Diffusion Mechanism of China’s Long-term Care Insurance System—An Empirical Analysis Based on 31 Provinces

A long-term care insurance system provides basic living assistance, medical care cost compensation, and service assurance for people with disabilities. In China, it was first piloted in Qingdao, Shandong Province, in 2012, and has now been implemented in 27 provinces as pilot areas. The locally started policy was adopted by the central government and extended to the whole country in eight years. We focus on answering two questions: How did the diffusion of the policy occur? What were its determining factors? Based on the perspective of policy innovation and diffusion, this study empirically analyzes the main factors influencing the diffusion of the long-term care insurance system using a Cox proportional-hazards model and data from 31 Chinese provinces. The study found that the main internal factors were the local aging coefficient and degree of socioeconomic development, and the main external factors were national competition pressure and central policy pressure.