Long-Term Care Governance in China and Italy. From State-Led Pilots to Familistic Fragmentation

This paper comparatively analyzes the long-term care (LTC) systems in China and Italy, two countries experiencing profound demographic shifts with rapidly aging populations. While both nations face the common challenge of providing sustainable and adequate care for an increasing number of older adults, their regulations and policy responses diverge significantly, shaped by distinct socio-economic contexts, welfare regimes, and cultural norms. Italy, representing a Southern European welfare model, has historically relied on a fragmented system characterized by familial support, supplemented by cash-for-care benefits and a significant influx of migrant care workers. In contrast, China is in the process of constructing its LTC system, moving from a tradition of family-based care towards a state-led, multi-pillar framework that includes social insurance experiments, private sector engagement, and the integration of health and social care. This paper examines the evolution of LTC policies in both countries, analyzing the drivers behind their different strategic choices. By contrasting the Italian model of "familism by default" with China's top-down, experimental approach, we highlight the respective strengths and weaknesses of each system. The analysis concludes that while no single model is universally applicable, a cross-national comparison offers valuable insights for policymakers grappling with the global challenge of providing sustainable and equitable long-term care in an aging world.