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Background <p>The Home and Community-based Elderly Care Services (HCBS) pilot aims to improve access to preventive, rehabilitative, and long-term care for a rapidly ageing population. This study estimates the effect of HCBS on elderly mental and functional health and examines mechanisms and distributional heterogeneity</p> Methods <p>This paper linked the roll-out of HCBS pilots (2016–2020) to five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample included 25,287 respondents aged ≥60 years. This paper implemented a multi-period staggered difference-in-differences (DID) with individual and year fixed effects to estimate impacts on depressive symptoms (10-item CESD, 0–30; higher = worse) and physical status (ADL, 0–11; higher = worse). Mechanisms were tested using community elderly care intensity proxies, including home physician visits, family-doctor contracting, and routine preventive care. </p> Results <p>The HCBS significantly improved both mental and functional health. CESD scores declined by 0.396 (≈4.53% of the mean) and ADL scores by 0.224 (≈20.1% of the mean). Mechanism analysis showed increased use of routine preventive care (2.52 percentage points) and higher participation in home visits and family-doctor contracting, consistent with enhanced accessibility of elderly care services. Robustness checks found no differential pre-trends; effects were driven primarily by treated vs. never-treated comparisons (Goodman-Bacon weight ≈0.96), and remained significant under plausible deviations from parallel trends. Larger CESD improvements among those without chronic conditions and with higher education, and larger ADL gains among those with chronic conditions, lower education, and rural residents.</p> Conclusions <p>The HCBS significantly improved the mental and functional health of the elderly through enhancing the accessibility of community elderly care services. Prioritizing service continuity and tailoring supports to functionally vulnerable groups could further amplify health gains and reduce disparities.</p> Clinical trial number <p>Not applicable.</p>

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The impact of the pilot reform of home and community-based elderly care services on the health of the elderly

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月19日

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  • Han Qiu,
  • Xiaoxuan Yang,
  • Yuying Zhu,
  • Yi Zhang

摘要

Background

The Home and Community-based Elderly Care Services (HCBS) pilot aims to improve access to preventive, rehabilitative, and long-term care for a rapidly ageing population. This study estimates the effect of HCBS on elderly mental and functional health and examines mechanisms and distributional heterogeneity

Methods

This paper linked the roll-out of HCBS pilots (2016–2020) to five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample included 25,287 respondents aged ≥60 years. This paper implemented a multi-period staggered difference-in-differences (DID) with individual and year fixed effects to estimate impacts on depressive symptoms (10-item CESD, 0–30; higher = worse) and physical status (ADL, 0–11; higher = worse). Mechanisms were tested using community elderly care intensity proxies, including home physician visits, family-doctor contracting, and routine preventive care.

Results

The HCBS significantly improved both mental and functional health. CESD scores declined by 0.396 (≈4.53% of the mean) and ADL scores by 0.224 (≈20.1% of the mean). Mechanism analysis showed increased use of routine preventive care (2.52 percentage points) and higher participation in home visits and family-doctor contracting, consistent with enhanced accessibility of elderly care services. Robustness checks found no differential pre-trends; effects were driven primarily by treated vs. never-treated comparisons (Goodman-Bacon weight ≈0.96), and remained significant under plausible deviations from parallel trends. Larger CESD improvements among those without chronic conditions and with higher education, and larger ADL gains among those with chronic conditions, lower education, and rural residents.

Conclusions

The HCBS significantly improved the mental and functional health of the elderly through enhancing the accessibility of community elderly care services. Prioritizing service continuity and tailoring supports to functionally vulnerable groups could further amplify health gains and reduce disparities.

Clinical trial number

Not applicable.