Quantitative evaluation and optimization of long-term care insurance policy texts in pilot cities of Guangxi Zhuang autonomous region

Shuang Liang, Li Li, Jun Luo, Lang Jiang, Z L Yang

Objective To systematically evaluate the quality and internal consistency of the long-term care insurance (LTCI) policy documents in five pilot cities of Guangxi Zhuang Autonomous Region, explore the allocation structure of policy instruments and the interaction pattern of stakeholders, and identify the strengths and weaknesses of the policy system. Methods A total of nine core policy documents from five cities including Hezhou, Nanning, Liuzhou, Beihai and Guigang were collected. The PMC index model and the policy tool analysis framework were adopted, and an evaluation index system was established after text mining with ROSTCM software. Two researchers conducted independent coding, and consensus negotiation was adopted to guarantee coding reliability (Holsti coefficient R = 0.9866, Kappa value of PMC scoring = 0.918). Results The average PMC index of policies in the five Guangxi cities was 6.59 (good grade), with Hezhou (7.23) and Beihai (7.07) rated excellent. Environmental policy instruments occupied a dominant position, accounting for 41.47%, while supply-side instruments (25.08%) and demand-side instruments (33.44%) were relatively insufficient. Specifically, facility construction (6 items) and human resource development (16 items) were severely inadequate, and payment provisions (127 items) made up 63.50% of all demand-side instruments. Stakeholders presented the feature of “administrative dominance with insufficient diversified participation”: administrative departments accounted for 40.30%, social donors only accounted for 1.00%, and beneficiaries merely took up 1.33% in supply-side policy instruments. Policy timeliness (X2 = 0.40) and incentive and restriction mechanisms (X9 = 0.56) were the common deficiencies among the five cities. Conclusion The LTCI policy in Guangxi has initially formed an institutional framework suited to ethnic minority areas. It has met the national framework requirement of “ensuring basic needs with wide coverage” in terms of the coverage of insured parties and adaptation to relevant fields. However, policy timeliness and incentive and restraint mechanisms remain prominent shortcomings, and an effective connection has not yet been established between the construction of the institutional framework and its long-term operation. Improvements should be made in four aspects: promoting the county-level distribution of nursing facilities and professionals, optimizing the structure of demand-oriented policy instruments, institutionalizing the combination of progressive coverage and consumption vouchers, and filling gaps in full-chain supervision.