context: Following ten years of pilots in 49 cities, the State Council finally issued Opinions on accelerating establishment of a long-term care insurance system on 25 March, planning to roll out long term care insurance across the country in the next three years. The system has covered nearly 300 million people by end-2025, benefiting over 3.3 million disabled persons. Experts identified funding sustainability and severe nursing personnel shortages as critical challenges, with over five million nursing staff needed while current workforce ages rapidly.
Long-term care insurance emphasises comprehensive coverage, urban-rural coordination and sustainability, with enrollees reimbursing from the same fund pool with basic regional consistency in coverage targets and contribution rates, stated Wang Wenjun 王文君 National Medical Insurance Bureau vice director.
Subsidy funding comes from central and local fiscal budgets, with 2026 central transfers advancing based on projected enrollees and settling according to actual enrollees the following year, said Guo Yang 郭阳 Ministry of Finance Social Security Department director.
Disabled persons' benefit levels link to funding levels, with funds paying approximately 70 percent of employee long-term care service costs and 50 percent of resident costs. Annual maximum payments not exceed 50 percent of local previous year per capita disposable income.
Long-term care insurance should construct unified urban-rural systems where all populations share one fund pool, explained Lei Wen 雷雯 National Medical Insurance Bureau Treatment Guarantee Department Long-term Care Insurance Division director. She recommended establishing national unified funding benchmarks with regional adjustments whilst central fiscal transfers increase to economically underdeveloped regions.
NHSA (National Heathcare Security Administration) data showed long-term care insurance has attracted over C¥50 bn social capital during the 14th 5-year plan, with over 8,800 designated institutions and 300,000 nursing personnel, growing over 50 percent. However, supply-demand mismatches remain severe.
The 2025 Nursing Personnel Occupational Status Survey Report predicted care-dependent populations will exceed 40 million within five years, with nursing shortages exceeding five million, 85-95 percent concentrated in home and community sectors. China Insurance Industry Association research estimated demand will reach C¥3.1 tn by 2030 and nearly C¥6.6 tn by 2040.
Policymaking fails to distinguish long-term care services for disabled elderly from aged care services, causing inaccurate targeting and low social awareness, Yang Tuan 杨团 Chinese Academy of Social Sciences Social Policy Research Centre researcher pointed out.
The report showed nursing workforce age and gender imbalances. Staff aged 40-59 years and female staff comprised 83.25 percent and 89.25 percent respectively, while staff under 30 years comprised less than two percent with nearly 20 percent departure inclinations. Industry personnel emphasised that retaining talent requires establishing fair compensation mechanisms considering service years, labour intensity and skill levels.