Abstract: Since 2026, China's long-term care insurance (LTCI) scheme has shifted from local pilots to nationwide implementation. Amid moderate population aging, nationwide LTCI is essential for equitable access to care for people with disabilities and the sustainable development of an aging society. The Urban and Rural Resident LTCI scheme covers non-employed residents and is financed by individual contributions and government subsidies. This study examines fund balances, regional disparities, and central-local fiscal responsibilities across 31 provincial-level regions in Chinese mainland during 2026-2036.

The data and methods are as follows. First, using China's 2020 Seventh National Population Census and statistical yearbooks, the cohort-component method is employed to project population by urban-rural residence, age, and sex, accounting for urbanization and interprovincial migration. Second, using the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), a Markov model is constructed based on six activities of daily living (ADLs). Transition probabilities are estimated among five states—independent, mildly disabled, moderately disabled, severely disabled, and deceased—to project disability prevalence among the older population. Third, based on China's existing LTCI pilot policies, annual benefits under the low, medium, and high scenarios are set at 10%, 20%, and 30% of each province's previous-year per capita disposable income, respectively. In accordance with Chinese policies, the 31 provinces are grouped into five tiers. The central government covers 80%, 60%, 50%, 30%, and 10% of government subsidies in these tiers, respectively, with local governments covering the remainder. Fourth, national and provincial policies guide enrollment and contribution rates. Fund revenue, expenditure, balances, and government subsidies are estimated to assess provincial financial sustainability and central-local fiscal responsibilities.

The findings are as follows. First, provincial financial sustainability under the medium-benefit scenario falls into five categories, whereas the high-benefit scenario increases the number of provinces experiencing deficits. Population aging, the size of the adult contributing population, enrollment rates, contribution rates, and benefit levels explain regional disparities. Second, central subsidies as shares of central general public budget revenue, expenditure, and outstanding central government debt peak in 2033 at 0.181%, 0.415%, and 0.046%, respectively. Tiered central subsidies alleviate local fiscal burdens but cannot eliminate structural pressures in regions experiencing advanced population aging and net population outflows.

Policy recommendations include shortening the contribution-rate transition period or temporarily increasing contribution rates in regions with persistent deficits. For provinces with limited fiscal capacity, annual benefit caps should initially be set at 30% of residents' previous-year per capita disposable income, while benefit levels should reflect care costs and actuarial balance. Fiscal burden-sharing should account for demographic structure and fiscal constraints while strengthening provincial pooling and interregional transfers.

This study makes three contributions. First, it extends analysis from local pilots to all provincial-level regions and identifies regional differentiation driven by demographics, financing capacity, institutional parameters, and fiscal capacity. Second, it addresses the understudied resident LTCI scheme and redefines its funding sources under current policies, aligning actuarial assumptions with institutional arrangements. Third, it develops an actuarial framework linking fund operations to fiscal responsibilities. These findings inform enrollment expansion, contribution rates, benefit levels, fiscal capacity assessment, and intergovernmental burden-sharing to promote equitable access to basic long-term care.

Keywords: Long-term Care Insurance, Nationwide Implementation, Urban and Rural Residents, Financial Sustainability, Central-local Fiscal Responsibility

摘要： 在中国已步入中度老龄化社会的背景下，长护险全面建制对保障失能群体照护公平可及、促进老龄社会可持续发展具有重要意义。本文以最新政策为参数锚点，面向31个省级行政区，构建2026~2036年居民长护险财务可持续性和央地财政责任精算框架。研究发现，中待遇方案下各省份财务可持续性发生分化，高待遇方案下赤字省份明显增加，人口老龄化程度、成年缴费人口规模、参保率、缴费费率及待遇支付标准是导致分化的主要因素；中央财政责任总体可承受，地方财政责任则受央地分担比例、人口结构及制度参数影响。建议长期赤字地区缩短费率过渡期或阶段性提高目标费率；在建制初期以上年度居民人均可支配收入的30%作为年度最高支付限额的审慎边界；完善央地分担机制，推动建立省级调剂金制度。本文从财政风险视角拓展了居民长护险财务研究边界，为统筹照护公平、基金可持续、财政可承受的目标提供了省域依据。

关键词: 长期护理保险, 全面建制, 城乡居民, 财务可持续性, 央地财政责任