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

The 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.