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2018 Conference Presentation

Policy developments China

10 September 2018

Increasing demand for care while promoting institutionalisation: a preliminary study on the impacts of long-term-care insurance in Guangzhou

Wing Kit (Jack) Chan, School of Government, Sun Yat-sen University, China

Zhang, Jiayu, School of Government, Sun Yat-sen University, Guangzhou, China


Ageing societies in the world are desperately looking for a proper and sustainable way to finance long-term-care for their elder citizens. While many societies in East Asia are opting for a moderated form of social insurance in financing long-term care, for example, Japan in 2000 and South Korea in 2008, not much has been discussed on its impacts on care servcies though. China introduced a nationwide pilot scheme of long-term-care insurance in the summer of 2016 while most cities chosen by it did not embark it until 2017. Previous studies in the area suggest that the pilot scheme rely heavily on resources diverted from the surplus of existing medical insurance schemes. As a result, not only the medical professionals have a larger say in the direction of the piloted new scheme, but also cities in the hinterland would find it less viable to implant the models piloted by their coastal peers. By looking into the practice of the piloted scheme in Guangzhou, one of the major cities in coastal China, this study discovers that a paradox of this pilot scheme. On the one hand, long-term-care insurance would strengthen care demand among elderly with physical and psychological disabilities, and, indeed enhance their well-being, on the other hand, due to the complicated mechanism in assessing eligibility, it tends to push such elderly citizens to opt for institutional care rather then home-and-community-based care. The latter, in-depth study demonstrates that, are not only against the genuine wish of most elderly but also against a world trend of de-institutionalisation in social care, a rich body of literature has been suggesting for a long time. In addition, it is found that the pilot scheme also prioritising formal care over informal ones by relatives and friends. This paper appreciates that the fact that the piloted long-term care insurance in Guangzhou significantly subsidise demand for care services, but it questions the intention of the existing mechanism of delivery which twitted such demand for institutional care instead of home-and-community-based care and suggests for a redesign to better target the need of the elderly. This paper also argues that developing countries appraise the implicit de-institutionalisation aspects of long-term-care insurance better before decided to adopt a contributory system in financing long-term care.

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