Earticle

초록

영어

China's Long-Term Care Insurance (LTCI), established as the country's “Sixth Social Insurance” following pension, medical, work-injury, unemployment, and maternity insurance, is undergoing a critical transition from selective pilot programs toward nationwide institutionalization. Yet this expansion has brought deep structural contradictions into sharp relief: why do multi-actor coordination failures persist despite continuous technological upgrading, and why does rapid enrollment growth coexist with widening regional imbalances? Existing research has largely approached LTCI through an instrumental efficiency lens, leaving the governance mechanisms that underpin—or undermine—institutional performance poorly understood. This study addresses that gap by constructing an integrated analytical framework that links institutional logic conflicts, collaborative governance mechanisms, and public value realization, drawing on institutional logics theory (Thornton et al., 2012), collaborative governance theory (Ansell & Gash, 2008), and public value theory (Moore, 1995). Empirically, DEA-Malmquist analysis of 44 pilot cities over 2020-2024 finds that the national average technical efficiency (TE) of LTCI financing stands at only 0.738, constrained primarily by insufficient scale efficiency (SE mean: 0.818), with only 10 of 44 cities achieving DEA efficiency. From a dynamic perspective, total factor productivity (TFP) averages 0.891 across the observation periods—declining on average by approximately 10.9% per period—driven by declining technical efficiency (TEC mean: 0.887) while technological change remained stable (TC mean: 1.003). Dagum Gini decomposition further shows that inter-regional disparities account for 43.0% of total efficiency variation. These findings are interpreted through the lens of four competing institutional logics—state, market, professional, and community—whose unresolved tensions produce structural governance failure. Comparative case analysis of the Shanghai and Nantong models illustrates how different logic integration strategies generate distinct public value outcomes. Systematic evaluation along three public value dimensions reveals significant gaps: in outcome value (insufficient fiscal sustainability and persistent regional inequity), process value (low administrative transparency and limited democratic participation), and relational value (fragile multi-stakeholder trust and weak value consensus). The paper concludes that the over-reliance on technological fixes and administrative monitoring—what Power (1997) termed “audit governance”—cannot substitute for genuine collaborative governance reform. Building a public-value-oriented collaborative platform, extending commercial insurer contract cycles, establishing unified digital assessment infrastructure, and institutionalizing multi-stakeholder participation are identified as the key levers for converting logic conflicts into institutional symbiosis and consolidating the long-term foundations of China's LTCI system.

목차

Abstract
1. Introduction
1.1 Research Background and Problem Statement
1.2 Research Objectives and Methods
2. Theoretical Foundations: Institutional Logics, Collaborative Governance, and Public Value
2.1 Public Value Theory: A Paradigm Shift in Evaluation
2.2 Institutional Logics Theory: Actors' Cognitive Schemata
2.3 Collaborative Governance Theory: The Mechanism of Conflict Transformation
3. Multiple Institutional Logic Tensions in LTCI Operations
3.1 The Conflict between Universal Welfare and Insurance Contract Logics
3.2 The Tension between Bureaucratic Hierarchy and Market Flexibility
3.3 Professional Assessment and the Discretion Dilemma of “Street-Level Bureaucrats”
3.4 Institutional Fragmentation and the Coordination Dilemma of Regional Disparity
4. Collaborative Governance Mechanisms and the Mediation of Logic Conflicts
4.1 Initial Conditions: The Structural Context of Efficiency Disparities
4.2 Key Collaborative Mechanisms in the Interaction Process
4.3 Comparative Analysis of Collaborative Governance Models
5. Institutional Assessment and Structural Review of Public Value Realization
5.1 Outcome Value: Fiscal Sustainability and Distributional Equity
5.2 Process Value: Administrative Transparency and Service Responsiveness
5.3 Relational Value: Multi-Stakeholder Consensus and Institutional Legitimacy
6. Conclusions and Policy Recommendations
6.1 Research Conclusions
6.2 Policy Recommendations
References

키워드

저자

• Zhou, Kaichao [ Department of Business Administration, aSSIST University, Korea ] Corresponding Author

참고문헌

발행기관

간행물

표지보기 관심저널 등록

• 간행물명

  Journal of China Studies

• 간기

  계간

• pISSN

  1975-5902

• eISSN

  3022-5590

• 수록기간

  2006~2026

• 등재여부

  KCI 등재

• 십진분류

  KDC 912 DDC 951