This study examines the structure and evolution of China’s elderly care policy instruments from 1992 to 2024, in the context of persistent low fertility. The aim is to identify key policy priorities, structural gaps, and emerging governance patterns, providing evidence to guide the enhancement of elderly care policies in aging societies facing declining fertility rates. A content analysis was conducted on 54 elderly care policy documents issued by the Chinese government. Using Rothwell and Zegveld’s policy instrument framework and major milestones in policy evolution, a two-dimensional analytical matrix was constructed. The frequency and proportion of policy tools were quantified and analyzed to reveal their distribution and temporal variation. From the 54 documents, 427 discrete policy items were coded. On the X- dimension (instrument type), supply-oriented, demand-oriented, and environment-oriented instruments accounted for 50.6%, 15.7%, and 33.7% of all items, respectively. The Y-dimension (policy development stage) showed three distinct phases: the initial exploration period (19.4%), the integration and development period (46.4%), and the innovation and expansion period (34.2%). China’s elderly care policy landscape is characterized by a dominance of supply-oriented instruments, an underrepresentation of demand-oriented tools, and a moderate presence of environment-oriented instruments, reflecting an imbalanced structure. Supply-oriented instruments emphasize public service provision but lag in digital infrastructure and technological innovation. Demand-oriented instruments remain insufficient, indicating limited measures to stimulate and expand the elderly care market. Environment-oriented instruments exhibit substantial internal variation and require further structural refinement. To promote sustainable development of the elderly care sector under low fertility conditions, a more balanced and comprehensive mix of policy instruments is recommended, with particular attention to strengthening demand-oriented measures.
Su et al. (Tue,) studied this question.