Duan Peixin, Wang Jiayi, Zhang Ruisi, Jia Haiyan, Sun Hui, Li Yanfang
School of Public Administration and Policy, Shandong University of Finance and Economic, Jinan, China.
Department of Basic Education, Shandong College of Electonic Technology, Jinan, China.
Front Public Health. 2025 May 22;13:1467062. doi: 10.3389/fpubh.2025.1467062. eCollection 2025.
Policy pilots and policy diffusion are important tools for national governance and policy innovation in China. Long-term care insurance (LTCI) offers a potential solution to the challenges posed by the aging population. Currently, the pilot program for the LTCI system in China has gone through two phases, but a unified national policy framework has yet to be established. Therefore, the outcomes of the policy pilots and the diffusion process of this policy warrant further exploration.
Based on the perspective of policy diffusion, this study employs textual analysis and applies the Policy Modeling Consistency (PMC) index model to evaluate the quality and consistency of LTCI policies. A quantitative evaluation is conducted on 29 LTCI policies from two groups of pilot cities in China. The characteristics of policy diffusion are analyzed from both temporal and spatial dimensions.
(1) According to the PMC index results, LTCI policies of 25 cities achieved an excellent level, 4 cities reached an acceptable level, and there were no substandard policies among the 29 pilot cities. The overall consistency of LTCI policies in the first batch of pilot cities in China is higher than that in the second batch, with PMC index of 6.61 and 6.23. The LTCI policy still faces many challenges, such as limited funding sources and a narrow scope of care services. (2) The diffusion of LTCI policy across different regions and batches has the following characteristics: the diffusion of LTCI policy has followed an "M-shaped" curve over time. In terms of spatial diffusion, there is an interaction between spatial proximity and social proximity effects. In terms of diffusion pathways, there is a combined effect of vertical and horizontal diffusion, reflecting a hierarchical diffusion pattern.
This paper constructs a new analytical framework for studying policy diffusion. Based on the analysis of policy texts using the PMC model, we focus on the analysis of policy quality and consistency to the diffusion characteristics and exploring the underlying reasons for the diffusion of the LTCI policies. This extends the research of LTCI policy from traditional qualitative analysis to the quantitative research domain.
政策试点与政策扩散是中国国家治理与政策创新的重要工具。长期护理保险为应对人口老龄化带来的挑战提供了一种潜在解决方案。目前，中国长期护理保险制度试点已历经两个阶段，但全国统一的政策框架尚未建立。因此，政策试点的成效以及该政策的扩散过程值得进一步探究。
基于政策扩散视角，本研究采用文本分析方法，运用政策模型一致性（PMC）指数模型评估长期护理保险政策的质量与一致性。对中国两组试点城市的29项长期护理保险政策进行量化评估。从时间和空间维度分析政策扩散的特征。
（1）根据PMC指数结果，25个城市的长期护理保险政策达到优秀水平，4个城市达到可接受水平，29个试点城市中无不合格政策。中国首批试点城市长期护理保险政策的整体一致性高于第二批，PMC指数分别为6.61和6.23。长期护理保险政策仍面临诸多挑战，如资金来源有限、护理服务范围狭窄等。（2）长期护理保险政策在不同地区和批次间的扩散具有以下特征：长期护理保险政策的扩散随时间呈“M形”曲线。在空间扩散方面，存在空间邻近性与社会邻近性效应的相互作用。在扩散路径方面，存在纵向与横向扩散的综合效应，呈现出分层扩散模式。
本文构建了一个研究政策扩散的新分析框架。基于使用PMC模型对政策文本的分析，我们聚焦于政策质量和一致性对扩散特征的分析，并探究长期护理保险政策扩散的潜在原因。这将长期护理保险政策的研究从传统的定性分析扩展到了定量研究领域。
