Consumer-directed care (CDC) for older people enables clients to arrange personalized services and improves their well-being. However, little is known about clients' preferences for policies in collectivist cultures. We investigate the views of older clients and family members about policies that promote consumer direction in a collectivist cultural setting - Guangzhou, China. Using semi-structured interviews, we recruited older persons and their family members (n = 24) in 2021. Inductive thematic analysis was employed. Two themes emerged. The first theme, the need for flexibility in utilizing benefits, includes the need for: 1) flexibility in selecting care workers; 2) autonomy in choosing budget management agents; 3) flexibility in selecting care-related goods; and 4) adequate and equitable benefits. The second theme, the need for professional support, contains the need for: 1) information and support; and 2) individualized training for care workers. Similar to those in individualistic cultures, people in collectivist environments desire autonomy and choice in service arrangements. However, the welfare and preferences of family members, rather than clients, may be prioritized by family members when making care decisions. Adapting CDC to collectivist cultures requires navigating between client preferences and family preferences.

There is a growing demand for dementia care to be funded by long-term care insurance (LTCI). However, evidence indicates that people with dementia are overlooked in China’s LTCI policy and empirical research on this issue is notably scarce. Among the first seven LTCI pilot cities that officially enrolled people with dementia, Guangzhou is unique for roll-back LTCI policies related to eligibility criteria and benefits. This study aims to explore why people with dementia are overlooked in China’s LTCI policy, using Guangzhou as a case study. Semi-structured interviews were conducted with stakeholders involved in LTCI need assessment and care delivery in Guangzhou. Eight LTCI assessment specialists, 22 formal caregivers, and six informal caregivers were interviewed from December 2021 to October 2022. Data was analyzed using NVivo 11.0 software and the Gilbert welfare framework to identify themes. Interviewees reported that need assessment lacked a clear definition, were poorly supervised, and had high moral hazards. Challenges to care delivery included unprofessionalism of formal caregivers, shortage of resources, unprepared informal caregivers, a lack of a supportive environment and the negative impact of COVID-19. People with dementia are overlooked in LTCI policy which may result from difficulties in implementing dementia-related assessment criteria, and hampered service delivery due to a shortage of skilled caregivers. These issues need to be carefully considered before scaling up the coverage of LTCI policy nationwide.

ObjectiveThis study examines the use of publicly funded formal and informal care among community-dwelling long-term care insurance (LTCI) beneficiaries in China and how dementia differentiates the choice of care.MethodsUsing administrative data from a LTCI pilot scheme in Guangzhou (n = 2043), we conducted a multinomial logistic regression to examine the association between dementia and the choice of family members (informal unpaid care), domestic helpers (informal paid care) and care workers (formal care), controlling for demographics, living environment and intensity of paid care hours.ResultsMost LTCI beneficiaries chose a family member (65%), followed by a domestic helper (21%) and a care worker (14%). After controlling for covariates, LTCI beneficiaries with dementia were more likely than their counterparts without dementia to choose care provided by a care worker (RRR: 1.73) or a living-in helper (RRR: 1.43) than a family member.ConclusionsA preference for informal care was observed among LTCI beneficiaries in China. Those with dementia were more likely than those without dementia to use care provided by non-family caregivers. The pilot scheme findings provide further insight into care recipients' preferences for service utilisation and how dementia impacts these preferences, which should be considered in future policy and service provision.

The COVID-19 pandemic presented unprecedented challenges for residential care homes for older people. However, the obstacles they faced and their resilience strategies have received insufficient research attention. This study, focusing on 13 residential care homes in Southeast China, addressed this research gap. The homes were visited between February and March 2023; 38 staff members (managers, nurses, social workers, and care workers) were interviewed. Thematic analysis revealed that the homes faced multidimensional challenges, including infection risks, declining mental health among residents, heavy workloads, and financial difficulties. Despite these challenges, they exhibited organizational resilience, primarily in their ability to cope with immediate issues during the pandemic, although their capacity to anticipate and adapt was weak. Factors influencing organizational resilience included their knowledge base, critical resources, a stable team with high morale and motivation, better integration of healthcare services, and government anti-COVID policies. This research highlights valuable insights for improving the quality of care in residential care homes in the post-pandemic era and in aiding policymakers and administrators in strengthening the organizational resilience of residential care homes in future crises.

Consumer-directed Care (CDC) empowers older people to flexibly arrange services and enhances their well-being. Prior studies have suggested that limited attention and hassle costs are major demand-side barriers to using CDC. However, many other psychosocial factors were unexplored. In this study, we explore associations between CDC utilization and a wider range of psychosocial factors based on behavioral economics theories. A cross-sectional telephone survey of older persons (or family members that represent them) was conducted in Guangzhou, China in 2021. We adopted a two-stage sampling method based on administrative records and analyzed the data using multivariate logistic models. Procedural literacy, hassle costs, and social norms regarding CDC were associated with using CDC. The findings reveal nuances in the decision-making process, and people are not unboundedly rational in making care-related decisions. Policymakers could employ cost-effective tools to facilitate CDC utilization and optimize resources to address the most crucial service barriers.

Since the global outbreak of COVID-19, the traditional face-to-face classes in colleges have been seriously challenged, and the discussion about the function and application prospects of the educational metaverse has become a hot topic. Some scholars have analyzed and predicted the use of metaverse in the field of education, covering various aspects of basic education, inclusive education, vocational education, and lifelong education. However, the higher education stage has been little studied. In order to rationalize as much as possible the real problems faced in the current educational metaverse, and in the absence of sufficient reference materials, this paper composes the concept and development of educational metaverse through literature analysis and theoretical research, defines the characteristics and current patterns of educational metaverse, analyzes four application scenarios of educational metaverse in colleges, such as contextualized learning, personalized learning, gamified learning , teacher training, and finally reveals the inner mechanism of metaverse empowering college teaching from three aspects: the embodiment, immersion, and concretization of educational metaverse. The paper shows a new progress and blueprint for the development of information technology in college education, hoping to contribute to the development of the education meta-universe and to provide some materials for later researchers' research and practice concerning college education.

Background From 2020 to 2050, China’s population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer’s disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. Methods Using official and population-level statistics, we summarise China’s demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China’s improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: ‘what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?’. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China’s second long-term care insurance pilot phase in 2020. Results Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. Conclusions China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

Changing central-local relations shape social policymaking and implementation in China. We develop a social decentralisation perspective to explore various inter-governmental dimensions in the formulation and implementation of social policy, based on experimentation in the provision of long-term care insurance starting in 2016. As localities devised new programmes, they initiated innovations in the context of central-local relations with Chinese characteristics. Three areas are duly examined: central coordination, regional competition, and regional protectionism. Intending to develop a national programme but reluctant to provide support through tax revenues, central government coordination reflects in both the central government's selection of cities across regions and allowing room for local diversity-some with deliberate experimental purposes-a feature which generated regional competition between pilot cities. Furthermore, as additional contributions for pilot programmes in some cities are waived, this process entails resource extraction from existing funding surpluses, unleashing local protectionism contrary to central government interests. Our analysis finds that the central government faces a dilemma: either meeting new social needs at the cost of increased regional inequality or balancing social policy developments across regions by enacting necessary programmatic reforms that sap central resources and weaken the central government's coordination capacity. These dynamics of social decentralisation will shape the future development and impact of Chinese social policy.

OBJECTIVE:This paper investigates how the public-private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing-in-place programs.METHODS:Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships.RESULTS:Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public-private co-constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing-in-place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context.CONCLUSIONS:PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher-quality care options for the public. They are also a feasible solution for the local government due to more cost-effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing-in-place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China.

This study investigates preference for ageing-in-place (AIP) among local older adults in a Chinese county with a large concentration of internal migrants. The current study was a secondary analysis of data from 755 community-dwelling elderly linked with county-level neighbourhood administrative data. We found that older adults living in neighbourhoods with a high concentration of migrants were 46% less likely to prefer AIP than those living in neighbourhoods with a low concentration of migrants. Such associations remained significant only among those less educated. Community-based programmes to encourage social contact among migrants and local older adults should be promoted.

Higher education expansion is expected to widen access to universities and promote social mobility, but evidence from the real world frequently contradicts this expectation, and China is no exception. Most empirical studies have been conducted on the relationship between social origins and education without considering studies on education and social destinations. As a result, relatively weak modifying measures are suggested without a panoramic view to inform structural changes. Inspired by the 'positional competition' observed by Mok, this study attempts to continue the exploration by constructing a dialogue between the two studies and look into the fluidity process across the two relationships to trace the determinants of social stratification in the country. Key findings include the following: 1) The education system is obligated to play a specific role in China depending on the governing theme of the regime, that is, the existing one prioritises economic growth but not social mobility. 2) Social elitist status in China is associated with an occupation in the public sector, the pursuit of which constitutes over-education among graduates. 3) The queuing model derived from the screening and signalling theory exercises explanatory power in the analysis of the public sector, whereas the thesis of human capital may still be illuminative in the private market. This study argues that, without addressing the state's continual grip on commanding heights, which is a fundamental reason behind weak fluidity, future modifying measures to propel mobility may be fruitless.

Purpose Before the turn of the century, taking overseas students was more about a diplomatic issue dominated by the state in China, for which reason this section is relatively independent within the higher education system. However, evidence from a series of new policy documents and their impacts suggests that international student mobility (ISM) has been intensively shaped by the central government in the desire to promote its national strategy, namely the belt and road initiative. ISM policy, although with a significant proportion marketized, was introduced for a clear purpose of cultural diplomacy. The paper aims to discuss these issues. Design/methodology/approach Looking beyond the debate of market-driven vs state-dominated, this paper attempts to provide a thorough understanding of this changing pattern based on examination of key changes of policy statements along with official data analysis. Findings This paper argues that the new pattern must be understood against a context of a hierarchy of higher education institutes in contemporary China: a sector led by a small number of prestigious universities generously funded by the central government with a large number of ordinary universities underfunded and eager to generate income. Prestigious institutes enroll international students to satisfy performance indicators listed by policies like “Double First-rate”; other universities, benefiting from the reputation and momentum generated by the top ones, take self-funded students for profit. Originality/value By making good use of both performance indicators and market motives, the country managed to move a state-dominated ISM policy in the twentieth century into the existing state-steering marketization model and made China a major destination for overseas study.

In the summer of 2013, the number of Chinese university graduates who did not know where to go after graduation reached an unprecedented 2 million. These graduates are not illegible to claim any benefits from social insurance schemes that based on formal employment. When away from home, neither do they have access to other supplementary benefits based on household registration status (hukou) financed and provided by the local governments of host cities. To address the issue of massive unemployment among graduates, the Chinese government has introduced a range of policy measures with an emphasis on ‘flexible employment’, an umbrella for several types of atypical jobs, while leaving the basic structure of social protection intact. This study reviews the development of the Chinese graduate employment policy with emphasis on the changes in the forefront of massive unemployment among graduates. By evaluating the effectiveness of policy measures, this study argues for a thorough reform of the higher education system.

Since 2003, Chinese university students have faced a dangerous level of unemployment after graduation. Current trends indicate that the situation is likely to remain at this level for some time. This article argues that it is difficult to generalize that there has been a decline in the competitiveness of all university students in the job market and that they all face serious employment difficulties, because there is a rather significant difference in competitiveness among graduates from different types of institutions. Exploring the issue by applying human capital theory and screening theory in analyzing statistical data on the employment of university graduates, this research suggests that the most competitive graduates are likely to be those from economically developed areas who are studying at elite institutions. For university graduates, the ability to find a job does not necessarily mean being competitive. Taking into account the inequities in the education system overall, most students getting into these elite schools come from families with higher social class backgrounds, indicating an important relationship between competitiveness and various ascribed factors. This article argues that, when comparing the competitiveness of Chinese university students with that of their peers from other regions of the world, one cannot ignore social backgrounds.

Since 1999, the expansion of higher education has been viewed as an important step in accumulating human capital for China that was to gradually open its domestic sectors to the global market at a turbulent time at the turn of the century. Recent studies suggest that the improvement of human capital has succeeded in preparing China with a solid platform to weather the economic crisis in recent years. However, these changes have not necessarily favoured the disadvantaged groups or promoted social mobility. This article demonstrates that access to elite universities of prestigious status is not equal for students from different socio-economic backgrounds. An analysis of graduates' starting salaries shows that educational inequality has contributed to income inequality, which is one of the key obstacles to building a harmonious society. Inequality of opportunity in higher education occurred in the context of marketization and localization of higher education, which have been worsening the regional disparity of human capital investment. This article examines the pros and cons of the policy changes, and attempts to draw lessons from the structural problems lingered from the past policies which China has to address in the aftermath of the current economic crisis.