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

## TL;DR

A pilot program in China improved elderly mental and physical health by expanding access to home and community-based care services.

## Contribution

This study provides empirical evidence on the health impacts of home and community-based elderly care services in China.

## Key findings

- HCBS reduced depressive symptoms by 4.53% and functional limitations by 20.1% on average.
- Health gains were driven by increased preventive care and home visits.
- Benefits varied by education, chronic conditions, and rural residence.

## Abstract

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

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.

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.

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.

Not applicable.

The online version contains supplementary material available at 10.1186/s12889-026-26244-4.