Market-Oriented Policies on Care for Older People in Urban China: Examining the Experiment-Based Policy Implementation Process

Abstract

The rapidly ageing population and increasing care needs provide the rationale for care systems progressively shaped by a growing market in a global context. In China the approach to policy making, which has been largely experimental, has involved market-oriented reforms since the 1980s. While marketisation processes have been well studied in various European care systems, very little is known about their implementation in the Chinese context. Based on qualitative interviews with local government officials and care providers in Shanghai, this article discusses the Chinese policy process in the field of care for older people and the barriers to effective implementation. It investigates the experiment-based marketisation policy process, the power hierarchy and the lines of accountability of the state in the care field. Multi-layered barriers are identified in the market-oriented policy process. These include (1) inherent bureaucratic obstacles at practice level: reluctance to exercise discretionary power, administrative inefficiency, incoherence of care schemes and poor inter-department communication; and (2) complexities and failures at policy-making level: the infeasibility of policies, underestimation of operational capacity and inadequate involvement of practice knowledge. These findings have implications for balancing the efficiency, effectiveness and sustainability of care policies in an era of public service austerity.

Evolutionary game analysis of rural public–private partnership older adult care project in the context of population aging in China

“…In addition, in the PPP older adult care project, public participation can not only promote government efficiency but also affect the effective operation of the project. To address this issue, Zhang ( 30 ) suggested that the specific implementation of the older adult care service market needs to further clarify the interest coordination mechanism, establish a compensation payment mechanism, and ensure sustainable collaborative participation of multiple parties ( 30 ).…”

Emerging Quasi-market of Home Care for Older People in Urban China: A Case Study in Shanghai

“…The characteristics of quasi-markets observed in European welfare states over the past five decades are also emerging in the field of care for older people in China (Zhang, 2022). Since 2000, there has been a significant increase in the involvement of non-state care agencies, both private and not-for-profit, with many previously state-owned agencies being contracted out to forprofit and not-for-profit organisations (Qu et al, 2023).…”

“…For instance, Ningbo's municipal government implemented local regulations in 2008 to standardise basic requirements for various home care services, while the Xuanwu District of Nanjing established an independent home care assessment centre in the same year. Despite these efforts, there is a lack of formal regulations and practical rules for social care in China (Zhang, 2022).…”

Philanthropic Foundations and Institutional Change under Rigid Authoritarianism: Exploring the Ford Foundation’s Historical Grantmaking in the Chinese Family Planning Field (1991–2005)

“…A burgeoning body of research on social policy reforms in authoritarian contexts has highlighted the implications of states' exclusive control of policy processes. For instance, the Chinese state's hierarchical dominance in the field of care for older people created multi-layered barriers for institutional change (Wenjing Zhang, 2022); when promoting community governance reforms, the Chinese Communist Party's dominant network in urban communities prevented authentic implementation of residents' self-governance (Howell, 2016). In a similar vein, the authoritarian Mexican Government (1995) was found to have enacted unpopular pension polices through a process of controlling the policy discourse and stifling the opposition (Marier and Mayer, 2007).…”