Informal Long Term Care in China and Population Ageing: Evidence and Policy Implications

Long-term care (LTC) policy in China is in its infancy, and it is highly decentralised. Where policy structures exist, they are poorly resourced. Although China’s demography is still young by developed country standards, it is ageing very rapidly, and by mid-century will have “caught up” with many countries in the developed world with respect to population ageing. LTC policy development, therefore, is becoming a priority in China. We argue that it should be formulated with population ageing as a framework.

Policy designs, which take account of and encourage, informal care provision, will be critical to the fiscally sustainable delivery of LTC. In China, informal care is sometimes seen as very scarce because of the one child policy. With only one child, it is argued, there will be less informal care offered than in societies with larger families.

This paper uses the recently developed China Health and Retirement Longitudinal Study (CHARLS) dataset to analyse the current patterns of disability and informal care availability. In particular, and contrary to expectation, we find that fertility change is not the main driver for reducing informal care. Education levels, living standards, urbanization and co-residency are much more important. This suggests that current policy, which targets those with one child families, may be misguided, and also that mechanical extrapolations of future demand for care may be misleading.