Evaluating the impacts of integrating health and social care systems on social care use among older adults with chronic diseases in China

Abstract

Health and social care systems often operate in silos and cannot meet the complex needs of older adults with multiple chronic conditions. Since 2016, China has been implementing an integrated care initiative in some cities. This study aimed to evaluate the impacts of integrating health and social care in China on social care use among older adults with chronic conditions. Using panel data from the China Health and Retirement Longitudinal Study (N = 5,259), I employed a difference-in-differences analysis to evaluate the effects of the integrated care initiative. The initiative reduced social care use by 4.5 percentage points, primarily through a decreased receipt of informal care rather than formal care. The reduction in social care use was primarily due to a delayed increase in care levels, rather than a substitution with outpatient or inpatient services. The integration of health and social care was found to delay the progression of instrumental activities of daily living (IADL) by 8.8 percentage points but had no impact on activities of daily living (ADL). Heterogeneity analysis showed that the effects of the integrated care initiative on social care receipt and IADL limitation were weaker among those living in the Eastern region of China compared to other regions, indicating additional benefits of the initiative in mitigating geographical disparities. My findings suggest that integrating health and social care can effectively reduce the likelihood of older adults with chronic diseases receiving assistance for daily living tasks from family carers and delay the decline in their functional capabilities.