The Flynn Effect of Multidimensional Health and The Impact of Long-term Care Insurance Scheme for Chinese Middle-and-Old Age Adults

Background With global population ageing accelerating, healthy ageing has emerged as a key priority for both individuals and healthcare systems. Cohort differences in health serve as indicators of improvements in population health over time. However, evidence on whether later-born cohorts are healthier in middle and later life remains limited in China. Methods Using data from five waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020), we examined the presence and drivers of the Flynn effect in multidimensional health among adults aged 45–85. Comparison groups with the same age periods were constructed to isolate cohort effects from ageing effects. Multivariate regressions and Oaxaca-Blinder decomposition were used to unpack the Flynn effect. We further employed a propensity score matching difference-in-differences (PSM-DID) approach to evaluate the impact of China’s long-term care insurance (LTCI) pilot policy on participants’ limitations in activities of daily living (ADL). Results We observed significant Flynn effects in self-rated health, chronic disease, disability, and ADL limitations (under age 65). Endowment effects, particularly sleep quality, internet use, and early-life conditions, explained a large portion of these improvements. However, future trajectory of health Flynn effect remains uncertain due to inconsistent impact directions of the factors. Meanwhile, LTCI significantly reduced ADL limitations, with stronger effects among women and residents in less developed regions. Conclusions While the Flynn effect reflects long-term structural improvements in population health, LTCI pilot represents a policy intervention aimed at enhancing physical function among older adults. Combining these perspectives allows us to assess both secular and policy-driven progress toward healthy ageing. Policy refinements that promote positive health behaviors and expand LTCI coverage, especially in underdeveloped areas, are essential to support healthy ageing.