Analysis of the Performance of China's Long-term Care Insurance Pilot Program: Focusing on the Urban-Rural Disparities

This study aims to examine structural disparities between urban and rural areas in China’s Long-Term Care Insurance (LTCI) pilot programs and assess their implications for equity and sustainability. Focusing on Qingdao, Shanghai, and Suzhou as first-round pilot cities, it compares four key policy components—allocation, benefits, financing, and delivery systems—using Gilbert and Specht’s policy analysis framework. Based on a systematic review of literature and policy documents, the analysis finds that urban areas benefit from stronger administrative capacity, denser service infrastructure, and more stable financing arrangements, whereas rural areas face constrained service access, limited resources, and weaker delivery systems. To address these gaps, the study proposes policy adjustments, including rural-tailored benefit designs, strengthened community-based delivery systems, and more equitable financing mechanisms. The study contributes to comparative social policy research by offering a structured urban–rural analysis within a single national framework and by extending the application of Gilbert and Specht’s model to multiple pilot cases. Its findings provide a theoretical basis for debates on equity and sustainability in the expansion of long-term care systems in transitional societies beyond China.