Rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen steady increase in public funding to long-term care (LTC), the narrow financing base and vast population combined mean large unmet demand, calling for financing reforms. This paper focused on institutional LTC care by examining new LTC financing models emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging LTC financing models are discussed in the paper: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao, and means tested model in Nanjing. We conducted a focused review of academic and grey literatures to identify and assess these LTC financing models in China, supplemented qualitative interviews with government officials from relevant departments, care home staff and service users. This paper finds that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, as well as created powerful incentive for over-providing unnecessary services. Means-tested method has been remarkably constrained by narrow eligibility and insufficient amount of payment. LTCNI is by far the most desirable policy option among the three, but narrow definition of eligibility has substantively excluded a large proportion of the needy elders from gaining access to care, which needs to be addressed in future reforms. This paper calls for immediate action from the government to establish a financing mechanism for prepayment and pooling specific to LTC cost nationally, incorporate eligibility rules and strict needs assessment, as well as to reform the predominant fee-for service payment method for LTC service provider.
|Publication status||Published - Jun 2016|