Deputy Director of the National Healthcare Security Administration Wang Wenjun: From "pilot breakthroughs" to "full system coverage," long-term care insurance is entering the fast lane, currently covering 308 million people.

This report (chinatimes.net.cn) reporter Guo Yilin and Yu Na report from Beijing

On March 26, 2026, during a press conference held by the Beijing State Council Information Office, Wang Wenjun, deputy director of the National Healthcare Security Administration, presented a set of data to outline the achievements of China’s long-term care insurance system after a decade of pilot programs: the number of pilot areas expanded from 15 at the start in 2016 to 92, covering a population of 308 million, with total fund expenditures exceeding 100 billion yuan, benefiting more than 3.3 million disabled individuals.

“For disabled individuals, establishing long-term care insurance is a necessity,” Wang Wenjun said at the press conference. “Through professional care, the quality of life for disabled individuals can be greatly improved, alleviating the dual burden of economic and caregiving responsibilities for families.”

The day before the press conference, 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,” marking the official transition of this system, referred to as the “sixth insurance,” from localized pilots to nationwide implementation. According to the plan, by the end of 2028, a long-term care insurance system that covers all citizens, integrates urban and rural areas, is equitable and unified, safe and standardized, and sustainable will be fundamentally established.

In this regard, Shi Tianyi, an analyst from the Healthcare and Medical Department of Hejun Consulting, stated in an interview with the Huaxia Times that the shift of long-term care insurance from “pilot” to “full implementation” signifies that China’s institutional response to population aging has upgraded from a patch to a core support. The coverage of 308 million and expenditures in the hundreds of billions not only uphold the dignity of the disabled population but also stimulate a trillion-level gray-haired care industry. In the next two years, the nationwide coordination challenges will hinge on diversifying funding channels and standardizing care service standards, which represent not only the improvement of the healthcare insurance system but also a profound layout for building a social safety net for the elderly.

Ten Years of Exploration

Turning the clock back to 2016, China’s population aged 60 and above reached 230 million, with the number of disabled elderly exceeding 40 million. “One person becomes disabled, and the whole family is thrown off balance” became a true reflection of countless families. It was in this year that the long-term care insurance system was piloted in 15 cities, marking a new exploration in building China’s social security system.

Wang Wenjun summarized the ten years of pilot experience into “four explorations”: exploring a system model that integrates urban and rural areas, exploring a diversified funding mechanism, exploring a scientifically reasonable benefit determination mechanism, and exploring an effective management and operation mechanism.

In terms of the system model, regions such as Suzhou, Nantong, and Jingmen took the lead in implementing a universal mutual aid system, incorporating insured individuals into the same system, effectively enhancing the system’s fairness and mutual aid capacity. Jilin and Shandong provinces initiated pilot programs at the provincial level, implementing them step by step according to local conditions, gradually achieving relative policy uniformity within their provinces.

In terms of the funding mechanism, pilot areas raised funds through mutual assistance, clarifying the funding responsibilities of units, individuals, government, and various social parties. Regarding benefit determination, Ningbo City explored a scientific and standardized disability level assessment mechanism to accurately identify beneficiaries; it defined the nursing service items covered by the fund and specified service duration, frequency, operational norms, and personnel qualifications.

Innovations in management and operation mechanisms are also noteworthy. Qingdao City developed and issued 10 local standards covering disability level assessments, service quality control, and management processes, strengthening the management of service agencies. Shanghai actively explored a third-party comprehensive evaluation mechanism for service agencies, developing a chain brand of 27 nursing service institutions.

“These pilot experiences are invaluable,” Wang Wenjun stated, emphasizing that the National Healthcare Security Administration, in conjunction with relevant departments, would timely summarize and refine these experiences, subsequently issuing 17 supporting documents, including management measures for disability level assessments, management of designated service agencies, catalogs of service items, and training for long-term care professionals, thereby laying a solid foundation for the comprehensive establishment of the system.

0.3% Rate

The “Opinions” issued on March 25 and the implementation plan jointly released by eight departments provide a complete policy framework for the long-term care insurance system.

In terms of insured individuals, the system clarifies that employers, employees, retirees, flexible employment individuals, and unemployed urban and rural residents will participate in long-term care insurance according to the principle of local management, gradually achieving universal coverage. Localities can start with covering employees, retirees, and flexible employment individuals based on actual conditions, progressively including unemployed urban and rural residents in the coverage.

The funding mechanism is the key to the sustainability of the system. At the national level, a benchmark rate system has been established, with the overall rate uniformly controlled at around 0.3%, linked to income levels. Employees’ contributions are shared equally by employers and employees, each contributing about 0.15%. Retirees pay their own contributions, also at around 0.15%, with the contribution base linked to basic pensions.

For unemployed urban and rural residents, the funding consists of personal contributions and government subsidies, with a ratio of approximately 1:1. Government subsidies are jointly borne by the central and local finances. Guo Yang, director of the Social Security Department of the Ministry of Finance, introduced at the press conference that by 2026, the central finance had pre-allocated long-term care insurance subsidy funds in the budget for transfer payments to localities, and as the number of insured individuals increases, the financial support will continue to strengthen.

It is noteworthy that the system provides special consideration for disadvantaged groups. The government categorically subsidizes the personal contributions of eligible disadvantaged individuals, fully subsidizing those in extreme poverty and providing fixed subsidies for individuals receiving minimum living allowances and those at risk of falling back into poverty.

In terms of benefit protection, the system will initially guarantee benefits for severely disabled individuals, gradually expanding the scope of beneficiaries as the economy develops and the system improves. There is no minimum payment threshold for receiving benefits. For eligible long-term care service costs, if insured as unemployed urban and rural residents, the fund’s payment ratio is about 50%; if insured as employees, the payment ratio is about 70%.

The annual maximum payment limit for the fund does not exceed 50% of the per capita disposable income of urban and rural residents in the coordinated area for the previous year. Differentiated benefit standards are determined based on different disability levels, with encouragement for the use of home and community care services, providing appropriate preferential payment ratios.

600 Billion Yuan of Social Capital Flows into New Tracks

The establishment of the long-term care insurance system not only improves the social security system but also gives rise to a brand new industrial ecosystem.

According to preliminary statistics from the healthcare insurance department, since the pilot began in 2016, long-term care insurance has driven social capital investment in related industries exceeding 600 billion yuan. Wang Wenjun pointed out at the press conference that the establishment of this system has generated demand for new business forms and models, such as the research and production of assistive devices, disability level assessment work, and participation of social forces in management, all of which can form new economic growth points.

From the perspective of the industrial chain, long-term care insurance has driven the development of multiple links, including assessment, service, training, and assistive devices. In the assessment link, a nationally unified disability level assessment standard is being improved, and the assessment results will achieve mutual recognition nationwide. The management of assessment institutions and the standardization of training mechanisms for assessors are also gradually being established.

In the service link, long-term care service institutions are subject to designated management, encouraging grassroots medical and health institutions and elderly care service institutions to provide long-term care services, with eligible institutions included in the designated range as per regulations. Insurance companies such as Taibao Life Insurance have established comprehensive operational norms covering disability assessments, auditing supervision, and cost settlement, and have formed independent actuarial teams to develop long-term care insurance-specific calculation models.

The construction of the workforce is also receiving attention. Long-term care professionals have emerged as a new occupation alongside the establishment of the long-term care insurance system. Huang Xinyu, director of the Medical Services Management Department of the National Healthcare Security Administration, introduced that by 2025, the number of long-term care professionals nationwide will exceed 10,000, with certified long-term care professionals in every province, autonomous region, and municipality.

However, the shortage of professional caregivers remains a bottleneck constraining the development of the system. The “2024 Survey on the Current Situation of Elderly Care Workers” released by the China Aging Development Foundation shows that there is a shortfall of 5.5 million elderly care workers in China, with junior high school education caregivers accounting for 56.13%, and only 2.93% holding a bachelor’s degree or higher. National Committee member and Vice President of Southern University of Science and Technology Jin Li pointed out that as the population aged 60 and above reaches 323 million, with over 45 million disabled and demented elderly individuals, the shortage of professional caregivers has become the greatest challenge in perfecting the care system for disabled and demented elderly individuals.

Commercial Insurance Opens Up Supplementary Space

The relationship between policy-based long-term care insurance and commercial long-term care insurance has become another focus of industry attention.

According to our reporter, the two are generally “layered and complementary” rather than directly conflicting. Social long-term care insurance is positioned as “basic protection,” focusing on covering the severely disabled population and basic care needs, emphasizing fairness and inclusiveness; while commercial insurance is more oriented toward differentiated needs, providing higher levels of coverage, broader service ranges, or more flexible product designs.

Public information shows that based on international experience, mature long-term care insurance systems typically present a “social insurance + commercial supplement” multi-layered structure. Germany’s commercial long-term care insurance expenditures reached 1.4 billion euros in 2023, with a compound annual growth rate of 16.2% from 1995 to 2023, significantly higher than the overall industry growth rate.

Currently, some domestic insurance companies have actively attempted commercial long-term care insurance. In addition to insurance payouts, insurance companies also provide various services such as outpatient appointments, accompanying visits, home care assessments, home care coordination, guidance on care hardware, rehabilitation nutritional guidance, and coordination with disability care institutions.

In this regard, Shi Tianyi believes that policy-based long-term care insurance is positioned to “provide basic protection and wide coverage,” fulfilling a safety net role, but the demand for high-quality, personalized care protection and caregiving for disabled elderly individuals is ever-growing, which is precisely the space for commercial long-term care insurance to thrive.

Tax incentives have become an effective means to stimulate the demand for commercial long-term care insurance. In July 2023, the National Financial Supervisory Administration issued a notice expanding the range of products eligible for personal income tax preferential policies to include long-term care insurance and other types, providing the public with more choices.

Editor: Jiang Yuqing Chief Editor: Chen Yanpeng