From pilot programs to nationwide implementation: Reform of China's long-term care insurance in an aging society

China is experiencing rapid population aging and a growing burden of disability, creating urgent demand for sustainable long-term care systems. In response, China has progressively developed a long-term care insurance system since the launch of national pilot programs in 2016. China's long-term care insurance has evolved through three major stages: Pilot launch phase (2016-2019), Expansion phase (2020-2025), and Comprehensive implementation phase (2026-present). The system has significantly expanded coverage, improved access to long-term care for severely disabled older adults, reduced the family caregiving burden, and promoted the transformation of elder care from a family-based responsibility to a shared social responsibility. However, substantial structural challenges remain. These include heavy dependence on medical insurance funds, lack of a sustainable financing mechanism, regional disparities in disability assessment standards, a dearth of professional caregivers, fragmented governance structures, and inadequate digital supervision systems. Looking forward, China's long-term care insurance is expected to transition from a supplementary medical insurance arrangement toward an integrated social care security system. Future reforms should focus on establishing diversified financing mechanisms, unified disability assessment standards, delivery of community-centered care, integrated health and social care governance, and digitalized regulatory systems. China's experience may provide an important policy reference for other rapidly aging middle-income countries facing growing long-term care demands.