Abstract The recent introduction of a national long-term care insurance (LTCI) policy marks a major institutional shift in China’s response to rapid population aging. Rather than representing a fully developed system, the current framework defines a three-year “establishment phase” during which core institutional arrangements are to be developed and refined. This study provides a system-oriented analysis of China’s LTCI, conceptualizing it as an integrated configuration of financing, governance, service delivery, and eligibility assessment mechanisms. Drawing on this analytical framework, the study examines key institutional domains that are likely to shape system development during the establishment phase, with particular attention to payment incentives, administrative processes, eligibility design, and service capacity constraints. It identifies a set of underlying tensions—between standardization and regional flexibility, formal service provision and informal care integration, and short-term expansion and long-term sustainability—that structure policy choices and may generate path-dependent trajectories. Beyond institutional design, the study highlights the broader implications of LTCI for care industry development, labor markets, and social organization. It argues that LTCI should be understood not only as a social insurance program, but as a dynamic system whose effectiveness depends on the alignment of its core components and its capacity for adaptive policy refinement.
Yan Lin (Wed,) studied this question.