Do Community-Based Elder Care Services Prevent Falls and Improve Physical Functioning? Evidence from China

Falls are a major global public health concern, especially among older adults, with risk escalating sharply with age. In response, China implemented the Community-based Elder Care Services (CECS) pilot program (2016-2020), one of the first large-scale fall prevention interventions implemented at the national level in an upper-middle-income country. This study evaluates the effects of CECS on fall incidence, fall-related medical treatment, and physical functioning (ADL) using a Difference-in-Differences estimation strategy with nationally representative data from the China Health and Retirement Longitudinal Study (2011-2020). Results show that CECS significantly reduced fall incidence by 20.3%, fall-related medical treatment by 23.9%, and mild disability by 26.8%. The program is especially effective for adults aged 60-75. Economic analysis confirms cost-effectiveness, with projected benefits ($34.4-45.2 billion) exceeding total investment ($32 billion), and the program demonstrates greater efficiency in improving physical function compared to direct cash transfers for older adults. This study provides valuable policy insights and establishes CECS as a replicable model for other countries experiencing rapid population aging.