The Alienation of Emotional Labor and the Reconstruction of Dual-dimensional Incentives in Rural Areas under the Long-term Care Insurance System—Qualitative Study Based on Rural Doctors in Guilin City

Abstract

As China’s long-term care insurance (LTCI) system expands into rural areas, village doctors in aging mountainous cities like Guilin will become core providers of home care. Although Guilin has not formally implemented LTCI, emotional labor is already a key variable in rural “quasi-long-term care”. This study employs an interpretative sequential mixed method: a word frequency analysis of 249 policy documents from 29 pilot cities nationwide, combined with in-depth interviews with village doctors in Guilin to simulate future LTCI scenarios. The study finds a significant policy bias toward “strong control and neglect of emotional support,” with emotional and incentive terms accounting for less than 0.1% of texts. Under administrative and social network pressures, village doctors use “quasi-kinship” strategies to compensate for care resource shortages. However, the current mechanism treats emotional labor as an unpaid obligation, leading to dignity erosion and emotional exhaustion. We propose a dual-dimensional incentive scheme (“emotional points + care difficulty coefficient”) to incorporate trust-building costs and emotional value into the payment system, shifting LTCI from “payment based on quantity” to “payment based on quality” to stabilize the rural doctor team.