Crossing the river by feeling for the stones: contesting models of marketization and the development of China’s long-term care services

Abstract

Incorporating market mechanisms into public provision of long-term care (LTC) is part of a global trend featuring the liberalization of policies and politics during the past four decades. Drawing on a conceptual framework of marketization developed by Anttonen and Meagher, this article examines how the market mechanism has been introduced in the delivery of public LTC services in Germany, U.S., and China. It also examines the lessons that China has learned and can further learn from the German and American experiences. The article shows that the U.S. and German models, which differ considerably from each other, have had strong influences on LTC policy-making in China, but the emerging Chinese system appears to be substantively different from both.

Keywords:

• Long-term care
• marketization
• neoliberalism
• policy learning
• international influence

Notes

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 He, Goodkind, and Kowal, International Population Reports.

2 Butler, “Report and Commentary from Madrid,” M770–M771.

3 Meagher and Szabehely, Marketisation in Nordic Eldercare. See also Warner and Clifton, “Marketization, Public Services and the City,” 45–61.

4 Kettl, The Global Public Management Revolution.

5 Osborne and Gaebler, Reinventing Government.

6 Harrington, “Understanding the Relationship,” 229–240; Polivka and Luo, “Women and the Crisis of Care”; Theobald, “Combining Welfare Mix and New Public Management,” 61–74; Theobald and Hampel, “Radical Institutional Change,” 117–138.

7 Luo and Zhan, “Aging Related Welfare Programs in China.” See also Zhu, “Retrospect and Reflection,” 66–72.

8 Anttonen and Meagher, “Mapping Marketisation,” 13–22.

9 Maurer, “Market Domination, Competition and Cost Optimization: Marketization”; Pfau-Effinger et al., “Marketization, Care Policy, and Structures of Old-age Care”; Warner and Clifton, “Marketization, Public Services and the City,” 45–61.

10 See note 8 above.

11 ibid., 16.

12 Clifton, Comín, and Díaz-Fuentes, “Privatising Public Enterprise,” 736–756; Warner and Clifton, “Marketization, Public Services and the City,” 45–61.

13 See note 8 above.

14 See note 8 above. See also Warner and Clifton, “Marketization, Public Services and the City,” 45–61.

15 See note 8 above.

16 See note 8 above.

17 See note 8 above.

18 Nadash, Doty, and Schwanenflugel, “The German Long-Term Care Insurance Program”.

19 Götze and Rothgang, “Fiscal and Social Policy”.

20 Statistisches Bundesamt, Older People in Germany and the EU.

21 ibid.

22 See note 18 above.

23 Theobald, “Combining Welfare and New Public Management,” 61–74.

24 ibid.

25 Liu, “Nursing Care for Elderly People,” 1–4. See also Nadash, Doty, and Schwanenflugel, “The German Long-Term Care Insurance Program.”

26 See note 18 above.

27 Götze and Rothgang, “Fiscal and Social Policy.”

28 See note 18 above.

29 See note 18 above.

30 Theobald, “Combining Welfare and New Public Management,” 61–74.

31 ibid., 67.

32 Unger, The German Model.

33 See note 18 above.

34 Campbell and Ikegami, “Long-Term Care Insurance Comes to Japan,” 26–39; Chen, “The Long-term Care Policies,” 49–69.

35 Polivka and Luo, “Neoliberal Long-term Care.”

36 He, Goodkind, and Kowal, International Population Reports.

37 See note 35 above.

38 Ortman, Velko, and Hogan, An Aging Nation.

39 Reinhard et al., Picking Up the Pace of Change.

40 Kaiser Family Foundation, “Long-Term Care in the United States.”

41 Harrington et al., “Ownership, Financing, and Management Strategies,” 725–746.

42 Harrington, “Understanding the Relationship,” 229–240.

43 Kaiser Family Foundation, “Long-Term Care in the United States.”

44 Niles-Yokum and Wagner, The Aging Networks.

45 ibid.

46 See note 35 above.

47 Eiken et al., “Medicaid Expenditures for Long-Term Services.”

48 See note 35 above.

49 Niles-Yokum and Wagner, The Aging Networks.

50 Reed, “A Matter of Balance,” 59–63.

51 Harrington et al., “Ownership, Financing, and Management Strategies,” 725–746.

52 ibid.

53 Kwak and Polivka, “The Future of Long-Term Care,” 67–73. See also Polivka and Luo, “Neoliberal Long-term Care.”

54 ibid.

55 See note 35 above.

56 Polivka, “Women and the Crisis.”

57 See note 35 above.

58 Salamon, “The Marketization of Welfare,” 16–39.

59 Eikenberry and Kluver, “The Marketization of the Nonprofit,” 132–140.

60 Eikenberry and Kluver, “The Marketization of the Nonprofit,” 132–140; Kramer, Voluntary Agencies in the Welfare State. See also Salamon, “The Marketization of Welfare,” 16–39.

61 Luo and Zhan, “Aging Related Welfare Programs in China.”

62 Du, Long-Term Care for Older Persons in China.

63 Ministry of Civil Affairs of PRC, “Socializing Social Welfare.”

64 Zhu, “Retrospect and Reflection,” 66–72.

65 Arrighi, Adam Smith in Beijing; Callick, “The China Model”; Poznanski, “Confucian Economics,” 362–384.

66 Chen, Social Policy of the Economic.

67 ibid., 115.

68 MCA, “Socializing Social Welfare.”

69 Cao, “Stories Behind,” 53–55.

70 Liu, “Nursing Care for Elderly People.”

71 Han, “Evolution Path”; Zhu, “Retrospect and Reflection,” 66–72; Yang, “Policy Selection,” 87–110.

72 Ministry of Civil Affairs of PRC, “Socializing Social Welfare.”

73 National People’s Congress, “The Elderly Right Protection Law.”

74 Yang, “Policy Selection for China’s Long-Term Care,” 87–110.

75 Ibid.

76 National Home and Family Planning Commission, “Decisions Regarding Strengthening Aging Work.”

77 The State Council of PRC, “Opinions Regarding Speeding.”

78 Yang, “Policy Selection,” 87–110.

79 Luo and Zhan, “Aging Related Welfare Programs in China.” See also Polivka and Luo, “The Future of Retirement,” 39–45.

80 Yang, “Facing Population Aging.”

81 Du, Long-Term Care; Yang, “Exploring Home and Community-Based,” 82–91; Yang, “Facing Population Aging.”

82 Yang, “Exploring Home and Community-Based.”

83 Han, “Evolution Path and Development Direction of China’s Elderly Care Service Policy.”

84 Yu and Chen, “Does Nonprofit Marketization,” 1–13.

85 Ministry of Human Resources and Social Security of the People’s Republic of China, “Guiding Opinions.”

86 State Council, “Opinions Regarding Strengthening.”

87 Horwitz, “Milton Friedman in China.”

88 Leng and Wang, Chronological Biography of Deng Xiaoping, 1338.

89 See note 70 above.

90 Hsiao, “Correcting Past Health Policy Mistakes,” 52–68.

91 See note 70 above.

92 Nadash, Doty, and Schwanenflugel, “The German Long-Term Care Insurance Program.”

93 Alpermann and Zhan, “Population Planning after the One-Child Policy.”

94 Xiong, “Transforming Governmental Functions.”

95 Yang, “Policy Selection,” 87–110; Zhu, “Retrospect and Reflection,” 66–72.

96 Wang and Tian, “Reflections on the Structural,” 23–28.

Additional information

Notes on contributors

Baozhen Luo

Baozhen Luo is an associate professor in Sociology at Western Washington University and an affiliate researcher of the Claude Pepper Center at Florida State University. She studies population aging, social policy, and contemporary Chinese society. Her current research examines political economies and long-term care policies and practices in the Global North (with a special focus on the U.S.) and the Global South (with a special focus on China). In addition to producing scholarly works, she also hosts a column called ‘Four Dimension Channel’ (四维频道) discussing a wide range of topics related to elder care policies, cultures, and practices at www.thepaper.cn (澎湃新闻) based in Shanghai. She has also written for Foreign Affairs and served as a regular commentator for China’s Global Television Network.

Shaohua Zhan

Shaohua Zhan is an assistant professor of sociology at Nanyang Technological University in Singapore. He studies migration, historical and contemporary rural development, social policy, land rights, and food politics. His works have appeared in The Journal of Peasant Studies, World Development, Journal of Rural Studies, Journal of Agrarian Change, Studies in Comparative International Development, Geoforum, The China Journal, Journal of Contemporary China, Modern China, etc. His forthcoming book examines the contrasting development paths of industrious revolution and agrarian capitalism in rural China.