Emerging quasi-market of home care for older people in urban China: a case study in Shanghai

Context: China’s reforms of long-term care stem from significant demographic and socio-economic changes since the 1980s. The growing involvement of the market in care provision for older people is a notable trend in its urban areas.

Objective: This study investigates how the marketisation process is shaping home care policy and practice in urban China.

Methods: Qualitative case study research was conducted in Shanghai. The data source includes interviews with 21 care provider representatives and 9 local government officials and follow-up consultations with 4 interviewees. Interview data were analysed thematically.

Findings: This article outlines three quasi-market models and power dynamics in Shanghai’s home care sector, reflecting marketisation strategies and state-market relationships: the state-controlled model, the limited competition model, and the free market model. In Shanghai’s home care market, heightened competition does not necessarily correlate with improved care quality, echoing international concerns such as disparities in access, care quality, and market concentration. These challenges extend beyond ‘market failures’ and increased risks to older people but also contradict the rhetoric of markets as being more responsive to consumers.

Limitations: The study only included Shanghai as the research site. It is an exploratory study that requires additional statistical data for future research.

Implications: This study underscores the influence of long-term care policy and local government characteristics on purchaser–provider relationships in commissioning and public procurement. The findings suggest that robust regulation and monitoring within the care market is crucial for mitigating associated risks and prioritising care quality during the development of the care market.