In 2016 and 2020，China selected 29 cities to take the pilot reform of long-term care insurance system. This report systematically studies the differences and changes in financing arrangements，payment policies and management methods between the two rounds of pilot projects. It is found that compared with the first round of pilot projects，the coverage of long-term care insurance in the second round is more extensive，the provision methods of insurance payment care services are more diversified，the payment level is improved，and the regional differences are narrowing. The evaluation of disability level is standardized. However，there are still some problems in the pilot areas，such as the fragmentation of pilot policies，which increases the difficulties in formulating the national framework. System of disability prevention and the institutional framework guiding the elderly care service have not been formed. To this end，this report proposes to speed up the formulation of long-term care insurance law，broaden financing channels and expand the scope of payment. Government should also pay attention to disability prevention services and guide the in-house and institutional care through payment rules. It is also important to realize the transformation from payment “according to bed” to payment “according to service”，accelerate the transformation from “supply-side orientation” to “demand-side orientation”，and include the purchase and rental of elderly care equipment and the elderly-friendly house reconstruction into the scope of insurance payment.