Frontiers in public health · 2026
Institutionalizing family care responsibility in China's multilevel medical security system: evidence from long-term care insurance policy texts through a Confucian care ethics lens.
СтатьяНазвание и аннотация: Перевод в очереди
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Chen Chuanzhao, Zhang Yigang, Liu Peng
Аннотация
BACKGROUND: China's long-term care insurance reform is a key component of multilevel medical security for addressing care needs among older adults with substantial functional decline, and it also raises an ethical governance question: how family-based Confucian care responsibilities are translated into modern rules of eligibility, payment, service provision and regulation.
METHODS: This study analyzed core long-term care insurance policy texts from 48 pilot cities through directed content analysis, a 45-item coding framework, policy text indices, K-means clustering and a supplementary comparison with the 2026 national rollout document. The 48-city sample was drawn from the 49-city national pilot framework after one city was excluded because no eligible core implementation text was located.
RESULTS: Local policy texts most clearly institutionalized needs assessment, payment responsibility and socialized service provision. Home-based or visiting care was widely recognized, but more specific caregiver-support rules, including caregiver training, respite care, family participation in care planning and detailed home-care service packages, remained less developed, as did digital governance. The national rollout document strengthened equity protection and family care responsibility, but detailed caregiver support and age-friendly digital access still require further specification.
CONCLUSION: Long-term care insurance in China functions not only as a financing and service instrument within multilevel medical security, but also as a public health governance mechanism that translates filial responsibility, care for vulnerable older adults, people-centered governance and benevolent rule into institutional arrangements.
METHODS: This study analyzed core long-term care insurance policy texts from 48 pilot cities through directed content analysis, a 45-item coding framework, policy text indices, K-means clustering and a supplementary comparison with the 2026 national rollout document. The 48-city sample was drawn from the 49-city national pilot framework after one city was excluded because no eligible core implementation text was located.
RESULTS: Local policy texts most clearly institutionalized needs assessment, payment responsibility and socialized service provision. Home-based or visiting care was widely recognized, but more specific caregiver-support rules, including caregiver training, respite care, family participation in care planning and detailed home-care service packages, remained less developed, as did digital governance. The national rollout document strengthened equity protection and family care responsibility, but detailed caregiver support and age-friendly digital access still require further specification.
CONCLUSION: Long-term care insurance in China functions not only as a financing and service instrument within multilevel medical security, but also as a public health governance mechanism that translates filial responsibility, care for vulnerable older adults, people-centered governance and benevolent rule into institutional arrangements.