Policymaking for Long-term Care Provision for Older Disabled People in China
: A Comparative Study of Beijing and Shanghai Municipalities

  • Chunhua Chen

Student thesis: Doctoral ThesisPhD


With over 40 million disabled older people, long-term care (LTC) provision has become one of the most critical social, economic, and political issues facing the Chinese government. Yet despite significant state attention, accessible and affordable LTC remains a challenge. This has highlighted problematic policymaking, as local policy responses are neither in line with their central instructions nor relevant to local capabilities or identified LTC needs. This study sought to understand why different or even contradictory LTC policy responses have occurred in two case study sites, Beijing and Shanghai, despite being driven by the same national policies. It addresses the lack of research, which has examined the policymaking process from LTC needs to LTC provision in China and how different geographical locations experience policymaking under the same institutions.
The thesis adopted a qualitative methodology, interviewing key policymakers and employing the Multiple Streams Approach (MSA) to analyse the LTC policymaking process in Beijing and Shanghai. The findings demonstrate a highly politicised process of LTC policymaking in China, with ambiguous national strategies of LTC provision and weak national steering on implementation. This has led to divergent approaches. In Beijing, politics-driven policymaking has let path-dependent LTC policies dominate, while in Shanghai issue-focused policymaking has resulted in path-departing LTC policies. Different policy responses in the two sites reflected either symbolic or thorough implementation of national policies. Given the evolving LTC policy system, the findings on the highly politicised LTC policymaking and its specific political processes have policy implications for policymaking, LTC provision and social welfare development in China. The thesis also makes a methodological contribution to the literature, showcasing the value of MSA for analysing policy responses of subordinate organisations to superordinate authorities under ambiguity in China.
Date of Award8 Sept 2021
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorLouise Brown (Supervisor) & Rana Jawad (Supervisor)


  • Population ageing
  • Long-term care
  • Policymaking
  • China
  • Multiple Streams Approach

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