This study aimed to analyze the institutional characteristics of China's long-term care insurance pilot project, clarify its achievements and limitations, and present desirable institutional measures ahead of the nationwide expansion of long-term care insurance in 2025. This study targeted three areas (Shanghai, Qingdao, Shandong, and Nantong, Jiangsu) and compared institutional characteristics in terms of allocation, benefit, delivery system, and finance. The three regions implemented long-term care insurance for all basic medical insurance subscribers, but Shanghai limited local subscribers to those aged 60 or older. Long-term care benefits are provided by home care, nursing care at nursing institutions, and medical care at medical institutions, and the benefit level differs between regions at 50-90% of basic living expenses and long-term care expenses. The three regions selected respectively a government-operating type, a private enterprise consignment type, and a state-owned enterprise consignment type in the delivery system. In terms of finance, the financial resources for the long-term care insurance fund and the insurance premium rate differed by regions. Next, this paper evaluated the achievements and limitations of the long-term care insurance pilot projects in terms of the comprehensiveness of subscribers, the adequacy of benefits, the accountability of delivery system, and the financial stability, and based on these, four desirable institutional measures were proposed. First, it is necessary to include residents in rural areas and establish standards for evaluation of loss of living ability. Second, the coverage rate of long-term care insurance should be set at 80% and home care service must be at least 3 hours a time. Third, it is desirable to select the government-operating type of Shanghai, and the government should strengthen its role as a regulator for the provision of care services by private institutions. Fourth, the government’s financial support should be limited to personnel expenses of the operating institutions.