A Study of the Cash Allowance Schemes for Family Caregivers in Hong Kong and Macao

Abstract

Against the backdrop of rapid population ageing, Hong Kong and Macao, the two special administrative regions of China, have introduced cash allowance schemes to support family caregivers of older adults. These policies recognise the immense pressure on informal caregivers. This paper presents a comparative analysis of the caregiver allowance schemes, examining their target groups, eligibility criteria, benefit adequacy, and governance issues. We offer a mechanism-based account: delivery architecture yields Hong Kong’s conditional, tiered model and Macao’s simple, household-anchored scheme, highlighting trade-offs between strict targeting and broader but flat, co-residency-tied support. This comparison shows that although both regions formally recognise the value of family caregiving through financial subsidies, significant policy limitations undermine the schemes’ effectiveness. Without relaxing restrictive eligibility criteria, reviewing the adequacy of benefits, the co-residency requirement, and holistic support for caregivers, these allowances will remain a limited solution to the escalating caregiver crisis.

1. Introduction

1.1. Family Caregiving and Caregiver Burden in Hong Kong and Macao

Population ageing across East Asia has intensified demand for long-term care, placing increasing reliance on unpaid family caregivers to support older adults and persons with disabilities. In Hong Kong and Macao, two densely populated Special Administrative Regions (SARs) of China, family caregivers play a central role in sustaining care within the community amid high living costs, limited availability of residential care, and strong cultural expectations of familial responsibility. A growing body of research shows that family caregivers in both cities face substantial physical, psychological, social, and financial burdens associated with intensive caregiving responsibilities (Guo et al. 2025; Daniel W. L. Lai 2012; Sit et al. 2020; So et al. 2022).

Empirical studies consistently link caregiver burden with adverse mental health outcomes. In Macao, a large-scale study found that 31.7% of family caregivers experienced moderate-to-severe depressive symptoms, while 46.6% reported moderate-to-severe anxiety (Sit et al. 2020). In Hong Kong, primary caregivers have significantly poorer physical and mental health and lower life satisfaction compared with secondary carers or individuals without caregiving responsibilities (Guo et al. 2025). Financial strain has been identified as a particularly salient component of caregiver burden, functioning both as a direct stressor and as a factor exacerbating psychological distress (Daniel W. L. Lai 2012; So et al. 2022). The need to balance caregiving responsibilities with paid employment further compounds this burden, with many caregivers reducing working hours or exiting the labour market altogether.

1.2. Growing Public Concern and Limitations of Existing Support Systems

Public and policy concerns regarding family caregivers have intensified in both Hong Kong and Macao as population ageing places increasing pressure on families. Existing support systems are frequently described as fragmented, insufficient, and difficult to access, particularly for caregivers providing intensive, long-term care (Che et al. 2024; Legislative Council Panel on Welfare Services 2023). In Hong Kong, high reported rates of depressive symptoms among caregivers, family dysfunction among working carers, and the absence of a legal definition or rights-based framework for caregivers have contributed to what scholars describe as a contemporary “care crisis” (Chan et al. 2021; Legislative Council Panel on Welfare Services 2023; Mao et al. 2025).

Similar challenges have been observed in Macao. Despite policy commitments to ageing in place, caregiving remains predominantly family-based, with limited formal support and significant reliance on co-residing relatives (Long et al. 2019). Civil society groups and media reports have criticised the insufficiency of caregiver support services, highlighting emotional exhaustion, service gaps, and unmet financial needs (Macao News 2022). In both SARs, caregivers often rely on informal or online networks for psychological reassurance due to the absence of timely, accessible professional support (Che et al. 2024).

1.3. Welfare Orientation in Hong Kong and Macao

Hong Kong and Macao share similar socio-cultural and political backgrounds but exhibit distinct welfare arrangements shaped by a broadly productivist or residual welfare orientation. Both jurisdictions prioritise economic development while assigning social policy a secondary role, relying heavily on family and market mechanisms to meet social welfare needs (Holliday 2000; Lai and Chui 2014; Mok 2013). Social security benefits are thus usually designed as a minimum level of support rather than as universal provision.

Nonetheless, regarding financial assistance for family caregivers, comparative research highlights important differences between the two systems. Macao generally provides higher benefits to a narrower group of recipients with less stringent conditionality, whereas Hong Kong covers a larger population through stricter means-testing and greater reliance on market provision (Chan et al. 2021; Kwong 2013; Dicky W. L. Lai 2017). These structural differences raise questions about how similar welfare ideologies can yield divergent policy outcomes, particularly in supporting unpaid family caregivers. Accordingly, our analysis, using cash allowances for family caregivers as case studies, explains the divergence between the two SARs through administrative capacity and policy choices—tiers/conditionality versus simple, flat transfers—within a shared productivist context.

To examine why the two productivist regimes diverge in welfare policies, particularly in cash allowances for family caregivers, we argue that these differences are linked to institutional path dependence. In Hong Kong, the long-term NGO subvention and pilot-to-regularisation models are reflected in the caregiver allowance scheme, whereas Macao’s executive-led, programme-centric model has created an allowance scheme with different eligibility criteria and payment levels. Moreover, Hong Kong’s sophisticated system, favouring verifiable targeting and activation, and Macao’s smaller administration, favouring simpler, broadly accessible transfers, have further differentiated the positioning of the allowance schemes, helping to explain variations and divergence in social policy developments across similar welfare orientations.

1.4. Cash Allowance Schemes for Family Caregivers in Both Jurisdictions

In recent years, both administrations have introduced cash allowance schemes to recognise the contributions of family caregivers and alleviate financial pressure, and both schemes have undergone various policy amendments (Table 1 and Table 2). In Hong Kong, the “Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families” was initially launched as pilot schemes under the Community Care Fund in 2014 and 2016 before being formalised in 2023 (Community Care Fund 2023a, 2023b). Eligibility is subject to strict means-testing and linked to the care recipient’s position on long-term care service waiting lists. Upon approval, recipients are linked to approved service providers for monitoring and support, with conditions regarding care hours and training engagement. To facilitate this, the scheme offers reimbursement of up to HK$1150 per year for course fees and related expenses, such as respite care, ensuring caregivers can upgrade their skills without facing additional financial or caregiving pressures.

Table 1. The key policy milestones of Hong Kong’s “Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families”.

Year	Policy Milestones
2014	Community Care Fund launched the Pilot Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families.
2014–2023	Pilot scheme continued through multiple phases and extensions under the Community Care Fund.
2022	Hong Kong Policy Address announced regularisation of carer-support measures.
October 2023	Pilot scheme formally regularised and renamed “Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families”. Monthly allowance increased from HK$2400 to HK$3000.
2024–2025	No major structural reform identified; eligibility framework maintained.

Table 2. The Key Milestones of Macao’s “Caregiver Subsidy”.

Year	Policy Milestones
December 2020	Caregiver Subsidy introduced as a pilot programme.
2021–2023	Pilot scheme operation period.
December 2023	Pilot scheme transformed into a permanent programme through the caregiver subsidy regulation framework.
January 2026	Broadened eligibility (including severe/profound primary psychosis and Hengqin-resident applicants); higher income ceilings, and relaxed administrative/eligibility requirements

Macao introduced its “caregiver subsidy” through a pilot programme around 2020, and it was subsequently formalised under Administrative Regulation No. 95/2023. The scheme prioritises households caring for individuals with assessed long-term and intensive needs and has been expanded in both benefit level and coverage over time (Secretary for Social Affairs and Culture 2023). Both schemes reflect growing policy recognition of caregiving labour through formalisation and regularisation as part of policy, yet concerns remain about their adequacy, accessibility, and overall effectiveness in supporting caregivers.

1.5. Study Aims, Methods and Analytical Framework

Despite the growing emphasis on caregiver support policies, systematic comparative analysis of caregiver cash allowance schemes in Hong Kong and Macao remains limited. Existing research generally concentrates on individual jurisdictions, caregiver burden, or service provision, with little integrated evaluation of how caregiver allowances function as social assistance tools. This gap is important because caregiver allowances target a significant group involved in extensive unpaid care work, rather than just addressing income poverty. Such allowances are often neglected in current social assistance studies related to labour markets, family responsibilities, and population ageing. Moreover, while Hong Kong and Macao are often categorised under similar productivist or residual welfare regimes, existing comparative studies tend to examine convergence and divergence at the system level, providing limited insights into how specific social assistance instruments operate for particular target groups.

This comparative qualitative policy analysis addresses those gaps by applying theory-informed evaluative criteria to compare caregiver cash allowance schemes in Hong Kong and Macao across three analytical dimensions: adequacy of benefits, scheme coverage and financial relief, and governance and policy processes. By examining these differences, the study contributes to comparative welfare scholarship and offers policy-relevant insights to strengthen caregiver support in ageing societies. We draw on two complementary frameworks: the World Bank’s Atlas of Social Protection Indicators of Resilience and Equity (ASPIRE) and the Social Protection System Review (SPSR) toolkit (OECD 2018; World Bank n.d.). ASPIRE provides a global benchmarking system that evaluates social assistance programmes across dimensions such as adequacy, the extent of coverage, and policy design and administration. The SPSR, on the other hand, offers an analytical lens to examine a programme’s generosity, conditionality, eligibility, and coordinated implementation.

For these frameworks, we operationalise three key analytical dimensions to evaluate the two cash allowance schemes:

(1)

Benefit adequacy: Measured by the nominal and real value of cash transfers relative to established benchmarks such as poverty thresholds, average wage levels, or estimated caregiving costs—whether the allowances approximate replacement of caregivers’ financial losses, including the out-of-pocket expenses and opportunity costs.

(2)

Scheme coverage and financial relief: Focused on the scope of eligibility criteria, inclusivity of caregiver populations, and the extent to which benefits enable caregivers to mitigate dependence on market income, i.e., financial relief. Key indicators to be discussed are means-test stringency, concurrent benefit restrictions, and reach among vulnerable subgroups.

(3)

Governance and policy responsiveness: Evaluated by examining the administrative processes, stakeholder engagement, evidence-based reforms, and adaptability to caregivers’ needs. Indicators encompass the frequency and scope of policy revisions, integration with other social services, and mechanisms ensuring accountability.

Given their modest amounts and conditions, we treat these allowances as income supplementation or relief instruments rather than decommodification in the classical sense for understanding social security programmes. Our analysis therefore focuses on how design features (eligibility, benefit level, conditionality) provide financial relief to caregivers.

2. Materials and Methods

The unit of analysis is the caregiver cash allowance schemes in Hong Kong and Macao, treated as a distinct social assistance measure rather than part of the broader welfare system. Focusing on a single policy instrument enables a more detailed examination of how benefit adequacy, coverage, and governance operate in practice for a clearly defined target group—family caregivers providing intensive unpaid care. We conducted a structured document review aligned with domains derived from ASPIRE and SPSR (eligibility, generosity/benefit design, coverage, conditionality, delivery, governance). Programme regulations, policy briefs, and legislative papers issued by both SAR authorities, together with recent academic and NGO reports (2013–2026), were categorised by jurisdiction. To ensure data reliability without overreach, we report only verifiable programme facts.

Because beneficiary counts and detailed data on caregivers’ financial status are not consistently disclosed by official or other publicly available sources, we discussed coverage and affordability qualitatively, drawing on documented design features of the two schemes and the circumstances of family caregivers in both cities. For Hong Kong, available cost estimates (Yi et al. 2025) are incorporated with caution, given the potential conflation of caregiver and care recipient expenditures. Macao’s lack of comparable primary data necessitated the use of proxy indicators to assess the adequacy of benefit amounts. These limitations are transparently acknowledged in the analysis, and calls for future empirical research are emphasised.

This study does not aim to establish causal impacts or behavioural effects of caregiver allowances. Instead, it provides a structured policy evaluation that highlights strengths, limitations, and the similarities and differences between the two cases. In doing so, the analysis seeks to enrich comparative social policy research by demonstrating how variations in policy design and governance affect different social groups within generally similar welfare systems.

3. Results and Discussion

3.1. Adequacy of Cash Benefits: A Modest Amount in the High-Cost Cities

The adequacy of a cash benefit must be assessed against the cost of living and the opportunity cost of caregiving, particularly the loss of income. In this context, both schemes only offer partial relief. In Hong Kong, the regular allowance of HK$3000 per month (approximately MOP 3090) is objectively higher than in Macao (Table 3).

Table 3. The amounts of caregiver allowances in Hong Kong and Macao before and after policy regularisation ¹.

Jurisdiction	Pilot Phase Benefit for Caring One Person	Regularised Benefit for Caring One Person
Hong Kong	HK$2400/month	HK$3000/month
Macao	MOP 2175/month	MOP 2400/month (January 2026)

¹ The Hong Kong Dollar (HK$) is linked to the US Dollar at US$1:HK$7.75–7.85, whereas the Macao Pataca (MOP) is pegged at HK$1 to MOP 1.03 (approximately equivalent to US$1:MOP 8).

Hong Kong’s rapid trend of population ageing has increased reliance on unpaid family caregivers and heightened concern about their financial burden; while the psychological and social impacts are well documented, measuring direct and indirect economic costs remains difficult, and no single monthly expense figure is universally accepted. The most comprehensive estimate to date (Yi et al. 2025) from a large 2023–2024 study puts average out-of-pocket spending at HK$30,200 annually (about HK$2520 per month), excluding the substantial value of unpaid labour and foregone earnings from reduced hours or job exit, which can more than double the overall burden. Other research shows lower-income families face sharper financial stress and struggle to meet basic expenses when relatives require long-term care (Fan and Yung 2022; Guo et al. 2025). A government-commissioned survey reported that 90% of Hong Kong caregivers experience substantial financial pressure and identified “cash allowance” as a top support need, indicating that the current allowance offers little compensation for lost income (PolyU Technology and Consultancy Co. Ltd. 2022). In Macao, the monthly allowance was recently raised to MOP 2400 (about HK$2330), and while appreciated, community feedback consistently calls for further increases to match inflation and rising care costs (Macao News 2022). Across both cities, studies link financial strain among caregivers directly to poorer mental health outcomes.

Nonetheless, the existing literature on Macao focuses on policy frameworks, demographic trends, psychological burdens, and service gaps, rather than providing concrete financial figures (Long et al. 2019; Zheng et al. 2025). Instead of a published average OOP figure, we grounded our discussions in recognisable expense categories reported in official materials and NGO service notes, such as recurring care supplies used at home; transport to and from medical appointments; occasional respite or day-care co-payments when utilised; and ad-hoc domestic help for heavier care tasks. On this basis, a single flat allowance is unlikely to keep pace with the steep increase in needs as care intensity rises. Yet although Macao’s government has made progress in supporting caregivers through policy and social welfare measures, the financial burden on families could still be considerable, especially given that most older adults, including those with dementia, are cared for at home (Long et al. 2019; Tang et al. 2024).

3.2. Scheme Coverage and Access to Income Support

The principle of coverage, or how far a policy extends to its intended population, is where the two systems differ most noticeably. The promotion of financial relief involves empowering citizens to maintain a socially acceptable standard of living independent of market forces, for which both cities appear to have underperformed in achieving financial relief for the caregivers, as evidenced by their means-testing mechanisms and other specific requirements for caregivers. The schemes differ most in gateway conditions and access to income relief for the family caregivers.

3.2.1. Hong Kong: Targeted with Constraints

Hong Kong’s allowance is narrowly targeted and includes exclusionary criteria that significantly limit its coverage and the promotion of financial relief for caregivers. Eligibility is based on the care recipient being on a waiting list for subsidised long-term care services (Social Welfare Department 2025). This single requirement excludes many families who provide home care but are not on, or not yet eligible for, these specific waitlists for government-funded long-term care services.

For example, a caregiver cannot receive the allowance if they already receive other social security payments offered by the government, including the Old Age Living Allowance (OALA), Comprehensive Social Security Assistance (CSSA) (Hong Kong’s safety net for low-income individuals and households), the Old Age Allowance (OAA) and Disability Allowance (DA). As the Legislative Council Subcommittee (2024) has noted (Legislative Council 2024), this is a major flaw. It may force low-income older caregivers to choose between their own subsistence (OALA) and the carer allowance, effectively excluding an entire demographic of “elderly caring for elderly”.

The strict means-testing system creates another obstacle. The household income limit (set below 75% of the median) is criticised by academics and welfare groups for excluding many “near-poor” families who still face significant financial hardship (Chan et al. 2024). Instead of allowing caregivers to withdraw from the market, the system is available only to those who have already fallen through multiple economic cracks. The PolyU Carer Study found that the main reasons for not using services were “I don’t know about the service” and “I don’t need the service”—the latter often indicating ineligibility (PolyU Technology and Consultancy Co. Ltd. 2022).

Eligible caregivers are also required to provide a minimum number of care hours per month, undergo regular interviews or home visits by Approved Service Providers, and submit periodic declarations regarding their caregiving activities. These requirements position caregiving as a form of monitored quasi-work rather than as a socially recognised status independent of performance verification. Moreover, the scheme’s emphasis on training and professional development—while potentially beneficial in enhancing caregiving skills—also reflects an activation-oriented logic. By linking eligibility and continued receipt of the allowance to compliance, monitoring, and capability upgrading, the scheme re-embeds caregiving within a framework of behavioural conditionality. This suggests that income support is granted not as an unconditional recognition of unpaid care labour, but as a contingent benefit subject to ongoing assessment and regulation. Nonetheless, a countervailing strength is Hong Kong’s acknowledgement of heavier workloads through tiering or top-ups for multiple recipients, which aligns payment more closely with care intensity. Yet it must be noted that stringent means testing and concurrent-benefit exclusions materially curtail access to this design feature for low-income and older-spouse carers.

3.2.2. Macao: Inclusiveness with Constraints

Macao’s scheme, although means-tested, is designed with substantially lower barriers to entry, leading to broader effective coverage. Eligibility depends on the care recipient’s assessed level of dependency, rather than their position on a service waiting list (Secretary for Social Affairs and Culture 2023). It recognises and supports caregiving at home, which is a more inclusive and logical approach. Most importantly, the regulations do not prevent caregivers from receiving their own personal social security, such as the Old Age Allowance. This allows older caregivers to access support without compromising their financial stability, presenting notable contrast to Hong Kong (Table 4). Yet, it has to be noted that Macao’s flat rate monthly allowance might under-recognise high-intensity care experienced by the needy caregivers.

Table 4. A summary of coverage, eligibility and relevant policy measures of caregiver allowance schemes in Hong Kong and Macao.

	Hong Kong	Macao
Target Care Recipients	Elderly persons & persons with disabilities on waiting lists	Persons with disability or bedridden status with assessed dependency
Caregiver Criteria	≥80 h/month care; resident; no CSSA or other allowance	Co-residing family member; residency; means-tested
Means Test	Household income <75% median; no concurrent social security schemes	Means-tested; income ceiling raised in 2026; residency flexible for those living in Hengqin, Guangdong Province
Additional Support	Training, counselling services, home visits, carer hotline, online information platforms	Psychological counselling services, respite services advocated; integration ongoing
Community Concerns	Stringent means test, limited places, financial pressure	Adequacy, coverage, psychological distress, need for integrated support

Two features limit Macao’s apparent inclusiveness: a co-residency rule that sidelines non-co-resident carers who nevertheless provide daily, intensive care (commonly adult children living nearby), and a single, flat allowance that does not scale with the intensity of care or the number of recipients. Policies like this can institutionalise gendered norms, limit caregivers’ economic autonomy and reinforce intra-household caregiving inequalities. For example, they can further exacerbate the disproportionate share of unpaid caregiving labour performed by female family members such as wives, daughters and daughters-in-law.

Apart from differences in caregiver coverage and eligibility for monthly allowances between the two regions, there is also a significant difference in the income eligibility threshold for family caregivers applying for the respective allowances. This emphasises that income ceilings vary with household size (Table 5).

Table 5. Financial eligibility thresholds for family caregivers applying for the respective allowance schemes in Hong Kong and Macao (Effective date: January 2026) (Social Welfare Department 2025; Macao SAR Government 2026).

Household Size	Hong Kong (HK$)	Macao (MOP)
1 person	18,750	Not applicable (minimum household size 2 persons)
2 persons	25,125	29,560
3 persons	31,500	40,770
4 persons	39,675	49,540
5 persons	50,025	55,940
6 persons	55,800	62,350

The table shows that Hong Kong has lower income ceilings, starting at HK$18,750 for a one-person household and rising to HK$55,800 for a household of six or more. In contrast, Macao’s thresholds begin at MOP 29,560 for two-person households and increase to MOP 75,000 for households of six or more. These differences reflect variations in means-testing criteria and household size categories between the two regions.

3.3. Governance and Process: Contrasting Adaptation Paths

The final pillar of evaluation is governance—the administrative process and the system’s capacity for evidence-based change.

Hong Kong’s long-standing subvention and pilot-to-regularisation pathway approaches aim to ensure administratively feasible and reviewable processes (e.g., wait-list verification, monitored care hours by individual caregivers, recommended training/activation), resulting in narrow gateways and incremental changes. The 2022 PolyU Carer Study, commissioned by the government itself, identified a lack a holistic carer-centred policy framework and that existing services are “not well coordinated and difficult to access.” The Legislative Council Subcommittee on Promoting Carer-centric Policies reiterated its calls to relax eligibility requirements of the cash allowance scheme, increase the allowance, and remove the punitive social security rules (Legislative Council 2024). The government’s response has been slow and incremental, with pilot schemes being regularised, but the core exclusionary criteria remaining unchanged. Macao’s executive-centric architecture and smaller administrative scale have facilitated simpler, rule-based transfers with periodic adjustments to parameters.

For example, the scheme in Macao originated from continuous advocacy by civil society and legislators (Hu 2022). More importantly, since its institutionalisation, the government has already implemented significant, evidence-based reforms. By 2026, it had not only increased the monthly allowance but also raised the household monthly income ceiling and broadened the scope of beneficiaries to include new disability groups and eligible residents in Hengqin (Macao News 2022). These actions demonstrate efforts to enhance policy effectiveness, to consider community feedback on adequacy and coverage, and to show a willingness to undertake substantial reforms.

Nevertheless, it is crucial to recognise that Macao’s co-residency requirement raises important normative and gendered concerns. Family-based care can reinforce women’s unpaid labour and entrench traditional caregiving roles, potentially genderising care work by heightening expectations of availability and emotional labour within the household. From this perspective, co-residency conditions risk strengthening familial obligations rather than advancing financial relief for caregivers.

Generally speaking, governance arrangements further distinguish the two cases of cash allowances for caregivers, emphasising key differences in institutional responsiveness. This contrast underscores the importance of governance capacity and policy learning in shaping how similarly structured welfare regimes can yield different policy outcomes for family caregivers. Both SARs produce “managed familialism” with different approaches—a conditional, social security and service-linked cash allowance in Hong Kong and a broader, co-residency-anchored cash allowance in Macao.

3.4. Discussion

Our analysis confirms that Hong Kong’s caregiver allowance has narrow coverage and stringent conditions, restricting access and limiting compensation for caregivers’ financial burdens, particularly among older and near-poor populations. The contribution is both explanatory and descriptive, as the accounts demonstrate that delivery architecture, administrative scale, and policy learning styles, rather than the traditional categorisation of welfare regimes, generate divergence in caregiver allowance design (conditional, tiered, service-linked versus simple, flat, household-anchored). This mechanism-based account contributes to innovative comparative welfare debates by specifying how governance capacity and path dependence shape instrument choice and distributional outcomes.

As in Hong Kong, benefits are layered on cash, whereas in Macao, with administrative simplicity and broader eligibility, benefits are more unitary and tied to household arrangements such as co-residency. Two practical implications follow: (1) tiering can cushion the burden of care, but only if access barriers are not too high; easing concurrent-benefit exclusions would extend this advantage to the most burdened carers; (2) co-residency recognises live-in care but risks embedding gendered norms and excluding non-co-resident carers, potentially creating gender stigmatisation. In this connection, a clear pathway for non-co-resident intensive caregivers in Macao would improve equity without abandoning administrative simplicity.

Theoretically, our analysis challenges the simplicity of categorising East Asian welfare regimes solely as productivist or residual. It helps explain divergence in social welfare approaches within the framework of “One Country, Two Systems”. The divergence observed in caregiver policy design and outcomes underscores the critical role of governance capacity, institutional flexibility, and political economy in shaping welfare variation within broadly similar regimes (Holliday 2000; Lai and Chui 2014). Governance differences reflect not only policy design choices but also scale, administrative capacity, and broader political economy factors, underscoring the need to consider structural context in comparative welfare analysis. Since becoming institutionalised, Macao’s scheme has undergone reforms, including higher benefit levels, relaxed income thresholds, and expanded categories of beneficiaries (Hu 2022). This pattern shows a stronger link between the administration and community stakeholders.

4. Conclusions

This study compared caregiver cash allowance schemes in Hong Kong and Macao across benefit adequacy, coverage, and governance. Our mechanism-based explanation shows how delivery architecture, administrative scale, and policy-learning styles produce a conditional, tiered, service-linked model in Hong Kong and a simpler, flat, household-anchored model in Macao, each with distinct trade-offs.

For Hong Kong’s experience, pragmatic gains lie in relaxing concurrent-benefit exclusions, moderating means tests, and preserving tiering calibrated to care intensity and carers’ financial position. For Macao, the priority is to retain broad eligibility while reducing the gendered effects of co-residency and introducing intensity-based supplements and portable benefits for cross-location caregiving. For both, routine publication of programme statistics (e.g., eligibility, approvals, take-up, exits) would enable better monitoring and timely policy reforms.

This is a document-based policy analysis. To avoid overreach, we refrained from constructing synthetic OOP totals for Macao and instead anchored adequacy in clearly defined cost categories. For Hong Kong, we restricted our discussion to caregiver-specific outlays and explicitly excluded recipients’ medical consumption. We also reported coverage qualitatively where official beneficiary counts are not consistently disclosed. These choices prioritised transparency and replicability while recognising that household-level OOP microdata, time-use evidence, and routine programme statistics would enable more precise estimates in future work. Future research that includes primary cost data or household expenditure surveys on family caregiving in Macao would enable more accurate cross-jurisdictional comparisons in the context of “One Country, Two Systems”. We can also address these gaps through qualitative interviews with caregivers and policy stakeholders, as well as quantitative analyses of take-up rates and expenditure patterns across income groups.

As demographic pressures mount across Greater China and East Asia, the sustainability and fairness of welfare systems will increasingly depend on how effectively they support those providing care at home. By highlighting both common challenges and significant policy differences between Hong Kong and Macao, this study contributes to comparative social policy scholarship and offers insights to improve caregiver support in ageing societies.