The seventh national census in China shows that the population aged 65 and above was approximately 200 million in 2021, accounting for 13.5 per cent of the total population and reaching an increase of 4.63 per cent compared to 2010. With China becoming an ‘aged society’, it is now facing soaring demand for long-term care (LTC) services and thus the Chinese government launched the pilot long-term care insurance (LTCI) system in 2016. The characteristically Chinese LTC services and LTCI systems are introduced by the book Ageing and Effecting Long-term Care in China. Based on the secondary data collected from government websites, newspapers and books, the authors, Sabrina Ching Yuen Luk, Hui Zhang and Peter Pok-Man Yuen, use an interpretative case study approach to investigate the development of the LTCI system and detail the problems that the government has encountered during the implementation of the system.
The book consists of eight chapters. Chapter 1, the Introduction, explains the concepts, importance and types of LTC worldwide as well as the difficulties of implementing LTC in China and in other countries. Chapters 2 and 3 introduce the Chinese social background where the LTC services are provided. Chapter 2, ‘Population Ageing in China’, explores the influences of the Chinese demographic characteristics of its ageing population on the demand for LTC services, including the rapid growth of the ageing population, the difference in the proportion of older people between urban and rural areas, and the increase in older people with chronic diseases, disability or dementia. Chapter 3, ‘Long-term Care, Dementia Care and End-of-life Care in China’, examines the factors that affect the supply of LTC services for older people in China, including changes in living arrangements, transformations in LTC policies, care and support for older people with disabilities and dementia, and the quality of end-of-life care.
Chapters 4–7 focus on the research outcomes. Chapter 4 introduces the LTCI schemes of 15 pilot cities, comparing the characteristics of the schemes and examining the challenges of LTCI sustainable development. Chapters 5–7 focus on the development and implementation of LTCI in three representative cities (Qingdao, Nantong and Shanghai), evaluating outcomes from five perspectives: medical resource utilisation, cost, equity, medical quality and sustainability. Although the implementation of LTCI in each of the three cities has individual characteristics and achievements, similar problems faced them: the limited financing sources for LTC, insufficient older care workers and inadequate professional service quality.
Chapter 8, the Conclusion, summarises the strengths and challenges of implementing LTC in China, highlighting the problems faced by the Chinese government in providing older care services during the COVID-19 pandemic, and suggesting improvements for the financing and delivery of LTC in China. The final remarks suggest insights that China's LTCI reform may provide for other countries and regions.
This book provides a valuable reference for researchers, care providers and policy makers in three main areas. First, this book comprehensively describes the current LTC services and LTCI system in contemporary Chinese society. Economic development and ageing situations vary across different regions in China, and this book uses extensive data to depict the implementation of LTC services in different regions, providing a comprehensive understanding of the reform of LTCI in China's first batch of pilot cities and offering a reference for the promotion of LTC in other places in China. Second, this book is insightful for the future implementation and reform of LTC in China. It summarises the development of LTC services from emergence to 2020, critically pointing out problems and proposing practical suggestions. These suggestions are valuable for the Chinese government to consider for future improvements and deployment of LTC. Third, this book provides a reference for other countries facing similar ageing problems. Many countries are now faced with the issues of sustainability of LTC financing, the balance of LTC between urban and rural older people, and the need for more-effective LTC. The success, and also the shortcomings, of China's experience can be a valuable reference for other countries.
This book also has its limitations. The cities involved in the investigation are too limited to represent all of China since there are significant urban–rural and regional differences across the country. The three cities selected in this book are highly homogeneous: all are coastal cities located in the east of China with a developed economy. The book would provide a more comprehensive understanding of China's LTC services if more cities from the western and central regions (such as Shihezi or Jingmen) were covered. Finally, the satisfaction of beneficiaries is a vital indicator for evaluating the implementation of LTC, but the satisfaction of individual beneficiaries is not well considered in the research. Except for a brief introduction on beneficiary satisfaction in Shanghai, there is no clear explanation of the satisfaction of older beneficiaries in the other cities. Further research about beneficiaries’ satisfaction, as well as the influences of beneficiary satisfaction on the improvement of LTC services, could offer more insights about how to provide LTC more effectively for people in need.
