Objective: The paper attempts to evaluate the mid-to-long-term sustainability of China's long-term care insurance (LTCI) fund under different financing models and provide empirical evidence for the nationwide establishment of the LTCI system. Methods: Four representative pilot cities — Qingdao, Shanghai, Nantong, and Chengdu — were selected as research subjects. Their financing models were classified into two categories: the medical-insurance-dominated model and the multi-source co-financing model. Based on national LTCI fund operation data from 2020 to 2024, a dynamic revenue-expenditure balance model was constructed. Fund sustainability was simulated under three scenarios (conservative, moderate, and aggressive) for the period 2024-2035, followed by univariate sensitivity analyses on three core parameters. Results: Under the conservative scenario, the revenue-expenditure ratio will decline gradually from 1.86 to 1.17, maintaining balance throughout the projection period. Under the moderate scenario, the ratio will fall below 1 around 2029 and further decline to 0.59 by 2035. Under the aggressive scenario, the fund deficit will emerge in 2028, with the ratio dropping to 0.39 by 2035. Sensitivity analysis revealed that the target benefit coverage rate had the greatest impact on fund sustainability, with the magnitude of impact approximately twice that of the financing growth rate and benefit growth rate. Conclusion: Given that expenditure growth driven by the expansion of coverage consistently outpaces financing growth, the sustainable operation of the LTCI fund requires coordinated efforts across three dimensions: controlling the scope of coverage, enhancing financing capacity, and managing cost growth.
Key words
long-term care insurance /
financing model /
fund sustainability /
scenario analysis /
population aging
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