The impact of home- and community-based services on life satisfaction among older adults: evidence from marginal treatment effect framework.

BACKGROUND

In the context of rapid population aging, home- and community-based services (HCBS) have become an important intervention for improving the quality of life among older adults. However, the causal impact and the heterogeneous effects of HCBS utilization on life satisfaction remain insufficiently explored.

METHODS

Data from the 2023 China Longitudinal Aging Social Survey (CLASS) were analyzed. An instrumental variable (IV) approach and the marginal treatment effect (MTE) framework were employed to empirically examine the main effects, mechanisms, and heterogeneous effects of HCBS utilization on life satisfaction. Additionally, policy simulations were conducted to explore how to optimize the role of HCBS in improving life satisfaction among older adults.

RESULTS

HCBS utilization significantly enhances the life satisfaction of older adults. MTE estimates reveal a pattern of positive selection on gains, indicating that older adults who are more likely to use HCBS benefit more from it. Mechanism analysis shows that heterogeneous health returns to HCBS utilization are the key underlying driver for positive selection on gains in terms of life satisfaction. Policy simulations demonstrate that increasing HCBS utilization rates improves life satisfaction among new users, and expanding the coverage of community service facilities, pension insurance, and medical insurance indirectly promotes life satisfaction by increasing HCBS uptake.

CONCLUSION

This study suggests that HCBS utilization improves life satisfaction among older adults, and this effect exhibits heterogeneity characterized by a positive selection on gains. These findings contribute to the empirical understanding of HCBS effectiveness and offer policy implications for targeted interventions to optimize the healthcare service system.