Market-Oriented Policies on Care for Older People in Urban China: Examining the Experiment-Based Policy Implementation Process

Wenjing Zhang

doi:10.1017/s0047279421000131

Abstract

AbstractThe rapidly ageing population and increasing care needs provide the rationale for care systems progressively shaped by a growing market in a global context. In China the approach to policy making, which has been largely experimental, has involved market-oriented reforms since the 1980s. While marketisation processes have been well studied in various European care systems, very little is known about their implementation in the Chinese context. Based on qualitative interviews with local government officials and care providers in Shanghai, this article discusses the Chinese policy process in the field of care for older people and the barriers to effective implementation. It investigates the experiment-based marketisation policy process, the power hierarchy and the lines of accountability of the state in the care field. Multi-layered barriers are identified in the market-oriented policy process. These include (1) inherent bureaucratic obstacles at practice level: reluctance to exercise discretionary power, administrative inefficiency, incoherence of care schemes and poor inter-department communication; and (2) complexities and failures at policy-making level: the infeasibility of policies, underestimation of operational capacity and inadequate involvement of practice knowledge. These findings have implications for balancing the efficiency, effectiveness and sustainability of care policies in an era of public service austerity.

Highlights

In the context of trends of global ageing and urbanization and industrialisation (Bergman et al, ), care for older people is increasingly shaped by markets across many countries in the world
The quasimarketisation characteristics emerge in the field of care for older people in urban China: non-state social care providers increasingly involved in care provision, both not-for-profit and for-profit organisations competing in the market, care service vouchers allocated by the state to older people to purchase from nonstate providers, and community officials or care managers representing older people to make choices in the quasi-market (Zhang, )
Based on the perceptions of care provider representatives and sub-district and community officials participated in this study, the following sections explore the characteristics of the policy process in the field of care for older people in China and the challenges and issues embedded in the process

Summary

Introduction

In the context of trends of global ageing and urbanization and industrialisation (Bergman et al, ), care for older people is increasingly shaped by markets across many countries in the world. The marketisation of care, which concerns the application of markets and market mechanisms in social care, has been widely investigated in welfare states (Glendinning, ; Shutes and Chiatti, ; Bolton and Wibberley, ). As a “path-dependent” concept (Williams and Brennan, ), the marketisation of care varies across countries, Downloaded from https://www.cambridge.org/core. The quasimarketisation characteristics emerge in the field of care for older people in urban China: non-state social care providers increasingly involved in care provision, both not-for-profit and for-profit organisations competing in the market, care service vouchers allocated by the state to older people to purchase from nonstate providers, and community officials or care managers representing older people to make choices in the quasi-market (Zhang, )

Methods

Results

Conclusion