China’s Ambitious Policy Experiment with Social Long-Term Care Insurance: Promises, Challenges, and Prospects

In 2016, China launched long-term care insurance (LTCI) pilot programs in 15 cities across the country. In this Commentary, we provide an overview of these pilots regarding the target insured population, sources of financing, beneficiary eligibility criteria, and benefit design. We offer perspectives on the strengths and limitations, implementation challenges, and future prospects of these ongoing pilots. Also, we highlight the needs for addressing several key policy issues and challenges before further expanding these programs toward national implementation. These include solidifying the LTCI financing pool for independence and self-sustainability, balancing national priorities and local needs in LTCI design, reducing coverage gaps and disparities, ensuring quality of care through pay-for-performance and regulatory oversight, and strengthening independent evaluation of LTCI implementation and impacts.China is piloting public social insurance as its core long-term care financing strategy.Current long-term care insurance pilots vary greatly in program design across pilot sites.Long-term care insurance financing should move away from current over-reliance on existing health insurance funds toward independence and self-sustainability.While balancing national priorities, it is essential to design and implement appropriate long-term care insurance programs locally.China should dedicate time and resources to allow for sufficient policy learning, adaption, and evaluation through ongoing pilot programs.