Do Home- and Community-Based Services Reduce Elderly Care Needs and Family Caregiving Burden? Evidence From China

This study examines the impact of China's home- and community-based services (HCBS) pilot program on elderly care needs and the family caregiving burden. Using 2008-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, we exploit the phased rollout of HCBS pilots and identify their effects using a difference-in-differences approach. Results show that HCBS implementation significantly reduces unmet care needs, caregiving hours, and the likelihood of intensive family caregiving. These effects vary by gender, age, location, cohabitation status, and pension receipt, reflecting differences in care needs and resource access. A cost-benefit analysis indicates an economic return of approximately CNY 1.339 to CNY 1.488 for every CNY 1 invested, suggesting improved resource allocation and a more sustainable long-term care system. These findings highlight HCBS's role in reducing structural disparities in elderly care access and alleviating the family caregiving burden, offering valuable insights for care policy development in China and other aging societies.