Home care for older people in urban China: Impacts of the marketisation process
Wenjing Zhang | Bristol University
The reforms of care for older people have been embarked upon in urban China as a result of the dramatic demographic and social-economic changes that have taken place since the 1980s. Home care is proposed to fulfil the rising care deficit for older people, while the market plays an increasingly active role in the field of care in urban China. Although various strategies of marketisation have been applied in financing and service provision in urban China, few studies pay attention to the marketisation of home care. This exploratory study aims to examine how the marketisation process is shaping the development of home care policy and practice for older people in urban China. The primary objective is to explore the model of the marketisation of home care in urban China. This leads to the following objectives: examine the rationale behind the marketisation of care; understand the marketisation trend of home care; discuss processes of marketisation of home care; and explore existing and potential impacts on the care system and participants in the care market. Five key stakeholders are identified in the home care market in urban China, namely service users, providers, purchasers, care workers, and regulators. Central to this case study is experiences and viewpoints of service providers and local regulators in Shanghai, who have first-hand information about how home care agencies are organised, how government policies are implemented, and what kind of marketisation processes are proposed. Semi-structured interviews with managers in home care agencies and local public officials are the main data source, supplemented by policy documents. The marketisation of care in urban China is distinctly based on its strong state, the traditional emphasis on family, state-based community, and increasing market involvement. This study explores the role of service providers and local regulators in the policy process, as well as identifies the characteristics embedded in the policy and practice of home care for older people. Key strategies have been applied in the trials of maketisation of care in Shanghai: ‘contracting out’ from the state to independent providers, cash or noncash financial support to older people and family for purchasing care services and employing care workers, and direct purchasing in the care market through private funding. This study discusses the impacts of the marketisation of care for older people on care recipients and providers and shifts of the care diamond, under the themes of equality, competition, efficiency, quality, care relationships, and shifts of care regime.