China's population is ageing rapidly and the increase in life expectancy is accompanied by a loss of capability with advancing age, especially in the Northeast. This study adopts qualitative research methods to analyze the overall status and problems of China's LTCI policy pilots. Taking four LTCI pilot cities in three northeastern provinces as samples, we used purposive sampling to recruit 10 beneficiaries and providers of LTCI in nursing homes of different kinds, as well as 2 operators (Medical Insurance Bureau staff) for semi-structured in-depth interviews. We developed a social welfare policy analysis framework based on Gilbert's framework, designed interview outlines and conducted a thematic analysis of the interview data along five dimensions: allocation base, type of provision, delivery strategy, finance mode, and external environment. The results of the research indicate that the coverage of the system is narrow and that disability assessment criteria are fragmented; that the substance of service provision is lacking, both in terms of precision and dynamic adjustment mechanisms; that socialized care synergy cannot be achieved, informal care lacking policy support; that there is an over-reliance on medical insurance funds and that unfair financing standards are applied; and that economic and social development is insufficient to cope with ageing needs and uncertain risks. Accordingly, this research proposes several optimization options to promote the full establishment of LTCI.
Keywords: long-term care insurance (LTCI); optimization options; policy evaluation; policy pilot programme.