First Japan, Next South Korea; Now China Launches Nationwide Long-Term Care Insurance as Ageing Crisis Bites

• China expands long-term care insurance to a nationwide system.
• The program covers basic care services for people unable to self-care.
• Nearly 310 million enrolled; 3.3 million beneficiaries so far.
• Reform addresses rapidly aging population and declining birth rate.

China's central government issued national guidelines on Wednesday to establish a nationwide long-term care insurance system, formally extending a decade-old pilot program to cover the entire country. The guidelines, jointly issued by the general offices of the Central Committee of the Communist Party of China and the State Council, define long-term care insurance as a form of social insurance providing services and financial support for basic living care and related medical services to individuals unable to care for themselves.

China began piloting long-term care insurance in 2016 across 15 cities, expanding to 49 pilot cities by 2020. Since then, nearly 310 million people have enrolled, and over 3.3 million people with disabilities have directly benefited. The fund covers 20 living care services, including assistance with meals, toileting, and mobility, under a service list published in September 2025.

The urgency of the reform is underscored by the scale of China's demographic challenge. The country has approximately 300 million citizens aged 60 and above, the largest elderly population on Earth, and an estimated 40.63 million older adults living with disabilities or semi-disabilities.

The birth rate has fallen to 6.8 per thousand, one of the lowest ever recorded in the country. By 2050, those aged 65 and above are projected to reach 366 million, or 26 percent of the total population. Family-based care, the traditional cornerstone of Chinese elder support, is under severe strain as urbanization separates adult children from aging parents.

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The nationwide rollout follows Japan, Germany, and South Korea, all of which established mandatory long-term care insurance systems between 1994 and 2000 as the number of their own populations aged was increasing rapidly.

China's system is modeled on the social insurance approach used in those countries rather than the commercial insurance model prevalent in the United States. Key unresolved issues include a unified national financing mechanism, geographic coverage equity between urban and rural areas, and a significant shortage of trained care workers.