Abstract

Background: China is experiencing rapid ageing and is facing an increasing need to provide long-term care services for the frail older and disabled people. As a response to the growing needs, the Chinese government has embarked on a journey of policy experimentation in long-term care insurance, launching pilot models in 15 pioneer cities. Given their recent implementation, still little is known about the implications of these fresh pilot programs, including consequences for rural-urban disparities.

Objectives: This study, firstly, attempts to investigate unmet needs for long-term care and their associated factors in China, with a focus on rural-urban disparities. Then, secondly, it undertakes an initial appraisal of China’s policy experimentation in long-term care insurance, analysing the basic issues of the pilot models and exploring their implications for (in)equalities in long-term care.

Methods: We use the China Health and Retirement Longitudinal Study to explore the prevalence of unmet needs in LTC among rural and urban groups. Using logistic regressions, in examining factors that may contribute to disparities the focus is on place of residence and the role of the hukou system. These results are then linked with an assessment of the basic characteristics of the pilot LTC insurance programs.

Results: There are considerable rural-urban disparities in unmet long-term care needs in China. Rural hukou holders are significantly more likely to have unmet needs regardless of their residency. China’s long-term care insurance pilots start with strict eligibility rules and are highly dependent on the current health care system. Hence, existing inequalities will persist.

Conclusions: We conclude that the hukou status rather than residency aggravates rural-urban disparities in unmet long-term care needs. China’s long-term care insurance pilots can strengthen the capacity of the social security system to cover long-term care needs, but in their current form often disfavor rural groups. To reduce unmet long-term care needs and narrow rural-urban disparities, China requires not only increasing long-term care coverage, but also a reduction of the specific access barriers arising from the hukou system.