Long-term care insurance is here, ensuring that disabled elderly can always enjoy care | Beijing News Column

Ask AI · What are the key breakthroughs of the long-term care insurance system from pilot programs to nationwide promotion?

▲ Long-term care insurance is referred to as the “sixth social insurance” after pension, medical care, work-related injury, unemployment, and maternity insurance in the industry. Photo/IC photo

According to CCTV, the General Office of the CPC Central Committee and the General Office of the State Council recently issued the “Opinions on Accelerating the Establishment of a Long-term Care Insurance System,” requiring the basic establishment of a long-term care insurance system suitable for China’s basic national conditions within about three years (hereinafter referred to as long-term care insurance).

Previously, the National Healthcare Security Administration, in conjunction with relevant departments, organized two pilot programs in 2016 and 2020 to explore the construction of the long-term care insurance system. Over the past decade, the long-term care insurance pilot programs have benefited more than 3.3 million disabled individuals, reducing the burden of care costs for the public by over 100 billion yuan.

The release of this “Opinion” marks the transition of the long-term care insurance system from local pilot programs to nationwide implementation. This system, as a key measure to address population aging, not only improves the social security system but also has far-reaching significance in protecting the rights of disabled individuals, optimizing resource allocation, and promoting social and economic development.

The long-term care insurance system has undergone multiple development stages

From its initial exploratory phase to its current comprehensive promotion, the long-term care insurance system has gone through several important development stages.

First is the exploratory and initial phase. In December 2006, the General Office of the State Council issued the “11th Five-Year Plan for Population Development” and the 2020 Plan, which first proposed the exploration of establishing a voluntary elderly service and long-term care insurance system, seen as the germination of the long-term care insurance concept.

In 2012, Qingdao took the lead in establishing a demonstration project for the implementation of long-term care insurance policies in urban areas, extending it to rural areas in 2015. From 2013 to 2015, Shanghai carried out a pilot program for the “Medical Care Plan for the Elderly.” In July 2016, the Ministry of Human Resources and Social Security issued the “Guiding Opinions on Carrying out Pilot Programs for Long-term Care Insurance,” clarifying the goals, main tasks, and basic policies of the long-term care insurance pilot programs, marking the formal entry of the long-term care insurance system into the pilot phase.

Next is the phase of pilot expansion and system improvement. In September 2019, the National Development and Reform Commission and 21 other departments jointly formulated the “Action Plan for Promoting High-Quality Development of the Health Industry (2019-2022),” further emphasizing the need to actively pilot and promote the long-term care insurance system, and to improve the grading recognition standards, service specifications, and quality evaluation systems.

In September 2020, the National Healthcare Security Administration and the Ministry of Finance issued the “Guiding Opinions on Expanding Pilot Programs for Long-term Care Insurance,” adding 14 new pilot cities and further expanding the coverage of the long-term care insurance system.

From 2023 to 2024, the National Healthcare Security Administration successively released the “Management Measures for the Assessment of Disability Levels in Long-term Care Insurance (Trial)” and the “Management Measures for Designation of Assessment Institutions for Disability Levels in Long-term Care Insurance (Trial),” further improving the assessment and identification management of long-term care insurance and forming a comprehensive assessment index system.

It then entered the comprehensive promotion phase. In July 2024, the “Decisions of the Central Committee of the Communist Party of China on Further Comprehensively Deepening Reform to Promote Chinese-style Modernization,” adopted at the third plenary session of the 20th National Congress of the Communist Party of China, further emphasized the importance of accelerating the establishment of a long-term care insurance system.

In March 2026, the release of the “Opinions on Accelerating the Establishment of a Long-term Care Insurance System” marked the successful conclusion of the pilot phase. The design of the system has risen from “local experience” to a “national plan,” clarifying the overall goal of “covering all, coordinating urban and rural areas, ensuring fairness and unity, being safe and standardized, and sustainable,” and proposed three major tasks to complete the system’s configuration, mechanism improvement, and system formation within three years.

The significance of the long-term care insurance system is profound

With the acceleration of population aging in China, the number of disabled elderly individuals is increasing, leading to a more urgent demand for long-term care. However, the current social security system has obvious shortcomings in disability care, and family care faces immense pressure. In this context, this system has far-reaching significance and plays a key role in multiple aspects.

First, it fills the gap in disability care protection.

Currently, China has formed a social security system centered on basic pension insurance and basic medical insurance, but the institutional arrangements for the long-term care needs of disabled individuals are still insufficient. Disabled individuals, due to the loss of self-care ability, require continuous professional care services, and their expenses often exceed the family’s financial capacity. Moreover, basic medical insurance primarily covers the costs of disease treatment, making it difficult to cover long-term care costs.

The long-term care insurance system provides funding guarantees for basic daily care and medical care for disabled individuals through independent financing and management, filling the gap in the social security system in the field of disability care.

This system complements basic medical insurance, extending the social security system from “having medical care for illnesses” to “having care for the elderly,” constructing a social security safety net that covers the entire life cycle and population, reflecting the equity and inclusiveness of social security.

Second, it alleviates the pressure of family care.

Currently, in China, families are still the main providers of care for disabled individuals. However, with changes in population structure and an increase in women’s employment rates, the family care function is gradually weakening. Long-term care for disabled individuals not only consumes a large amount of time and energy but may also lead to family economic difficulties and intergenerational conflicts, affecting family harmony.

The long-term care insurance system, through a social mutual assistance mechanism, disperses the risk of disability across society, reducing the economic and care burdens on families. The system design prioritizes the care of severely disabled individuals and gradually expands coverage to ensure that the disabled population can access professional care services, avoiding the dilemma of “one person becoming disabled, the whole family becoming unbalanced.”

At the same time, the provision of professional nursing services compensates for the shortcomings of family care in skills and energy, improving the quality of life for disabled individuals and maintaining the integrity of family functions.

Furthermore, it optimizes the allocation of medical resources.

In the absence of a long-term care insurance system, disabled individuals often rely on long-term hospitalization to solve care issues, with hospitalization costs being several times that of ordinary elderly individuals, occupying a large amount of medical resources (such as hospital beds and staff time), leading to medical resource waste and exacerbating supply-demand conflicts, putting immense pressure on basic medical insurance funds.

The establishment of a long-term care insurance system gradually separates disability care from the medical field, guiding disabled individuals to shift from hospitals to community or home care institutions, effectively alleviating the tension of medical resources.

The design of the long-term care insurance system emphasizes the integration of “medical care and nursing” and the concept of “tiered diagnosis and treatment,” encouraging the development of home and community care services through differentiated payment policies, reasonably guiding disabled individuals to choose appropriate care methods based on their conditions, alleviating the pressure on large medical institutions, allowing disabled individuals to enjoy professional services close to home, reducing care costs, promoting the descent of nursing resources, and enhancing the level of grassroots nursing services.

In addition, this system helps promote the development and employment in the nursing industry.

The implementation of the long-term care insurance system provides stable demand support and policy guidance for the nursing industry, promoting the standardized and professional development of the industry.

The expansion of the system’s coverage and the unification of service standards encourage nursing service institutions to improve service quality, forming a complete industrial chain from nursing talent cultivation, assistive device research and development, to community day care and full-day institutional care.

At the same time, the comprehensive implementation of this system can promote the development of related industries such as nursing training, assistive device research and development, and health management, directly driving the emergence of positions such as caregivers, rehabilitation therapists, and nursing management personnel, creating a large number of employment opportunities. These positions can not only absorb the urban and rural labor force but also provide new employment options for groups facing employment difficulties, alleviating employment pressure and promoting stable economic and social development.

The introduction of the long-term care insurance system is of great significance. As the system continues to improve and land, it will continue to exert efforts in social livelihood security and economic structure optimization, laying a solid foundation for addressing aging challenges and promoting high-quality social development, painting a happy picture of “aging with dignity.”

Written by / Zeng Yi (Professor at the School of Public Management, Zhongnan University of Economics and Law)

Edited by / Ke Rui, Xu Qiuying

Proofread by / Zhao Lin