Mapping out China’s regulations of home health care: a configuration approach using policy texts from long-term care insurance pilot cities

Background: Regulations of home health care are critical for quality assurance. There is a lack of empirical research regarding the increasing diversity of home health care regulations among long-term care insurance pilot projects and the implications for policy action. Purposes: To explore home health care regulation models across China’s long-term care insurance pilot cities. Method: A rigorous comparative method, the fuzzy set qualitative comparative analysis (fs/QCA), was used to build a typology of home health care regulation among long-term care insurance pilot cities. The dimensions unique to home health care regulation were identified based on the literature review and under the guidance of the Medical Insurance Supply Chain framework. Ultimately, 36 cases were purposively selected among all nationwide long-term care insurance pilot cities and analyzed using the software fs/QCA 4.1. Results: Our analysis leveraged seven dimensions of home health care regulation models drawn from existing research, revealing a typology comprising five ideal types that collectively account for the constellation of possible, empirically relevant regulation models across China’s long-term care insurance pilot cities. Conclusion: This study offers a multi-dimensional typology of five regulatory models, combining theoretical innovation with practical guidance for complex policy environments. These models reflect diverse configurations and suggest an evolutionary pathway for regulatory development. As aging populations increase demand for long-term care, such structured frameworks gain importance. Future research should explore their applicability across contexts and examine how regulatory models evolve with technological and societal change, particularly through data-driven oversight.