With the improvement of the long-term care insurance system, analysis of domestic pilot experience is crucial to the development of a model with Chinese characteristics. As one of the first pilot cities in China, Chengdu has gone through three stages of exploratory piloting, deepening implementation and systematic improvement over the past seven years. This evolution has not only deepened the connotation of the system, but also gradually constructed a financing mechanism with clear rights and responsibilities, a scientific and accurate assessment system, an extensive coverage of service provision, and an efficient and orderly management system. The purpose of this paper is to present the development history of the long-term care insurance system in Chengdu, distill the pilot experience and deficiencies in Chengdu through comparative analysis with the policies of other pilot cities in the five southwestern provinces, provide references for further optimizing the local long-term care insurance policy, and to provide useful insights for the top-level design of the national system.