Evaluating long-term care insurance policies in China: an integrated analysis of policy instruments and PMC index model

TL;DR

This study evaluates China's long-term care insurance policies using a framework to analyze policy instruments and finds areas for improvement in their design and implementation.

Contribution

The novel contribution is the development and application of a two-dimensional 'policy instrument–policy level' framework integrated with the PMC index model for policy evaluation.

Findings

Environment-based policy instruments dominate (48.9%) in LTCI policies in China.

The PMC index evaluation showed an average policy grade of 'Acceptable' with room for improvement in coordination and timeframe planning.

Local-level policies show a stronger reliance on environment-based instruments compared to central-level policies.

Abstract

Widespread population aging has significantly intensified the pressure on caring for older adults with disabilities. Establishing a long-term care insurance (LTCI) system has emerged as a pivotal strategy for many countries to mitigate this challenge. China is currently in a critical phase of implementing its LTCI system, and a systematic evaluation of its policy instrument is needed to optimize the design and implementation thereof. This study aimed to establish a two-dimensional analytical “policy instrument–policy level” framework to conduct a qualitative analysis of LTCI policy texts from the promotion phase.

We established a two-dimensional analytical framework. By integrating the Policy Modeling Consistency (PMC) index model, we selected a total of 45 LTCI policy documents issued between January 1, 2020, and April 1, 2025, for qualitative analysis and policy scoring. Eleven documents were issued at the central level by national institutions, and 34 at the local level by provincial or municipal government departments.

Environment-based policy instruments accounted for the predominant proportion (48.9%) among all instruments utilized, whereas supply-based (27.8%) and demand-based instruments (23.3%) were relatively underutilized. The central level employed policy instruments in a comparatively balanced manner, while the local level demonstrated a pronounced reliance on environment-based instruments (51.0%). Furthermore, the PMC index evaluation indicated that the average PMC index for the 45 policies was 6.01, which corresponds to an Acceptable average policy grade. Areas for improvement were identified, specifically concerning policy targets, policy timeframe, and policy level coordination.

China’s LTCI policy framework demonstrates an acceptable overall performance level. However, it is characterized by a structural imbalance in the use of policy instruments, differing emphases between the central and local levels, and inadequate systematic design in certain policy components. Accordingly, recommendations for refining the policy system include optimizing the structure of policy instruments, enhancing the systemic integration of policies to improve institutional synergy, rationally planning policy timeframe, and expanding the coverage of policy targets.

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