Unpacking variations in local governance policy design: A comparative analysis of China’s long-term care service provision

Population ageing poses a significant challenge to the redistribution of welfare responsibilities across sectors. Long-term care (LTC) has been widely recognized as an efficient service to improve older adults’ quality of life. However, concerns arise regarding the provision and responsibility of LTC services for the diverse ageing population (Fang et al., 2020). As a highly centralized and rapidly ageing nation, China has initiated a local pilot programme, enabling multiple governments to design their own LTC service systems as a foundation for a national programme. This study explores the design of municipal-level LTC policies and aims to investigate local patterns of welfare service provision. This study uses an ideal type of qualitative comparative analysis (QCA) to examine the policy documents of China’s LTC social insurance trial programme. The findings reveal that each pilot city complied with the national guidelines. Yet, the overall coverage of LTC services remains limited. A three-layered provision pattern has been identified, showcasing various welfare mix models. This study highlights the growth of inter-regional diversity in LTC service provision, echoing the call for future discussions on welfare localism and policy design in China and beyond (Lei et al., 2022).