A Thesis Submitted for the Degree of PhD at the University of Warwick Permanent WRAP URL: http://wrap.warwick.ac.uk/108843 Copyright and reuse: This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. For more information, please contact the WRAP Team at: [email protected] warwick.ac.uk/lib-publications A STUDY ON FUNDING FOR ELDER CARE IN CHINA PEIQI DENG A thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Philosophy in Social Policy Department of Sociology University of Warwick May 2018 Table of Contents Table of Contents ......................................................................................................................... I List of Tables ........................................................................................................................... VII List of Charts .............................................................................................................................. X List of Figures ............................................................................................................................ XI Acknowledgements .................................................................................................................. XII Declaration .............................................................................................................................. XIII Abstract ................................................................................................................................... XIV List of Abbreviations ............................................................................................................... XV Chapter 1 Introduction ............................................................................................................... 1 1.1 Research Background .......................................................................................................... 1 1.2 Significance of the Research ............................................................................................... 7 1.3 Research Questions ............................................................................................................. 9 1.4 Research Contributions ..................................................................................................... 10 1.4.1 Contribution on Theoretical Exploration ................................................................... 10 1.4.2 Contribution on Empirical Guidance ......................................................................... 11 1.4.3 Contribution on Research Methods ............................................................................ 12 1.5 Thesis Structure ................................................................................................................. 12 Chapter 2 Theoretical Perspectives ......................................................................................... 15 2.1 Rise of Neo-liberalism: Against Welfare States and In Favour of Markets ...................... 16 2.2 Restructuring Delivery Mechanisms: Alternative Governance ......................................... 18 2.2.1 New Reforms in Public Management ........................................................................ 19 2.2.2 Public-Private Partnerships (PPPs): Seeking Pathways to Social Investment ........... 21 2.3 From Welfare State to Social Investment State: A New Trend in Social Service Expenditure ............................................................................................................................. 24 2.3.1 Origins and Nature of the Social Investment State .................................................... 24 2.3.2 Returns from Social Investment: A Perspective on Social Care Provision ................ 28 2.3.3 Criticisms and Problems of the Transition: Issues of Co-ordination in Elder Care ... 29 I 2.4 Creating the Social Investment State in China: Social Services for the Elderly People ... 32 Chapter 3 Literature Review and Research Methodology .................................................... 38 3.1 Literature Review: Current Trend of Funding for Elder care/Long-term Care (LTC) ...... 38 3.1.1 Categories of Funding Arrangements for LTC in the Western Countries .................. 39 3.1.2 Problems of LTC Funding in the Western Countries ................................................. 43 3.1.3 Research on Funding for Elder Care/LTC in China ................................................... 46 3.1.4 Summary .................................................................................................................... 53 3.2 Research Methodology ...................................................................................................... 53 3.2.1 Research Strategy: Qualitative Case Studies .............................................................. 54 3.2.2 Qualitative Research Methods: Data and Source Materials ....................................... 58 3.2.3 Quantitative Research Methods.................................................................................. 67 3.2.4 Ethical Considerations ................................................................................................ 70 Chapter 4 Historical Development and Rationales Leading to the Construction of the Elder Care System in China ..................................................................................................... 72 4.1 An Ageing Society in China: Longevity Risk and its Features ......................................... 72 4.1.1 An Increasing Aged Population ................................................................................. 73 4.1.2 China’s Transformation in Family Structure .............................................................. 76 4.1.3 An Uneven Ageing Situation in Urban and Rural Areas ........................................... 78 4.1.4 Elderly Poverty: Getting Old before Getting Rich ..................................................... 78 4.2 The Historical Development of Elder Care in China ........................................................ 79 4.2.1 Family-supported Elder Care (1949~1982) ................................................................ 80 4.2.2 Government-leading Elder Care (1982~2000) ........................................................... 84 4.2.3 The Market-oriented Elder Care System (2000~the Present) .................................... 86 4.3 Rationales for the Construction of the Social Elder Care System in China ...................... 89 4.3.1 Changes of Policy Orientation ................................................................................... 89 4.3.2 Economic Transition and Market Prosperity .............................................................. 99 4.3.3 Social Development and Urbanisation ..................................................................... 101 4.4 Summary ......................................................................................................................... 103 Chapter 5 Funding Models for Elder Care in China ........................................................... 104 5.1 The Overall Structure of the Elder Care Funding System in China ................................ 105 II 5.2 Public Funding Models ................................................................................................... 107 5.2.1 Central Fiscal Expenditure ....................................................................................... 109 5.2.2 Local Fiscal Expenditure (including Fiscal Transfer Payments) ............................. 111 5.2.3 Public Welfare Lottery Funds .................................................................................. 113 5.2.4 Charitable Donations ................................................................................................ 115 5.3 Mixed Funding Models: Varied Typologies of Public and Private Partnerships (PPPs) 117 5.3.1 ‘Public Construction and Private Operation’ (‘gongban minying’) ......................... 117 5.3.2 ‘Private Construction and Public Subsidy’ (‘minban gongzhu’) ............................. 119 5.3.3 Elder Care Industry Investment Funds ..................................................................... 123 5.3.4 Other PPPs ............................................................................................................... 127 5.4 Market Funding Model.................................................................................................... 135 5.4.1 Commercial Old-Age Real Estate Model ................................................................. 135 5.4.2 Commercial Insurance Company Old-Age Model ................................................... 137 5.5 Indirect Funding Models for Elder Care in China ........................................................... 138 5.5.1 Preferential Taxation Policy ..................................................................................... 138 5.5.2 Land Leasing/Grant Policy ....................................................................................... 139 5.5.3 Credit Funding Policy .............................................................................................. 140 5.6 Summary ........................................................................................................................