Political dynamics behind different policy options: Long-term care insurance policymaking in Beijing and Shanghai from the perspective of local policymakers

Facing ageing challenges, long-term care (LTC) has become a focus of policymaking and policy analysis in China. However, the burgeoning literature obscures a lack of understanding of LTC policymaking, implying a linear and neutral process. This depoliticisation is unrealistic and contributes little to understanding the diversity of LTC policies and improving inclusive LTC provision. Focusing on the core institutional arrangement, LTC insurance (LTCI), this article explores a highly politicised policymaking process and reveals complex political deliberations behind different LTCI choices across regions. Underpinned by the multiple streams approach, which supports a systematic comparison of the policy process, this article identifies four key factors from a relational perspective that influence LTCI policymaking, including the tension between evidence and politics in the construction of LTC issues, the tension between policy effectiveness and stability in the assessment of policy options, strong or weak political will, and the presence or absence of municipal government.