In China, the demands of long-term care for a rapidly ageing population have become an increasingly challenging issue. While the government has responded by introducing a variety of policy reforms to develop a modern long-term-care (LTC) system, the financing and delivery of the system and its performance on the ground remain under-explored. It is against this backdrop that Sabrina Ching Yuen Luk, Hui Zhang and Peter P. Yuen have co-authored this book. Their main objective is to examine the financing and delivery of the LTC system in China from a demand–supply perspective. Based on solidly researched secondary data, the authors present a systematic analysis of recent government policies on the development of China's LTC system and long-term-care insurance (LTCI) reforms, most of which have received scant attention in Western scholarship. Supplementing their documentary analysis with interpretative case studies, they offer an in-depth evaluation of the performance and sustainability of LTCI schemes in China in particular.

The book is the fruit of three years’ investigation into the funding and delivery of LTC in China. Laying the theoretical foundations essential to understanding China's LTC system, chapter one outlines the definition, importance and prospects of LTC, as well as the development of LTC structures and the associated challenges of financing and delivery around the world. Because a better understanding of current LTC demand and delivery is fundamental to informing policy development and healthcare resource allocation in this area, chapter two examines the demands faced by LTC and the background factors contributing to it, characterized by geographical and rural–urban disparities, the decline in informal care, and the prevalence of late-age disability and dementia. Chapter three investigates challenges in delivery, tracing how changing living arrangements experienced by older adults, the national policy development of LTC systems, and support for informal care of elderly people with disability and dementia all affect the development and supply of LTC.

The authors pay specific attention to pilot schemes for LTCI adopted in 15 cities from 2016. In chapter four, the sustainability of different financing models for LTCI schemes adopted by these cities is evaluated, with detailed comparisons of funding sources, contribution mechanisms, and enrollers. Their findings highlight the questionable sustainability, lack of coverage and inequality marking the delivery of LTC in China. Chapters five, six and seven focus on assessing LTCI reforms in three pilot cities – Qingdao, Nantong and Shanghai – which represent three different financing and delivering models. This part of the study focuses on the utilization of medical resources as well as issues of cost, equity, quality of care and sustainability. Despite the different prospects and challenges created by the different reform models, the authors are able to distinguish which of the three cities has, through the implementation of its LTCI programme, achieved more efficient utilization of healthcare resources and decreased financial costs borne by individual families. At the same time, they also point to the need for improved access to and better quality of LTC services, as well as the need to establish an independent funding mechanism to increase the accessibility, equity and sustainability of LTCI in the long term.

The final chapter recapitulates the development of the funding and delivery of LTC in China, including both the merits and challenges of the current approach. Recommendations for improving the financing and delivery of LTC are also proposed, as well as the positive outcomes of the Chinese experience and its implications for developing LTCI in other countries.

As the rapidly ageing Chinese population continues to pose tremendous challenges for late-age care provision, an extensive examination of the performance of China's LTC system is potentially of considerable interest to both academic researchers and policymakers. The well-researched and critical analysis of the funding and delivery of LTCI that this book has provided will certainly enrich our understanding of the policy landscape of the LTC system in China, with its associated challenges and prospects. It will be a valuable and essential source of reference for researchers interested in population ageing, healthcare policies, and welfare issues faced by the elderly in China. Such an early appraisal of the successes and challenges associated with Chinese LTCI reform will also assist political leaders and policymakers working on LTC reform in other countries and regions.

Finally, despite its many virtues, the book does contain some shortcomings. First, because much of the data presented is drawn from government documents and official reports, the book would have been strengthened by including independent data as well as a rigorous evaluation of official statistics. Second, because the urban–rural divide is such a pressing problem in China, greater attention could have been paid to the gaps and inequalities in the demand and supply of LTC between rural and urban areas. Lastly, the great majority of studies of LTC in China have been produced from the perspectives of public health and policy and developmental studies. It would be valuable to hear how, from a grassroots perspective, ordinary Chinese have been impacted by reforms in the LTC sector.