On June 17, 2026, in a rural house in Jiangyin City, 39 year old Zhao Yue was sitting in a wheelchair while a caregiver from the Wuxi Long Term Care Insurance (hereinafter referred to as "Long Term Care Insurance") project was wiping his face and washing his hands.

Zhao Yue has been suffering from epilepsy since childhood, and now he is unable to stand up and walk normally, nor can he take care of himself. A few years ago, his father took care of his daily life, but with the death of his father, his sister had to give up her job and return to go home to take care of him.

Thanks to the caregiver, "Zhao Yue's sister said. In 2020, Zhao Yue's family applied for long-term care insurance and was assessed as severely disabled by a professional assessment agency. Since then, nursing staff have come to provide nursing services five times a week.

To the delight of Sister Zhao Yue, the 5-year home care service has significantly improved Zhao Yue's mental state - in the past, he was always silent alone, but now he will make an effort to greet his family around him.

Photo provided by the interviewee

The local medical insurance department introduced that in 2019, Wuxi City implemented the long-term care insurance system, which extended the service forms of long-term care insurance to nursing institutions, elderly (disabled) institutions, and community home care according to the nursing needs of insured persons. As a county-level city under the jurisdiction of Wuxi City, Jiangyin City quickly followed up and launched long-term care insurance services. By 2025, the local long-term care insurance fund will provide nearly 300 million yuan in protection, covering over 30000 disabled individuals, effectively alleviating the economic burden related to their daily care.

Nursing model of "community home+institutional stay"

As a designated nursing service institution for local long-term care insurance, Huashi Nursing Home is located within the Fourth People's Hospital of Jiangyin City.

Currently, out of over 30 patients admitted to Huashi Nursing Home, 8 have undergone disability level assessment and are eligible for long-term care insurance benefits. The relevant person in charge of Huashi Nursing Home revealed that these 8 patients who enjoy long-term care insurance benefits are all disabled due to old age and illness. After stable treatment, they have lost their ability to take care of themselves for a considerable period of time and need long-term care.

In order to better take care of disabled patients, most family members choose to hire caregivers. For them, this is a significant expense. After all, local elderly people have a monthly retirement pension of about 3000 yuan, while caregiver fees are at least 2400 yuan per month. In this situation, long-term care insurance plays a significant role in reducing their financial pressure.

Aunt Liu has a deep understanding of this. Last December, her spouse was affected by various illnesses and found it difficult to take care of herself. She sought professional nursing care at Huashi Nursing Home.

Originally, I thought it would take more than a month to complete the application process for long-term care insurance. However, with the assistance of the staff, I was able to complete all the application, initial screening, evaluation, and public disclosure processes within 20 days and quickly enjoy Level 5 disability benefits, "said Aunt Liu. With a daily subsidy of 50 yuan for long-term care insurance, she feels that her financial burden has decreased significantly, and she can use more of her retirement pension for her spouse's medical treatment. More importantly, the professional nursing in the nursing home also made her feel at ease.

Photo provided by the interviewee

In Jiangyin City, the proportion of disabled people who choose to stay in institutional care is not high.

As the handling agency of the fourth district of Wuxi Mayor's Care Insurance, Yan Shousheng, the general manager of China Taiping Life Insurance Wuxi Branch, has a deep understanding of the nursing needs of the local disabled population.

He found that over 85% of disabled individuals who enjoy long-term care insurance benefits prefer "community home care" because they are more familiar with their family environment and believe that home care is more "intimate".

In the home care process, in addition to on-site services provided by designated nursing institutions, families of disabled patients can also independently provide home care services after passing professional training assessments and obtaining professional qualifications. If the family members fail to obtain the relevant qualifications, the long-term care insurance agency will require designated nursing service institutions to dispatch professional nursing staff to provide on-site auxiliary nursing services at the same time. This is to urge family members to provide more professional care services for disabled patients in the community home care process. In addition, the long-term care insurance agency will also develop corresponding nursing plans for disabled patients based on their physical condition, visit them regularly to understand the nursing effectiveness of disabled patients, and assist their families in better completing nursing work.

Professional organizations do professional things

In 2019, the Wuxi Municipal Government launched a pilot program for long-term care insurance. All insured personnel of local employee medical insurance and resident medical insurance are required to participate in long-term care insurance. The long-term care insurance fund consists of three parts: individual contributions, government subsidies, and medical insurance pooling fund transfers.

In order to ensure that the long-term care insurance fund fully covers the local disabled population and effectively alleviate their financial pressure on life care, the Wuxi Mayor's care insurance system adopts a "social business cooperation" model, which entrusts commercial insurance institutions to undertake specific long-term care insurance affairs through government purchasing services.

The original intention of this model is to enable professional institutions to do professional things, "said the person in charge of the local medical insurance fund management center. Commercial insurance companies have rich experience in underwriting, claims and other services, which can build a more efficient long-term care insurance "application evaluation service settlement" full chain closed loop, benefiting local residents. The work that government departments need to do well is to strictly manage the quality of long-term care insurance services, effectively connect long-term care related security policies, strictly control fund safety, and strengthen the assessment mechanism of commercial insurance institutions.

In the past 7 years, Wuxi has completed 3 rounds of bidding for long-term care insurance handling services. As the commercial insurance company that won the bid for the fourth area in three consecutive rounds, China Taiping Life Insurance Wuxi Branch deeply participated in the full chain service from application acceptance, disability assessment to benefit distribution, which made Yan Shousheng deeply feel the "difficulty" of this work.

In order to better serve the local disabled population with long-term care insurance, the medical insurance department has put forward a series of requirements for commercial insurance companies that have won the bid to handle long-term care insurance services: to conduct comprehensive investigations on the hospitalization expenses of disabled persons from time to time, strengthen supervision and inspection, and prevent designated nursing institutions from indirectly raising prices and harming the interests of disabled persons; Strengthen the management of designated nursing institutions, focus on inspecting the formulation and implementation of various nursing plans, and ensure that disabled persons enjoy high-level long-term nursing services; Strictly grasp the assessment criteria for disability levels, strictly control the admission process, and ensure that the assessment results objectively and truthfully reflect the status of insured persons; Optimize the handling process to ensure that the processing time of each link complies with regulations.

In addition, local medical insurance agencies will conduct quarterly inspections and assessments of long-term care insurance work for commercial insurance companies. If the assessment results are "not satisfactory", the corresponding proportion of commercial insurance company handling fees will be deducted.

Every year, the medical insurance department also conducts a special audit on the quality of disability level assessment. Each district randomly selects disabled personnel according to a certain proportion for inspection. If there are any discrepancies in the disability level assessment results, they will be included in the annual assessment scope of commercial insurance institutions, and the score proportion will reach 30 points.

Faced with strict assessment standards and business handling requirements, China Taiping Life Insurance Wuxi Branch has established an audit closed-loop mechanism of "on-site initial screening+dynamic verification". Insured persons apply for verification materials the next day, and within three working days, two people will come to the site for on-site initial screening, multi-dimensional verification and full process image recording. The on-site initial screening rate reaches 100%, and the long-term care insurance benefits are classified and managed according to high, medium and low risks; On the other hand, we will strictly implement the "three-level review and approval system for adjusting evaluation levels" and establish a responsibility sharing mechanism with third-party professional evaluation institutions to effectively reduce the probability of "moral hazard" occurrence.

Yan Shousheng revealed that the company has established a complete set of dynamic audit mechanisms to build a tight audit loop of "precise front-end control and continuous back-end supervision" for long-term protection insurance. In addition, regular assessments are conducted on local designated nursing institutions every quarter to continuously improve the level of nursing services through satisfaction surveys, service video tracing, and other methods.

The reporter learned from multiple sources that with financial institutions making every effort to do a good job in "pension finance", the competition in the local long-term care insurance handling service market is becoming increasingly fierce.

This invisibly brings considerable competitive pressure to strict conservation. We will continue to optimize policy consultation, simplify the application process, standardize initial screening and evaluation, and make treatment settlement transparent, further improving the quality of long-term care insurance handling services, "Yan Shousheng revealed. Another important task of China Taiping Life Insurance Wuxi Branch at present is to collaborate with upstream and downstream industries, cultivate an elderly friendly service market, strengthen nursing staff training and service quality evaluation, and promote the deepening and implementation of long-term care insurance.

In Yan Shousheng's view, whether commercial insurance companies can win the favor of local governments in long-term care insurance handling services depends on whether they can satisfy local governments and residents in terms of institutional construction, team building, handling capacity building, agreement management capacity building, and annual quantitative indicator assessment, rather than purely engaging in a "rate war".

(At the request of the interviewee, Zhao Yue is using a pseudonym)