Home Care for Older People in Urban China: An Analysis of the Marketisation Process

The reforms of care for older people have been embarked upon in China as a result of the dramatic demographic and socio-economic changes since the 1980s. Home care is proposed to fulfil the rising care deficit for older people, while the market plays an increasingly active role in the field of care in urban China. This thesis aims to examine how home care policy and practice are shifting in the marketisation context. A qualitative case study approach has been adopted for the empirical research in Shanghai. Semi-structured interviews with home care providers and local government officials compose the main data source, while policy documents, secondary data and literature have been reviewed to support the analysis.

This thesis provides an in-depth exploration of the policy process and policy implementation gap, the shifting dynamics in the mixed economy of care and the re-conceptualisation of ageing and care in the marketisation context. Findings suggest that home care is central to the Chinese care regime and reveal the rationale behind it. Illustrating key strategies of the marketisation of care applied in Shanghai, three models of the “quasi-market” are identified based on the fieldwork data, namely the state-controlled model, the limited competition model, and the free market model. Impacts of the marketisation of care are also investigated in relation to care practice and the entire care regime. This thesis contributes to the understanding of the process of marketisation of care in urban China with empirical evidence and theoretical analysis. Based on the findings and discussions, the conclusion indicates implications for care policy and practice in relation to regulation, geographical inequality and filial obligation in the marketisation context and implications for future research.