{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:59:19Z","timestamp":1785473959565,"version":"3.56.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>China\u2019s long-term care insurance reform is a key component of multilevel medical security for addressing care needs among older adults with substantial functional decline, and it also raises an ethical governance question: how family-based Confucian care responsibilities are translated into modern rules of eligibility, payment, service provision and regulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study analyzed core long-term care insurance policy texts from 48 pilot cities through directed content analysis, a 45-item coding framework, policy text indices, K-means clustering and a supplementary comparison with the 2026 national rollout document. The 48-city sample was drawn from the 49-city national pilot framework after one city was excluded because no eligible core implementation text was located.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Local policy texts most clearly institutionalized needs assessment, payment responsibility and socialized service provision. Home-based or visiting care was widely recognized, but more specific caregiver-support rules, including caregiver training, respite care, family participation in care planning and detailed home-care service packages, remained less developed, as did digital governance. The national rollout document strengthened equity protection and family care responsibility, but detailed caregiver support and age-friendly digital access still require further specification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long-term care insurance in China functions not only as a financing and service instrument within multilevel medical security, but also as a public health governance mechanism that translates filial responsibility, care for vulnerable older adults, people-centered governance and benevolent rule into institutional arrangements.<\/jats:p>\n                  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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Liu","sequence":"additional","affiliation":[{"name":"Academy for China's Rule-of-Law, East China University of Political Science and Law","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref1","volume-title":"Decade of Healthy Ageing: Baseline Report","year":"2021"},{"key":"ref2","volume-title":"Integrated continuum of Long-term Care","year":"2021"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12912-024-01789-0","article-title":"Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis","volume":"23","author":"Xiao","year":"2024","journal-title":"BMC Nurs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"954035","DOI":"10.3389\/fpubh.2022.954035","article-title":"The care 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