The Absence of Community Care in the Development of the Long-Term Care System: A Case Study of Guangzhou
As China enters the period of the 14th Five-Year Plan, the scale of the population with functional impairments has expanded rapidly, making it imperative to construct a long-term care system suited to China’s national conditions. However, under the two batches of Long-Term Care Insurance (LTCI) pilots, resources in most localities have shown a marked tendency to favor severely disabled older adults, leaving those with mild and moderate disabilities as blind spots in care provision. At the same time, within the construction of the LTC system, community care is confronted with a serious situation of inadequacy. This paper aims to explore the underlying causes of the community care gap and propose policy paths to improve the community care system. Based on institutional ecosystem theory, the analysis shows that at the microsystem level, community care services in Guangzhou face problems such as constrained financing channels, vague service function positioning, and inadequate regulatory mechanisms. At the exosystem level, long-term care involves multiple functional departments (e.g., civil affairs, health commissions, and medical insurance), resulting in fragmented governance and insufficient coordination. Additionally, urban–rural development remains imbalance, and the culture of mutual assistance among residents is weak. At the macrosystem level, China has not yet legislated for long-term care, so risks in care service supply are not effectively avoided, while “Not In My Back Yard (NIMBY)” effects and weak contractual awareness further constrain the development of community care. Finally, in the context of building a comprehensive long-term care system and advancing community care services in Guangzhou, this paper puts forward corresponding policy recommendations.
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