The impact of home and community care services pilot program on healthy aging: A difference-in-difference with propensity score matching analysis from China

Home and community care service (HACCS) is an important policy response worldwide to the growing and unmet care needs of the aging population. In China, the government also started to implement a HACCS pilot program in 2016. This study aims to evaluate the association of HACCS utilization with healthy aging in Chinese older adults.This study followed a quasi-experimental design and derived data from the nationwide China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. We employed the propensity score matching with difference-in-difference approach (PSM-DID) to examine the association between HACCS and healthy aging indicators.A total of 8345 older adults were incorporated for a final sample. The results indicated that HACCS utilization was associated with significantly reduced functional limitations (β for BADL=-0.124, β for IADL=-0.210; P<0.01) and depression (β=-0.386, P<0.05) as well as improved cognitive function (β=0.609, P<0.001), life satisfaction (β=0.083, P<0.01) and social participation (β=0.105, P<0.01) in older people, although its association with reduced disability was non-significant (β=-0.005, P = 0.676). The heterogeneous tests further found that rural older adults and older adults aged<80 were more likely than their counterparts to benefit from the HACCS utilization in specific healthy aging indicators such as cognitive function.The implementation of the HACCS program benefited a range of healthy aging domains among older adults in China. Policymakers are encouraged to further expand the program implementation and also continue to improve the services list and care quality of HACCS.