Impact of Policy Reforms on Hospital-at-Home Services: An Interrupted Time Series Analysis of Shanghai

TL;DR

This study examines how policy changes in Shanghai affected hospital-at-home services, finding that while capacity increased, challenges like workforce shortages remain.

Contribution

The paper provides the first empirical evaluation of policy impacts on hospital-at-home services in China using an interrupted time series analysis.

Findings

The 2010 policy significantly increased HaH service providers and beds in Shanghai.

Home-based medical visits declined after both policies, likely due to workforce shortages.

The 2020 policy led to a reduction in hospital-based HaH beds.

Abstract

The rapid growth of aging populations and chronic disease prevalence has increased demand for hospital-at-home (HaH) services, which offer home-based alternatives to traditional inpatient care. However, the policy impact on HaH service development in China remains understudied.

To evaluate the effects of two major policy reforms on HaH services in Shanghai from 2007 to 2022.

A two-stage interrupted time series (ITS) analysis with a control group was conducted. Data from Shanghai Statistical Yearbooks were used to assess changes in institutional capacity, home-based medical services, and HaH beds across hospitals and community health service centers. Eleven outcome indicators were analyzed.

Following the first policy in 2010, the number of HaH service providers increased significantly, particularly in community health service centers (β1 + β3 + β5 + β7 = 8.200, P < 0.001). HaH beds per 10,000 population also rose (β1 + β3 + β5 + β7 = 0.406, P < 0.001). However, home-based medical visits declined after both policies (β1 + β3 + β5 + β7 = −90,214.350, P < 0.01), likely due to workforce shortages and service delivery risks. After the second policy in 2020, hospital-based HaH beds decreased (β1 + β3 + β9 = −76.500, P < 0.01).

While policy reforms expanded HaH service capacity, challenges remain in sustaining home-based medical visits and ensuring workforce supply. Future policies should prioritize multidisciplinary care teams and address barriers to home-based geriatric healthcare to meet the needs of China’s aging population.