Background and Purpose: The phenomenon of population aging has brought much economic and social pressure on many countries across the world, resulting in increasing needs for long-term care (LTC) service and the development of long-term care insurance (LTCI) policy. Population aging has brought much pressure to China as well. On June 27, 2016, the Ministry of Human Resources and Social Security of the People’s Republic of China issued a Guide for Pilot Projects on Long-Term Care Insurance Policy to explore the establishment of a social LTCI system as a response to the issue of population aging. Previous studies have shown that collaboration among various stakeholders in policymaking can increase the quality of services designed in public health policies and improve the effectiveness of the service delivery. The current research on China’s LTCI policy largely focuses on the policy design but has only focused in a limited way on the role of stakeholders in policy design and implementation processes or the dynamics between and among different stakeholders.
This paper helps to fill this gap by examining the experiences of policymakers, service providers, and service users who have been involved in designing and implementing care benefits in Suzhou, one LTCI pilot city in China. Drawing on their own experiences, participants offer suggestions regarding designing and implementing benefits in the LTCI policy.
Methods: Twenty in-depth, semi-structured interviews were conducted with five policymakers who have been participated in the policy design, ten professionals in the LTC field, and five service users. Participants were recruited via posted fliers and emails from government agencies, public and private LTC facilities, and community centers. Participants were encouraged to share their experiences of using or delivering LTC services or designing the LTCI policy. Interviews were transcribed verbatim and coded thematically using NVivo qualitative software, guided by the principles of grounded theory.
Findings: Data analysis demonstrate older adults, families, community residents, healthcare service providers, insurance companies, assessment institutions, researchers, and government officials are the stakeholders involved in the policy process. Furthermore, the study findings identify three stages in the policy: policy design, benefits application, and service delivery. In addition to specifying the stakeholders at the different policy stages and their corresponding roles, the study findings uncover both positive and negative experiences of the stakeholders in the policy process.
Conclusion and Implications: The study has practical implications for designing and implementing care benefits in a social LTCI policy. First, policymakers designing LTCI policy should involve a variety of stakeholders in order to benefit from their knowledge and perspectives. Second, a digital LTCI information management system can be established and maintained to realize data sharing and facilitate communication between stakeholders in the LTCI application and assessment processes. Furthermore, to establish a more equitable and fair assessment process, an assessment committee can be formed to make final decisions on applications. Third, this study suggests increasing the wages of formal caregivers given that healthcare service providers are in shortage of formal caregivers due to the current low average pay.
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