Researchers examining municipal public long-term care insurance pilots across East China have developed an optimized three-layer integrated framework designed to transition regional programs from fragmented localized trials into an integrated care system. By analyzing local administrative structures and policy experiences, the authors established a structured design of regional reference significance to guide the ongoing development of public care systems.

The study addresses a pressing demographic and social challenge in China, where the growing prevalence of longevity but unhealthiness imposes a substantial burden on households. Within this context, long-term care insurance has become positioned as a critical formal care mechanism to support an aging population.

To evaluate the structural features of existing municipal programs, the researchers first conducted an extensive thematic analysis of public policy documents collected from the five neighboring cities. This textual analysis extracted operational data across five core policy dimensions: government liability, operating agent, beneficiary eligibility, fundraising source, and care supply. By structuring the document data around these five distinct categories, the analysis provided a visual demonstration of the specific intercity similarities and variations that currently characterize municipal long-term care insurance implementations along the Yangtze River Economic Belt.

The research team then applied a three-stage thematic analysis to the interview records, establishing a five-dimensional structural design. This qualitative process uncovered critical functional interrelationships among government liability, operating agents, beneficiary eligibility rules, fundraising sources, and care supply, clarifying how different components of local insurance schemes interact within municipal administrations.

By integrating the documentary policy analysis with the findings from the 22 in-depth interviews, the research team synthesized the five-dimensional structural design into an optimized three-layer integrated framework for long-term care insurance. The authors emphasize that while their qualitative exploratory investigation centered on five neighboring municipalities in East China, the resulting three-layer model provides valuable regional reference significance for policymakers seeking to transform isolated, fragmented pilot projects into an integrated and durable public care system.

Subject of Research: Public long-term care insurance integration in East China

Article Title: From fragmented trials to an integrated system: a selective examination upon the public long-term care insurance pilots in East China

Article References: Chen, W., Zhao, R., & Wang, J. (2026). From fragmented trials to an integrated system: a selective examination upon the public long-term care insurance pilots in East China. BMC Health Services Research. https://doi.org/10.1186/s12913-026-16156-9

Image Credits: AI Generated

DOI: 10.1186/s12913-026-16156-9

Keywords: long-term care insurance, East China, Yangtze River Economic Belt, thematic analysis, in-depth interviews, government liability, operating agents, beneficiary eligibility, fundraising sources, care supply, purposive sampling, snowball sampling, integrated care framework, pilot programs, aging population, formal care, policy document analysis