Article ID: 2026.01098
Rapid population aging is increasing demand for long-term care (LTC), prompting many countries to institutionalize financing and service provision through long-term care insurance (LTCI). Digital health technologies are increasingly embedded into LTCI, and yet the pathways in which they are embedded and their governance effects differ across institutional contexts. This comparative review synthesizes evidence from Japan, South Korea, and China across five operational domains—institutional foundations, eligibility determination, service management, fund oversight, and policy steering—and uses a sociotechnical systems lens to analyze how technology and institutions co-evolve. We propose a three-layer model of institutional embedding linking welfare-boundary constraints, governance mechanisms shaping data-driven operations, and path dependence in policy and implementation. In the three countries, digital health technologies have not fundamentally expanded the welfare boundary of LTCI, but they have reshaped how LTCI is administered, shifting i) needs assessment from experience-led judgment toward data-driven decision-making support, ii) service management from flexible discretion toward rules and platform-based coordination, and iii) oversight from ex post auditing toward process-oriented monitoring. Distinct national pathways have emerged: a supplementary-technology pathway in Japan, a state-led integration pathway in South Korea, and an exploratory co-evolutionary pathway in China. These benefits are accompanied by practical risks, including algorithmic bias, inconsistent data quality, privacy and security concerns, and potential erosion of institutional flexibility. The proposed model helps explain cross-national divergence and provides a governance-oriented basis for selecting embedding strategies and safeguards in different LTCI contexts.
