Beyond economics and politics : a sociological review of local long-term care service provision in China

Student thesis: PhD Thesis (Lingnan)


The socio-demographic transition presents a significant challenge that impacts the renewal of welfare arrangements and the reallocation of welfare responsibilities across sectors. Long-term care (LTC) services have emerged as a widely accepted strategy to promote the active daily living and human dignity of senior citizens. This study aims to assess the effective policy strategies employed in various Chinese contexts to address significant LTC policy concerns and synthesise lessons that can guide future policy decisions. The study addresses three questions to explore local variations in China's LTC service provision: (1) What differences exist in the long-term care services provision? (2) How do the service patterns of local long-term care practises differ? (3) Why are local long-term care service arrangements varied among pilot cities? The study employs an actor-centred framework that includes five service dimensions to explore the dynamic arrangements and welfare interactions in local LTC service provision. Qualitative comparative analysis and process-tracing case study methodologies are employed to interpret local service variations. In-depth interviews and document reviews are performed to collect first-hand and secondary data.

The research findings reveal that, although local long-term care practises in China have achieved the national guideline standard, there are variations in service eligibility, content, expenditure, delivery, and regulation. China's local long-term care service practises demonstrate distinctive features that challenge conventional economic and political paradigms. Firstly, it is noteworthy that developed coastal cities are not typically active in the development and investment of LTC welfare initiatives. Secondly, the effective welfare interactions and sufficient LTC service provision are more likely to occur in cities with well-established civil societies and pressing socio-demographic challenges. Lastly, the unequal distribution of welfare benefits is more pronounced in less developed cities. Moreover, the findings of Tsingtao city emphasizes that meso-level capacities and micro-level interactions strongly influence the pattern of LTC provision.

Accordingly, this study criticizes the previous debate on economic and political determinants and suggests that local LTC provision in China is contingent on multifaceted interplay, with the primary factor that influences the path of Chinese welfare localization being societal perception towards rapidly changing social policies. Practitioners in China demonstrate a high degree of professional autonomy and moral agency by navigating conflicting organizational agendas, investment priorities, and evolving service needs. However, local authorities have tended to adopt a more conservative approach in the development of welfare projects. As a response, this study offers deeper insights into the contradictory orientation of China's LTC service provision and suggest the need for further emphasis on cross-sectoral interaction. The conclusion contributes to clarify China's comparable position in welfare decentralisation studies and providing Oriental insights for future discussions on welfare localization in the social policy field.
Date of Award16 Aug 2023
Original languageEnglish
Awarding Institution
  • Lingnan University
SupervisorKa Ho Joshua MOK (Supervisor) & Chak Kwan Dickson CHAN (Co-supervisor)

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