Study On The Implementation Deviation Of Long-term Care Policy In China

Long-term care is not only the concomitant institution in the aging era of human society,but also an indispensable basic social service policy for the elderly with disabilities and dementia under the situation that the traditional family pension model is not sustainable.In 2011,the elderly with disability and dementia was officially identified as the target group of long-term care policy in China at the first time,and then Chinese government clearly proposed that solving the problem of care dependence of this group was the urgent task of strengthening the construction of social pension service system and promoting social harmony and stability.Since then,the Chinese Communist Party and the central government have increased the financial investment in the old-age service.Meanwhile,various ministries and commissions have carried out a series of relevant social policies such as the construction of different delivery modes of old-age service,special old-age service subsidies,and long-term care insurance pilot programs for long-term care.Unfortunately,these social policies have not been able to fundamentally improve the living conditions of the elderly with disabilities and dementia,nor have they been able to effectively target and meet the actual needs of long-term care subjects.In short,this deviation can be summarized as the following three categories: first,the old-age agencies invested by government which aimed at resolving the problem of care dependence,actually served for the healthy elder rather than the elderly with disabilities and dementia.Second,Fiscal subsidies at all levels of government which aimed at complementing the long-term care from both the supply-and demand-side to some extent mismatched with different groups.Third,financial sustainability of long-term care insurance which aimed at providing economic compensation for the elderly with disabilities and dementia was obviously insufficient and the coverage of long-term care insurance was quite limited.As a result,China’s long-term care policy has not achieved the expected goal,with a policy deviation.The policy aiming at "timely assistance" to solve the problem of taking care of the elderly with disabilities and dementia finally evolved into "decorating on the cake" to provide a variety of services for the healthy elderly.Reviewing the literature on explanations of long-term care policies,we find that most of scholars focus on micro level process of policy implementation and the phenomenon of description.However,these theories seem somewhat less reflective,overtly abstract and thus fail to explain the substance of deviations in policy implementing processes.According to the basic principle of structure-mechanism analysis,this study,therefore,from the view of social policy processes,establish a framework of “the starting point of implementation deviation—internal conflict—process tracing” to analyze long-term care policies.With the methodology of analyzing policy documents and conducting in-depth researches in J province,we aim to explore deep-seated explanations for policy deviations in implementing stage in order to contribute to current literature on Chinese long-term care policies.From the logical starting point of the long-term care policy implementation deviation,we find problems with conceptual deviation and inaccurate definition at the national level.On the one hand,the implementation of the long-term care policy is still trapped by Chinese traditional concept of aging,which indicates an institutional dependency dilemma.On the other hand,the connotation and extension of foreign concept have a tendency for being oversimplified.These two reasons make it difficult for long-term care policy to be a comprehensive system which is independent of the healthy elderly.From the internal conflict of long-term care policy implementation basis,the relevant state ministries and commissions published a number of notice,guidance and management measures about the long-term care.However,these policy documents are lack of multiple normative when investigating from a scientific perspective.First,the standards of long-term care policy are relatively vague.The policy documents are not only lacked of the demand assessment system and the standard of classification,but also failed to establish a scientific quality identification system and an evaluation system of long-term care.Second,the policy documents are lacked of consistent criteria.The policy priorities,principles,and ideas that published by the related national ministries and commissions are not unified.At the same time,care resources and services are relatively fragmented,lacking inadequate cooperation between departments.Third,the policy documents are insufficient legitimacy.The existing policies are relatively lower-level administrative regulations,and has not yet formed special laws and regulation systems.The operation model of long-term care policy in the implementation phase deserves more attentions and researches with regard to Chinese political institutions,complicated relations among local governments and existing problems mentioned above.From the perspective of vertical structure and transverse relationship,two practical logics,which are flexible execution and fragmented management,could be found through a wide range of researches of J province.From the perspective of horizontal structure,when the central government give a political task about old-age work,the local government would set up a pressure assessment mechanism.including “tough goal”,“strong incentives”,“one ticket veto”.When this assessment mechanism is transferred to the next level government,grass-roots government representatives tend to balance the perfect administration and local interests,generating three coping strategies,involving selective flexible,distorted flexible and perfunctory flexible.From the perspective of transverse structure,administrative departments under the affected by the logic of path dependence still follow the original concept and principle and do things in the same old way not as a whole to integrate long-term care resources and related services,all of which result in "fragmentation" dilemma of principle,service and management of the long-term care policy.To overcome the current difficulties of long-term care policy execution and correct the deviation of long-term care policy,holistic governance is a crucial technique through which the foundation of conceptualization transformation and the key point of scientific reinforcement could be achieved.specifically,at macro level,government should form concrete approaches with unified policy ideas when initiating policies,considering the actual care needs of the elderly with disabilities and dementia.Moreover,it should be more careful to choose long-term care financing mode through timely summing up experience and lessons from the long-term care policy pilot area.At the intermediate level of policy development,it is vital to develop a classification standard and evaluation system in accord with Chinese specific national characteristics.On the basis of above,defining the basic responsibility and primary task of government,market,family and individual are important in order to realize the diversification of care service supply.At the micro level,it is crucial to correct and eliminate the influence of governance pressure type system and of the logic of path dependence,through reducing the possibility of inconceivable missions and integrating fragmented resources,in order to avoid the recurrence of mentioned phenomenon,such as "performance projects","asylum relationship",and to achieve the target and performance of long-term care policy.