AUTHOR=Yi Yanling , Liu Junxia , Jiang Ling 

TITLE=Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1266949

DOI=10.3389/fpubh.2023.1266949

ISSN=2296-2565

ABSTRACT=Introduction: In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures.
Methods: Using data from China Health and Retirement Longitudinal Survey (CHARLS) and China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders. 
Results: We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, and also the total, out-of-pocket (OOP) and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control of LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; and both health care and spiritual consolation services have significant negative effects while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables.
Conclusion: This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure of disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, and pay more attention to the accessibility and affordability of HCBS for fragile groups, and the diversification and optimization development of the health service and the spiritual consolation service.