Handling Ageing with Care in Authoritarian and in the Democratic Regimes: Ideas, Institutions, and Explaining Long-Term Care Policy Development in Three Chinese Societies

The Chinese societies are ageing rapidly that generates pressure for long-term care (LTC) provision. Despite their ethnic similarities, three models stand out: LTC in Hong Kong is a universal tax-funded model with a publicly subsidised but privately-operated delivery system. China is moving from a means-tested model to a contributory model, with policy experimentation on its long-term care insurance scheme, which is now implemented in 49 cities. Taiwan initially followed the footsteps of Japan and Korea for a social insurance model till 2016, but eventually implemented a partially tax-funded one that might further evolve to a hybrid system combining tax and social insurance. Drawing on historical institutionalism and ideational analysis, this paper stresses the institutional logics underpinning policy evolution in light of policy learning and feedback effects as they related to the changing nature of the political regime at hand (i.e. authoritarianism, democracy and their evolution over time). We argue that both existing policy legacies and political institutions tied to the evolution of authoritarianism and democracy have shaped the ways in which various policy ideas about care provision have risen to prominence – or declined in importance – that led to diverse policymaking outcomes.