Power and actors, institutions, and ideas in policymaking

Power, defined by access to resources, for example, funds, capital assets, political connections and expertise (Shiffman, Reference Shiffman2014; Ho, Reference Ho2022), is most often identified as the key determinant of policy. However, power is dynamic and does not exist and operate in isolation. Despite different understandings of power through different theoretical orientations or frameworks, actors/interests, institutions, and ideas are useful concepts by which to understand the policy process and how power operates (Pomey et al., Reference Pomey, Morgan, Church, Forest, Lavis, McIntosh, Smith, Petrela, Martin and Dobson2010; John, Reference John2013; Sabastier and Weible, Reference Sabastier and Weible2014).

Actors, who are thought to vary widely in terms of identification, rationality, and power (Howlett and Ramesh, Reference Howlett and Ramesh2003; Hill, Reference Hill2005; Knoepfel et al., Reference Knoepfel, Larrue, Varone and Hill2007; Sabastier and Weible, Reference Sabastier and Weible2014), exercise power and make decisions. They can be regarded as self-interested utility-maximisers (Cairney, Reference Cairney2019), giving rise to competing, conflicting, and even contested interests in policymaking. As such, they are presented as “rational decision-makers” who critically and objectively review and choose between policy options (Griggs, Reference Griggs, Fisher, Miller and Sidney2006). However, in this process, powerful actors (e.g. social and political elites) can leverage other actors to advance their agenda (Shiffman, Reference Shiffman2014; Gore and Parker, Reference Gore and Parker2019).

Actors also need to be understood as acting within particular institutions, broadly defined as both formal organisations and informal but institutionalised norms, rules, precedents, and so on (Hall and Taylor, Reference Hall and Taylor1996; Howlett and Ramesh, Reference Howlett and Ramesh2003; Cairney, Reference Cairney2019). Institutions design power distribution, relationships, attention, and information flows (May, Reference May2015; Peters and Zittoun, Reference Peters and Zittoun2016; Dee et al., Reference Dee, Eala, Robredo, Ramiah, Hubbard, Ho, Sullivan, Aggarwal, Booth, Legaspi and Nguyen2023), providing incentives or constraints for actors to act rationally and thus shaping actors’ political behaviour (Béland and Waddan, Reference Béland and Waddan2015; Cairney, Reference Cairney2019).

Ideas, referring to knowledge or beliefs about what is and/or should be at three levels – policies, programmes, and philosophies – play a causal role in understanding policy change (Schmidt, Reference Schmidt2008; Pomey et al., Reference Pomey, Morgan, Church, Forest, Lavis, McIntosh, Smith, Petrela, Martin and Dobson2010). Beyond the exercise of power to pursue interests, actors, aided by ideas, deal with uncertainty in policymaking (Carstensen, Reference Carstensen2011; Berman, Reference Berman2013). Specifically, ideas shape actors’ goals, motivations, and preferences, as well as the constraints and opportunities they face in particular contexts (Béland and Cox, Reference Béland and Cox2010; Cairney, Reference Cairney2012; Berman, Reference Berman2013).

Key determinants in Chinese policymaking

Turning now to look at how these determinants of policy play out in China. First, elitism has been the basic policymaking model in the post-1949 era (Wang and Hu, Reference Wang and Hu2010; Liu, Reference Liu2016); however, the original assumption that policymaking only occurs at the top has been challenged. Attention has thus shifted from the top leadership to bureaucrats (Hammond, Reference Hammond2013), recognising that political compromise within power elites characterises Chinese policymaking (Lampton, Reference Lampton, Lieberthal and Lampton1992; Wang and Hu, Reference Wang and Hu2010; Duckett, Reference Duckett2019).

Second, central–local dynamics dominate Chinese policymaking (Schubert and Alpermann, Reference Schubert and Alpermann2019). The Chinese political system is a mix of political centralisation, fiscal decentralisation, and functional fragmentation (Lieberthal, Reference Lieberthal, Lieberthal and Lampton1992; Qian and Mok, Reference Qian and Mok2016; Zhang and Rasiah, Reference Zhang and Rasiah2016), creating complex vertical and horizontal relationships. Implementing state policy initiates a new round of policymaking at the local level, involving lobbying and negotiation between the central and local government (Shi, Reference Shi2011; Wang et al., Reference Wang, Liu and Dang2018). Policymaking thus revolves around consensus-building through inter-agency bargaining (Nathan, Reference Nathan2003; Mertha, Reference Mertha2009; Duckett, Reference Duckett2019), where superiors’ efforts, for example, coordination, mediation, or adjudication, are essential to overcome bureaucratic deadlocks (Lieberthal, Reference Lieberthal, Lieberthal and Lampton1992; Duckett, Reference Duckett2019).

Third, rationality as an explanation of human behaviour is context–specific (Townley, Reference Townley2008). In Chinese policymaking, rationality manifests itself as problem orientation and self-interest (Zi li xing). Policy problems are an important driver of Chinese policymaking, especially the logic of “problem-oriented reform,” that is, advancing reform by solving problems (Han, Reference Han2017; Wang and Ning, Reference Wang and Ning2018), which critically influences Chinese politics. Problem orientation suggests rational policymaking in response to objective and identifiable problems (Xu, Reference Xu2019). Since 1978, self-interest has become recognised as widely present in individual bureaucrats, functional departments, and the government (Dong, Reference Dong2008). It is currently reified as maintaining stability, a multidimensional concept referring to social, political, and financial stability (Wu and Li, Reference Wu and Li2006; Zhang, Reference Zhang2006; Xing and Chen, Reference Xing and Chen2007).

The emphasis on social and political stability stems from an increasingly heterogeneous Chinese society “full of anger, political consciousness, anxiety, and uncertainty” (Zheng, Reference Zheng2010, p. 28), and social unrest is considered a threat to social stability, economic growth, and the political regime. Thus, the primary task of cadre assessments is to maintain social stability (Lee and Zhang, Reference Lee and Zhang2013; Wang et al., Reference Wang, Liu and Dang2018), making stability maintenance a concrete self-interest of Chinese bureaucrats and local governments. Accordingly, attention to public opinion, which embodies the issues that matter to the masses (Kingdon and Stano, Reference Kingdon and Stano2011), serves stability, as public opinion that has not been properly addressed causes “mass incidents (Qunti shijian)” or even social unrest and political instability (Zhao and Xue, Reference Zhao and Xue2017).

Maintaining fiscal stability often explains the constant misalignment between central and local governments in policy implementation. Finances constitute a basic orientation in Chinese policymaking (Lieberthal, Reference Lieberthal, Lieberthal and Lampton1992; Han and Kung, Reference Han and Kung2015). In particular, the asymmetric assignment of revenue and responsibilities creates tensions between unfunded central directives and stretched local budgets (Qian and Mok, Reference Qian and Mok2016; Chan and Shi, Reference Chan and Shi2022). Thus, when carrying out unfunded central mandates, local governments often strategically compromise the intentions of their superiors (Ngok, Reference Ngok2013; Guess and Ma, Reference Guess and Ma2015; Qian and Mok, Reference Qian and Mok2016).

Limitations of existing research on Chinese policymaking

To date, most studies of Chinese policymaking have either focused on describing the outcomes of a policy, leaving how policymakers’ motives shape the policy remain underexplored (Duckett, Reference Duckett2019); or examined one component or aspect of the policymaking process, with little effort being made to systematically explore the interplay of multiple factors. Thus, the existing literature does not answer the question that requires tracing and explaining dissimilar LTC policymaking experiences in China: why do localities make significantly different choices under the same central directives?

While studies have focused on the role of political elites, studies on the role of other potential actors in the policymaking process, for example, activists, media, and professionals (Zhu, Reference Zhu2013; Cheng, Reference Cheng2014), remain scarce. This overlooks the increasing opportunities for non-state actors to participate in Chinese policymaking and extended government-society negotiations (Chan and Cabestan, Reference Chan and Cabestan2001; Moore, Reference Moore2014). Others have focused on the relative influence of central and local institutions (Nickum, Reference Nickum2010; Ahlers and Schubert, Reference Ahlers and Schubert2015; Zhang and Rasiah, Reference Zhang and Rasiah2016), which fail to explain divergent, inconsistent, or contradictory local responses to central directives within a unitary system. Moreover, they impede efforts to overcome institutional constraints to achieve equity and universalism (Lin, Reference Lin2001; Saich, Reference Saich2011; Ngok, Reference Ngok2013), a point highly valued by LTC. Furthermore, the role and influence of socially constructed realities, for example, policy problems and political interests, has received relatively little attention or recognition. A central political process of policymaking is to turn conditions into problems (Buse et al., Reference Buse, Mays and Walt2012; Bacchi, Reference Bacchi2016), while interest-based political behaviour involves interpreting interests (Campbell, Reference Campbell1998; Schmidt, Reference Schmidt2008; Berman, Reference Berman2013).

The location of the research

Beijing and Shanghai were selected by their capacity to elucidate the policymaking process (Barbour, Reference Barbour2007) and analytic potential for comparison and generalisation. Their full-range responses to the central directives on LTC, including policies and pilots, reflect the richness of policy setting, meeting the criteria being a core research setting, “bounded, rich … microcosms” (Holliday, Reference Holliday2007, p. 36).

As municipalities, Beijing and Shanghai provide a wealth of information on the complex central–local dynamics of state policy implementation, as political debates between central and local governments occur most at the provincial level (Lieberthal, Reference Lieberthal, Lieberthal and Lampton1992). Furthermore, unlike other provincial-level governments, municipalities develop specific measures for district-level implementation, allowing research to explore their political deliberations. Beijing and Shanghai also have the potential to provide valuable insights into Chinese policymaking. Both are seen as role models of governance and pioneers of social policy, making them the primary source of policy learning for the rest of China.

However, Beijing and Shanghai show striking contrasts in LTC arrangements, making them well-matched cases for instructive comparison. Compared to the rest of China, they are first-tier cities with more developed economies and greater fiscal capacity. Even compared with other Chinese metropolises, they face similar challenges from large ageing populations with high disability rates. However, Beijing opted for a system centred on targeted welfare and social care, while Shanghai established LTCI and an LTC-centric service system.

At the time of the fieldwork, Beijing and Shanghai were at different stages of piloting LTCI. Unlike Shanghai, which had joined the national pilot, Beijing was running a local pilot without discussing any form of expansion. However, this difference does not compromise the study, as the way of piloting LTCI itself, for example, whether or not to join the national pilot scheme, is part of the policymaking process.

Sampling and recruitment of participants

Purposive sampling was used. Given the research question, the samples must be insider view-holders, included by two criteria: participation in LTC policymaking and information richness (Bradley, Reference Bradley1993), which is more likely to be achieved when individuals hold key positions (Goldstein, Reference Goldstein2002). Based on a five-stage policy cycle and first-hand experience, the sample was then narrowed down to those involved in the drafting of the policy text. Once released for interdepartmental discussion, this often means that the main body of the policy text has been finalised by the responsible department (or jointly with highly relevant departments), with minor or technical revisions to follow. This critical stage involves three types of policymakers. Theoretically and empirically, the government is a central actor in Chinese policymaking (Wong, Reference Wong2004), especially (deputy) directors as policy drafters. Think tanks and researchers are increasingly involved in Chinese policymaking (Think Tank Research Centre of SASS, 2013). Invited by relevant government departments, service providers usually participate in policymaking as industry experts.

Using snowballing techniques, including reputation snowballing and interview tracing, 25 people were recruited, including central and local officials from four government departments (n = 17), researchers (n = 5), and service providers (n = 3). Self-identified researchers at government-affiliated institutions were divided into officials and researchers according to their specific roles, for example, those holding departmental directorships were classified as officials. Those from government-affiliated bodies, such as the Beijing Municipal Commission on Ageing and the Shanghai Research Centre on Ageing, were grouped as local government department participants.

Data collection

Informed by the topic and theoretical perspective of the study (Charmaz, Reference Charmaz1990; Green et al., Reference Green, Willis, Hughes, Small, Welch, Gibbs and Daly2007), interviews explored the five topic areas presented in a broad and open-ended format in the conversation to avoid overdirecting, including (1) Informational questions: state policy development and main initiatives after 2013/2016; (2) Informational and reflective questions: significant policy changes in Beijing and Shanghai; (3) Reflective questions: core issues and tension points of LTC policies and practices; (4) Reflective and feeling questions: the policymaking process and their role; and (5) Conclusion question: future policy changes.

After obtaining ethical approval through the University ethics committee, face-to-face interviews took place in Beijing and Shanghai between June and December 2018. Interviews were audio-recorded by the researcher’s encrypted recorder. Before the interview, informed consent was secured from participants. Most interviews lasted around 60 to 120 minutes (n = 21). Where participants had limited time (n = 5), the interviews focused on topics (3) and (4).

The analytical process

Audio-recordings were transcribed, and NVivo-12 used to support data analysis. Thematic analysis and comparative analysis were carried out by referring to MSA concepts (Figure 1).

Figure 1. Analytic process of data analysis.

Thematic analysis was used to bring together the accounts of different participants, reconstructing the LTC policymaking process in Beijing and Shanghai. With careful reading through the data, coding, and interpretation, 8 themes emerged from 64 codes, explaining the core processes of LTC policymaking in each site. Comparative analysis is central to this research design. A constant comparison of thoughts and perspectives across purposively selected settings and participants, as well as sectors, was conducted to identify similarities, differences, or even contradictions, “using qualitative datasets to full advantage” (Barbour, Reference Barbour2007, p. 1116). In particular, MSA allows comparisons at the theme level, overcoming a common flaw in thematic analysis – failing to show the connections between themes and gain insight into the phenomenon (Vaismoradi et al., Reference Vaismoradi, Jones, Turunen and Snelgrove2016).

The tension in constructing LTC issues

Comparing the factors that influenced the framing of LTC issues in Beijing and Shanghai highlighted the tension between political deliberations and evidence. Overall, the debates revolved around LTC needs, and local policymakers in both municipalities used similar factors to frame LTC issues, including political pressure, public opinion, research evidence,Footnote ¹ and budgetary/capacity constraints. However, they differed in the importance given to each factor.

Despite its leading role in the LTCI pilot, Beijing HRSS showed little concern for LTC itself. It was the constant pressure from its superiors, the Beijing People’s Congress and China HRSS, that pushed it to launch and lead the pilot. Another key actor in LTC policymaking, Beijing MOCA, relied solely on public opinion evidence and conceptualised the LTC problem as non-existent or viable. Strikingly, regular monitoring of public opinion did not capture voices about unmet or unaffordable LTC needs in Beijing. Therefore, Beijing MOCA ruled out LTC for policy intervention and thus the existence of the LTC problem. Importantly, this situation was not specific to Beijing. The account below shows how incomplete/biased public opinion has shifted the ageing policy system away from LTC in China.

Therefore, neither Beijing HRSS nor MOCA used evidence to inform the conceptualisation of LTC issues. Note that little use of evidence did not mean that evidence was unavailable. Instead, research projects and the Ability and Needs Assessment System yielded ample evidence of LTC needs; however, it was either overshadowed or ignored in LTC policymaking. Researchers reported that Beijing MOCA shelved data from a ¥ 11 million project, and Beijing HRSS even rejected a proposal for a small-scale survey of LTC needs.

Unlike Beijing, Shanghai policymakers did not even refer to political pressure from superior authorities as important in influencing their views on LTC issues. Instead, they perceived central directives as an opportunity to make or legitimatise policy change, for example, incorporating the unauthorised pilot into the national pilot. Also, public opinion and evidence were both used to support the policymaking process. Rather than treating public opinion as comprehensive and reliable, Shanghai official participants believed in the duty of speaking for those whose voices were weak in public opinion and intentionally sought further evidence on LTC needs. Thus, they reported different methods of collecting evidence for policymaking, for example, bureaucrats’ research, large-scale surveys, and field investigations. Relatively complete information revealed rapidly growing unmet LTC needs in Shanghai, forming a consensus on LTC issues as a societal risk. Unsurprisingly, as cited below, this view was consistent with all researcher and professional participants who also used evidence on ageing to frame LTC issues.

In addition to the three factors mentioned above, all Beijing official participants stressed LTC budget constraints, especially Beijing MOCA sought to use them to define a viable LTC problem, focusing only on seniors with severe disabilities. The following account explains the prevalence of this “reverse logic” in Chinese policymaking, which prioritises fiscal capacity over needs.

In Shanghai, fiscal and service capacity constraints overtook evidence on one occasion, ruling out cognitive disability–related needs from prior LTC policymaking; however, emerging evidence compelled Shanghai to reconsider them in 2018.

For both sites, concerns about budget/capacity constraints were understandable. In Beijing, even with a severe disability rate of 3% (Tang, Reference Tang2016), there were still an estimated 128,700 older people in need of intensive LTC, with a total cost of 3.24 billion per year estimated at the current level of LTCI benefits. In particular, the financial capacity of Shijingshan District, the LTCI pilot district, was weak. In 2021, its public revenue was 6.467 billion, the lowest among the six urban districts, less than one-tenth of the wealthiest district, and a third of the fifth-ranked district. In Shanghai, the LTCI fund expenditures were estimated to be 3.77–3.87 billion in 2020 (Zhang and Yao, Reference Zhang and Yao2022).

Comparing the process of conceptualising LTC issues in Beijing and Shanghai showed that by using more evidence, LTC issues were more likely to be constructed as a challenge for government intervention, as seen in Shanghai. While responding to political pressure, public opinion or budgetary constraints tended to ignore or minimise the magnitude of LTC needs, thereby overlooking or underplaying LTC issues. As seen in Beijing, none of the functional departments considered LTC severe. At most, it was regarded as a sub-problem of home care, as reflected in the guiding policy, the Beijing Municipal Regulation on Home Care Services (the Regulation), which placed LTC under the agenda of home care and integration.

The tension in assessing policy options

Comparing the three main criteria used by local policymakers to assess policy options for financing LTC revealed a tension between stability maintenance and policy effectiveness. Alongside policy effectiveness and multidimensional stability, policy responsiveness in this article refers to the “creation and implementation of timely, intentional, and effective policy actions” (Sogie-Thomas et al., Reference Sogie-Thomas, Sankofa, Reed, Mfume and Doamekpor2018, p. 367). Overall, Beijing policymakers gave conflicting accounts of the proposed funding solutions, reflecting their struggle to balance policy responsiveness and stability. Rarely bothered by this, Shanghai valued policy effectiveness and embraced reforms to the existing policy system.

Beijing official participants believed that instructions from higher authorities must be thoroughly implemented in the political centre of China. They, therefore, were keen to express their support in principle, agreeing on the imperative of LTCI. However, resistance to operationalising this new institution was evident, reflecting a deep-rooted preference for stability and great caution about change and risk within the Beijing government system.

Accordingly, various constraints to radical solutions dominated the discussion, being attentive to handy and low-risk options. In particular, whether LTCI was financially sustainable was most debated. The following narrative stresses the overall fiscal challenges facing the Beijing government, which effectively divert attention away from LTCI.

Then, the primary source of funding suggested by the central directives, the health insurance fund, was deemed unsustainable. Ironically, to seek financial stability, alternative funding sources were mentioned but were promptly abandoned due to political stability concerns, for example, collecting LTC insurance premiums in the name of health insurance, merging LTC-related social insurance funds, and reallocating welfare spending, all of which required reforms to the existing public finance and social security institutions, which entailed political risks. As a result, little data showed Beijing striving for more funding for LTC, especially dropping the opportunity to secure alternative funding sources for LTCI.

Given the constraints, no forces opposed the proposal for a small-scale LTCI pilot, referring to LTCI mainly funded by health insurance funds to cover urban residents with severe disabilities in a single district with the smallest aged population. Although limited to the lowest administrative level and coverage, it ensured a minimum level of policy responsiveness to central directives, financial stability, and minimal political risk.

Anticipating its effectiveness in tackling the severe LTC problem, Shanghai policymakers unanimously supported the universal approach to LTC provision, valuing LTCI as an imperative institutional reform, as shown below.

Thus, unlike their Beijing counterparts, who sought to preserve stability by maintaining the status quo, they were far less concerned about stability. Instead, they meant to achieve it through action, as inaction on rapidly growing LTC needs would cause social unrest. As such, Shanghai’s positive attitude to policy change was clear.

Moreover, Shanghai policymakers showed enthusiasm for seeking effective solutions regardless of political risks. Despite China HRSS’s explicit rejection, Shanghai initially explored LTCI through the “Post-80s Healthcare Plan” in 2013, which was legitimised till the national LTCI pilot launched in 2018. Also, Shanghai policymakers strived to overcome budgetary constraints by obtaining alternative funding sources. Disregarding state policy of lowering the social insurance premium rate by 1% to ease social burdens, Shanghai retained and reallocated this portion of funding to LTCI, thereby ensuring fiscal stability without increasing the tax burden.

Comparing the criteria valued by local policymakers showed that local policymakers paying more attention to responsiveness to higher authorities and to political and financial stability tended to prioritise retaining the status quo with minimal change over establishing new institutions, while local policymakers with a greater focus on policy effectiveness were attentive to the latter.

Political environments

The comparison of the political environment for LTC policymaking in the two sites highlighted the role of political will at the municipal level in shaping adverse or supportive political contexts. In this study, “political will” refers to the “extent of committed support among key decision-makers for a particular policy solution to a particular problem” (Post et al., Reference Post, Raile and Raile2010, p. 659). In Beijing, the municipal leadership’s weak political will fostered an unfriendly environment consisting of insurmountable obstacles, whereas in Shanghai, a firm political will constructed a favourable political context, drawing and sustaining the attention of relevant departments and eliminating constraints on LTC policymaking.

A lack of political will to drive LTC policy was evident in Beijing, starting with no intention of participating in the national LTCI pilot. The account below illustrates that active participation in other national pilots raised doubts about the municipal government’s motives for being passive to the national LTCI pilot.

Lacking political will was reflected in the low priority of, and little attention to, LTC, for example, excluding LTCI from the mayor’s regular meeting agenda and the precarious political support due to cadre turnover. This was particularly true in comparison with other cities.

A lack of political will made various barriers to LTC policymaking unbeatable. As noted above, even in terms of stability and political risk, which Beijing participants were most concerned about, the proposal to retain 1% of social insurance premiums for LTCI was achievable because it was a precedent in Shanghai; however, the municipal leadership did not take any action, declining the opportunity to remove financial barriers.

Consistent with the above quote, Shanghai policymakers attested to the intensity and continuity of the municipality’s will to tackle LTC issues despite high cadre turnover, leading to a willingness across the government system to reform the existing ageing policy system and take political risks.

In particular, a strong will transformed the old power structure unconducive to LTC. The data showed a relatively balanced power relation in Shanghai; however, it emerged not by natural evolution but by political intervention, for example, appointing Shanghai DRC and Shanghai HRSS to lead LTC policymaking successively and involving Shanghai HC. These appointments made more departments stakeholders and placed two LTCI-related departments at the centre, giving new impetus to LTC policy development. Note that losing dominance did not mean the marginalisation of Shanghai MOCA. Instead, with the continued support of the municipal leadership and its knowledge and experience of ageing policy, Shanghai MOCA remained a key player in influencing LTC, for example, developing new LTC services and negotiating services covered by LTCI.

Key actors

Comparing the different roles played by all the actors in the two sites revealed that the absence or presence of key players critically influenced LTC policymaking, as they brought together the problems, policies, and politics described above to achieve a profound policy change. Central directives created opportunities for LTC, but no forces in Beijing were dedicated to and/or capable of driving policy change, whereas the Shanghai municipal leadership played this central role.

At the municipal level, given the weak political will, there was little evidence that the Beijing municipal leadership participated in LTC policymaking in any form, for example, convening special meetings, coordinating relevant departments, listening to briefings, or giving direct instructions. Without higher-level involvement, LTC policymaking was carried out by independent parallel departments, for example, Beijing HRSS and Beijing MOCA, along with loosely linked researchers (see below), demonstrating the inability to overcome political, financial, and institutional barriers.

Unlike Beijing, the Shanghai municipal leadership showed a strong presence in LTC policymaking, especially its coordinator role. The early involvement of Shanghai DRC highlighted the municipality’s awareness and determination to coordinate departments to remove obstacles, mainly institutional barriers, as cited below.

A dispute resolution mechanism was also established to address cross-departmental issues. Thus, the monthly meeting convened by the deputy mayor and attended by all relevant departments became “the main battleground to discuss various LTC policy ideas” (CBS27: official, Shanghai HC). Through robust steering, Shanghai reached high levels of agreement on LTC issues and solutions.

At the departmental level, Beijing MOCA dominated the ageing policy system, including LTC; however, it was the defender of the status quo. Its dominance stemmed from active involvement based on long experience regulating welfare and aged care. Moreover, Beijing MOCA, as the implementer of the Regulation, received support from Beijing PC and the municipal leadership, which significantly strengthened its position, as cited below. Inevitably, Beijing MOCA effectively pushed its targeted welfare and home care agenda while suppressing LTC-centric solutions.

Conversely, lacking experience in ageing and political support, Beijing HRSS, the implementer of the LTCI pilot, was weak and showed little intention and capacity to lead LTC policymaking. It held passive attitudes towards LTCI, with its chief director in particular giving specific instructions to keep a low profile. Rather than leading relevant departments, Beijing HRSS tended to exclude or distance itself from Beijing MOCA and Beijing HC, which were only informed of the policymaking outcomes, according to complaints uncovered in interviews. The following quote captures this exclusive or antagonistic relationship. As a result, all efforts to draw the attention of key post-holders to LTC failed, as mentioned above.

In contrast to Beijing, where MOCA was dominant with a passive stance on LTC, Shanghai MOCA became an active contributor to LTC policy. As noted above, the strong presence of the municipal leadership changed the interdepartmental power relations by involving more departments and assigning a leading role to Shanghai DRC and HRSS, thus achieving relative balance in Shanghai. This clearly undermined the dominance of Shanghai MOCA. While in Beijing, none of these changes occurred, and the old power relations, dominated by Beijing MOCA, remained.

Both sites invited qualified researchers and industry professionals to participate in policymaking, for example, a good reputation in their field, familiarity with government officials, similar mindsets, and cooperation. Overall, mirroring the state-society relationship in China, they were disadvantaged, unwilling or unable to advance their proposals. This is particularly true of the Beijing researcher participants, who differed from most government officials by supporting new institutional arrangements to address serious LTC issues. More importantly, they lacked the willingness to stand up for their policy advocacy. As such, they tended to withdraw from policymaking when encountering disagreement, as cited below.

Interactions of problems, policies, politics, and actors

The interaction of the above four factors determined the different outcomes of LTCI policymaking in Beijing and Shanghai. Beijing’s LTCI policymaking was characterised by ignoring or denying LTC issues for policy intervention, an apparent preference for maintaining the existing ageing policy system, and the municipal leadership staying away without any forces committed to promoting LTC. As a result, various obstacles led to superficial policy change, a district-level LTCI. In contrast, Shanghai policymakers reached a consensus on a pressing LTC problem for governmental intervention, prompting them to seek effective solutions. To remove political, institutional, and financial barriers, the municipal leadership acted as the key actor, directing and coordinating concerted action across departments. Thus, Shanghai achieved drastic policy change, establishing a municipal-level LTCI.