this as a limitation. Overall, nice work. I hope this research contributes to the development of China's long-term care insurance system. Response： Thank you for your professional feedback and recognition of our manuscript. Your meticulous and professional attitude is commendable. Taking your suggestions into account, we have made the following modifications to the paper: Firstly, we have reorganized the methodology section based on your suggestions. We have rearranged and elaborated on the methods for different stages in the order of empirical analysis in our paper. We have removed statements describing the methodology in the "Results" section to align it as closely as possible with your requirements. Secondly, we have added a research limitation regarding the disclosure of response rates in the CHARLS dataset. In fact, based on the data processing results, the response rates for various questions in the CHARLS dataset exceed 90%, ensuring the reliability of the findings in this study. Other modifications: We made some slight revisions to the title to ensure a more comprehensive expression of the research content. Additionally, we have also made some formatting adjustments based on previously published papers in this journal. Finally, we would like to express our heartfelt gratitude for your thorough work. We wish you good health and a happy life in the new year. Attachments Attachment Submitted filename: Response to Minor Revision.docx https://doi.org/10.1371/journal.pone.0299974.r004
20 Feb 2024 Decision Letter - Yuxia Wang, Editor The impact of long-term care insurance on family care for older adults: The mediating role of intergenerational financial support PONE-D-23-25847R2 Dear Dr. wang, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Yuxia Wang Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for your revisions. No further comments. Great work. I hope this contributes to the development of long-term care insurance system in China. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0299974.r005
Formally Accepted
14 May 2024 Acceptance Letter - Yuxia Wang, Editor PONE-D-23-25847R2 PLOS ONE Dear Dr. Wang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Yuxia Wang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0299974.r006

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