From "Accelerating Establishment" to "Implementing Systems," how can the nationwide long-term care insurance system break through and improve quality?

Ms. Li from Shanghai recently renewed her long-term care insurance (hereinafter referred to as “LTC insurance”) for her immobile mother. “By applying for LTC insurance, we can spend just a few yuan to enjoy three visits a week, each lasting an hour. The care worker can help the elderly with bathing and massages, which truly eases the burden on us children,” Ms. Li told Yicai.

“The long-term care insurance system covers 300 million people.” “Implementing long-term care insurance” has been featured in the government work report for six consecutive years and has become one of the hot topics among delegates and members at the National People’s Congress and the Chinese People’s Political Consultative Conference this year.

As an important measure to address the aging population, LTC insurance—often called the “sixth social security”—has been in pilot programs since 2016, marking a decade of development. It is now transitioning from pilot exploration to a key stage of nationwide implementation.

According to suggestions from multiple delegates and members, the process of expanding LTC insurance nationwide still faces challenges such as inconsistent standards, an incomplete funding mechanism, and insufficient care service supply. Further improvements are needed in legislation, system construction, and talent development. They also recommend strengthening the professional capabilities of commercial insurance companies and developing supplementary commercial LTC insurance to better alleviate family caregiving pressures and improve the elderly care system.

Significant Pilot Achievements

The government work report lists “promoting the long-term care insurance system” as a major task this year to better safeguard and improve people’s livelihoods.

This is the sixth consecutive year LTC insurance has been included in the government work report.

Yicai reviewed recent government work reports and found that references to LTC insurance have been progressively detailed: from the “steady advancement of pilot programs” from 2021 to 2023, to “promoting establishment” and “accelerating establishment” in 2024 and 2025, and finally to “implementing the long-term care insurance system” in 2026.

“As you can see, the government’s language about LTC insurance has deepened over the years, with increasing policy emphasis. From local pilots to nationwide rollout, the subtle changes in wording clearly reflect the pace and determination of the country’s efforts to build the LTC system. It also shows that the implementation process is accelerating,” said an insurance company executive responsible for LTC insurance operations.

The ongoing aging of the population makes long-term care for disabled and cognitively impaired elderly a social necessity.

According to the National Bureau of Statistics, by the end of 2025, China’s population aged 60 and above will reach 323 million, accounting for 23% of the total population. Meanwhile, data from the National Health Commission shows that by the end of 2023, there were 45 million disabled or cognitively impaired elderly nationwide. Based on this, at least one in seven seniors needs long-term care services. “One person’s disability can throw the whole family off balance,” many families face this harsh reality.

“My mother is over 80, and I am already 60 myself. Taking care of an immobile elderly person is physically demanding. For example, helping my mother bathe is a major project. Even with family help, I increasingly feel overwhelmed,” Ms. Li said.

The launch of LTC insurance is a key step in solving caregiving difficulties. This social insurance scheme, providing basic daily care and medical services for the disabled, officially began exploring in 2016 when the Ministry of Human Resources and Social Security issued pilot guidelines. The pilot cities have gradually expanded to 49.

Over ten years, LTC insurance has evolved from nothing to a pilot program to a nationwide system, achieving phased results.

Zhang Ke, director of the National Healthcare Security Administration, said at the 2025 National Conference on High-Quality Development of Long-term Care Insurance last December that, after pilots, LTC insurance covers nearly 300 million people, benefiting over 3.3 million disabled individuals, with fund expenditures exceeding 100 billion yuan.

Against this backdrop, LTC insurance has begun to expand from pilot projects to nationwide implementation in recent years, with related policies and documents accelerating.

Zhang Ke stated, “During the 14th Five-Year Plan period, the National Healthcare Security Administration will accelerate the establishment of a LTC insurance system with Chinese characteristics, gradually covering the entire population, initially focusing on severely disabled individuals. During implementation, policies on funding, benefits, and payments will be standardized and unified, laying a solid foundation for high-quality, sustainable development of LTC insurance.”

Addressing Key Challenges

This year, as the first year of the 14th Five-Year Plan, is crucial for establishing a comprehensive LTC insurance system. Many NPC and CPPCC delegates believe that, in the process of nationwide implementation, LTC insurance still faces challenges such as standardization, funding mechanisms, and a shortage of care personnel.

“During the nationwide promotion of LTC insurance, systemic and operational issues are intertwined,” said Zhou Yanfang, director of the ESG Office at China Pacific Insurance, a delegate to the National People’s Congress.

One core obstacle is the lack of unified standards. Yan Jianguo, partner at Beijing Xinli Law Firm and NPC deputy, said that due to the absence of a unified legal framework and systematic institutional design, many issues remain in LTC insurance implementation, requiring legislative improvements. He recommends drafting LTC insurance laws to clarify legal status, basic principles, scope, and management systems, establishing LTC insurance as an independent social insurance alongside pension and medical insurance. Based on legislation, detailed implementation rules should be developed to address fragmentation, including standards for disability assessment, funding, benefits, service delivery, and information systems.

Funding mechanisms are also a major concern. Jin Li, vice president of Southern University of Science and Technology and NPC member, suggests creating a multi-layered protection system combining “basic insurance + commercial insurance” to ensure more families have stable payment sources. Yan Jianguo also emphasizes the need for diversified funding responsibilities, establishing dynamic adjustment mechanisms, expanding supplementary channels, regulating fund management, and preventing operational risks to ensure funds are used exclusively and safely.

Service supply remains a significant bottleneck. Many delegates and members point out that a severe shortage of professional care workers is a major challenge for nationwide LTC insurance rollout. “In these years of LTC services, several caregivers have come and gone. Most are quite good, but the professionalism and attentiveness vary,” Ms. Li said.

Jin Li noted that the shortage of care professionals is the biggest bottleneck. The elderly care workforce tends to be older, with insufficient skills and high turnover. Policies should encourage insurance and elderly care institutions to jointly train personnel, offer special allowances, and improve career advancement pathways. Ningxia CPPCC Chairman Chen Yong also suggested vigorously developing long-term care specialists and establishing relevant standards and norms.

Other issues include data sharing bottlenecks and insufficient accuracy in disability assessments. Sun Jie, vice dean of the Insurance School at the University of International Business and Economics and NPC member, recommends accelerating the integration and sharing of information among health, civil affairs, elderly care, and medical institutions, supporting the development of elderly health records, and leveraging blockchain and cloud computing to proactively manage elderly health and reduce care triggers.

Accelerating Commercial LTC Insurance Development

According to delegates and members, commercial insurance companies play an important role in LTC insurance. They not only handle policy-based LTC insurance but should also serve as a vital supplement to the system, addressing care needs beyond the basic safety net.

In operations, Zhou Yanfang said that all pilot cities have established a new cooperation model of “government-led, social participation,” with a separation of management and services, involving health authorities and commercial insurers. Whether through “funds not transferred, service purchase” or “funds transferred, risk sharing,” commercial insurers play a key role. However, they face issues such as sustainability, low profit margins, and imperfect systems. She suggests learning from mature models like urban and rural residents’ critical illness insurance, improving operational mechanisms, and providing tax and fee incentives to reduce costs. Additionally, LTC insurance should have separate accounts, clear accounting, dedicated assessments, and independent supervision to ensure policy and commercial operations are strictly separated.

Zhang Xiumin, director of Hebei Qixin Law Firm and NPC deputy, recommends drafting specific guidelines to promote commercial LTC insurance, clarifying its role and development goals, and exploring incentive policies. Insurance companies should develop diverse, inclusive products that incorporate disability prevention, health management, and rehabilitation. Public education campaigns involving insurers, care providers, and communities should also be encouraged to raise awareness and promote insurance coverage.