The General Office of the Central Committee and the General Office of the State Council issued a notice! The long-term care insurance system is being fully promoted!

On the evening of March 25th, the General Office of the Central Committee of the Communist Party of China and the General Office of the State Council issued the “Opinions on Accelerating the Establishment of a Long-term Care Insurance System” (hereinafter referred to as the “Opinions”). It calls for the development of a long-term care insurance system that is suited to China’s basic national conditions, covers all citizens, coordinates urban and rural areas, ensures fairness and unity, is safe and regulated, and is sustainable (hereinafter called the “Long-term Care Insurance System”). The goal is to continuously enhance people’s sense of gain, happiness, and security.

This marks the official transition of China’s long-term care insurance system from pilot projects to full implementation.

Basically Establish the Long-term Care Insurance System in About 3 Years

The “Opinions” propose that the main goal is to establish a basic framework for the system within about three years, including a coordinated urban-rural institutional arrangement, a shared responsibility funding mechanism, a fair and moderate benefit guarantee system, and a scientifically regulated management and operation mechanism. The long-term care insurance system that fits China’s basic national conditions will be fundamentally established.

The long-term care insurance system is a social insurance scheme that provides services or funding guarantees for the basic daily care and related medical nursing of disabled individuals. It is an important part of China’s social security system and a key component in implementing the national strategy to actively respond to population aging.

According to the “Opinions,” policies and systems will be unified and standardized at the national level, with coordinated urban and rural system design, based on facts and local conditions, and progress will be made steadily and orderly in building the long-term care insurance system.

Employers (including enterprises, public institutions, government agencies, and social organizations), as well as employees, retirees, flexible workers, and unemployed urban and rural residents, will participate in the insurance based on the principle of territorial management. The long-term care insurance fund (hereinafter referred to as the “Fund”) will be managed with unified accounts and funds will be pooled for use. Regions can initially cover employees, retirees, and flexible workers, gradually expanding to include unemployed urban and rural residents.

The system will start with city and prefecture-level coordination. Policies and management will be unified within these regions, with the Fund’s income and expenditure managed collectively and services integrated. Provinces with conditions may explore provincial coordination by standardizing policies, balancing fund transfers, improving tiered management, strengthening budget assessments, and optimizing management and services.

The “Opinions” emphasize maintaining the system’s unity and standardization to ensure balanced participation, contribution, benefit payments, disability level assessments, fund management, administrative handling, and information technology across regions.

As an important strategic measure to address the challenges of population aging, the full implementation of the long-term care insurance system is highly anticipated. By the end of 2024, China’s population aged 60 and above has reached 310 million.

Since 2016, China has launched pilot programs in 15 cities, expanding to 49 cities by 2020. Several other cities have also conducted pilots. By the end of 2024, nearly 188 million people in 49 pilot cities participate in the long-term care insurance, with 1.4625 million beneficiaries receiving benefits.

Since 2024, multiple supporting regulations and standards for the system have been issued; notably, on September 25th of last year, the National Healthcare Security Administration released the “National Long-term Care Insurance Service Items Directory (Trial),” further laying the foundation for nationwide promotion.

Since the second half of 2025, the implementation of the system has accelerated significantly. According to incomplete statistics from Securities China, since August last year, several provinces and cities—including Guizhou, Yunnan, Hainan, Liaoning, Quanzhou in Fujian, Shanwei and Huizhou in Guangdong—have introduced measures related to establishing the long-term care insurance system.

For example, Yunnan Province previously only included Kunming among the 49 pilot cities. Last year, the Yunnan Provincial Medical Insurance Bureau publicly solicited opinions on the implementation plan for establishing the long-term care insurance system, mentioning that it would take about three years to establish a system suited to the province’s conditions.

Unified Premium Rate Controlled at About 0.3%

The funding mechanism is the foundation and core of the long-term care insurance system’s sustainability. Setting appropriate contribution standards and sharing mechanisms is crucial. From current pilot experiences, the Fund generally operates smoothly.

The “Opinions” require establishing a diversified funding mechanism compatible with economic development levels, burden capacities, and sustainability needs. Contributions should be based on income and balanced to ensure stable fund collection, independent operation, and actuarial balance.

According to the “Opinions,” the premium rate for long-term care insurance will be uniformly controlled at about 0.3%.

Specifically, employer and employee contributions will be shared proportionally, with the contribution base for employers being the total wages of employees, and for individuals, their own wage income. Both employer and employee will contribute jointly.

Retirees will pay the same rate as current employees, with contribution bases linked to pension levels, paid solely by individuals; former employers will no longer contribute.

Funding for unemployed urban and rural residents will be shared reasonably between individuals and the government. Individuals will pay, and the government will provide subsidies, jointly funded by central and local finances. Considering urban-rural differences, localities may base contributions on the previous year’s per capita disposable income of urban and rural residents, or in rural areas, on the previous year’s rural per capita disposable income. Efforts will be made to explore more scientific and detailed funding mechanisms.

In the first year of establishing the system, the contribution rate for unemployed urban and rural residents will be halved, starting at about 0.15%, gradually rising over about five years to around 0.3%. Regions with conditions may start from 0.3% directly.

The “Opinions” encourage flexible employment personnel to participate at the same rate as unit employees, with contribution bases set at a certain percentage (not less than 60%) of the previous year’s average social wage in the coordination area, paid by individuals. They may also choose to participate under the policies for unemployed urban and rural residents.

The government will provide categorized assistance for the contribution parts of eligible low-income groups. Those under 18 will follow their parents or legal guardians for insurance, without separate funding.

Personal accounts of basic medical insurance can be used for contributions to long-term care insurance by the insured person and close relatives (including spouses, parents, children, siblings, grandparents, grandchildren, etc.).

Initial Focus on Severe Disability Benefits

Regarding benefits, the “Opinions” state that, considering economic development, fund capacity, and basic social needs, the system should be implemented within its capacity, with reasonable scope for beneficiaries, service items, and benefit standards to ensure a basic livelihood.

According to the “Opinions,” individuals who have paid premiums as required, and whose disability status persists long-term (generally over 6 months), and who are approved after assessment, can enjoy related benefits. The initial phase of the system will focus on severely disabled individuals. As the economy develops and the system improves, the scope of beneficiaries will be gradually expanded through national research, with adjustments to contribution rates based on fund expenditure needs.

The national level will specify baseline benefit standards, which localities can adjust appropriately. There will be no deductible standard for benefits. For eligible long-term care services, if insured under the unemployed urban and rural residents policy, the fund will cover about 50%; for those under the unit employee policy, about 70%, with retirees enjoying the same benefits as current employees. Flexible workers will receive benefits according to their chosen policy. Based on the development of a balanced funding mechanism and equitable contribution responsibilities between employed and unemployed persons, benefit levels will be gradually balanced.

The maximum annual payout from the fund will not exceed 50% of the previous year’s per capita disposable income of urban and rural residents in the coordination area.

The “Opinions” also regulate benefit utilization. The fund will mainly cover costs for approved long-term care institutions and personnel providing basic services, and will generally not directly pay cash to disabled individuals.

The “Opinions” call for strengthening organizational implementation. All regions and relevant departments should, under the unified leadership of the Party Central Committee, implement these policies based on local conditions, advancing reforms steadily and prudently. Publicity and policy interpretation should be strengthened, mutual aid concepts promoted, and reasonable social expectations formed.

Provincial governments should coordinate the pace of reform, avoiding uniform or “one-size-fits-all” approaches. Based on thorough assessment, targeted guidance should be provided for different cities and regions to advance reforms step by step. Regions with conditions should proceed cautiously and in an orderly manner. Areas lacking conditions should solidify their groundwork and initiate implementation at the appropriate time. Cities that previously piloted the long-term care insurance system should adjust and improve policies within three years to ensure a smooth transition.

Typeset: Liu Junyu

Proofread: Zhu Tianting