The Third Plenary Session of the 19th CPC Central Committee proposed for the first time in the documents of the plenary session of the party “to implement the national strategy of actively responding to the aging of the population”, and in the proposal of the CPC Central Committee on formulating the fourteenth five year plan for national economic and social development and the long-term goals for 2035 adopted by the plenary session, it was further clearly deployed to build an elderly care service system in which home-based community institutions are coordinated and medical care and health care are combined. So far, China’s social endowment service construction system has begun to shift from the “have” stage to the “good” stage. In order to evaluate the effectiveness of China’s home-based care service policy, this study used the data of CHARLS in 2018 to analyze the impact of home-based care service on the QoL of the elderly through OLS regression and PSM method, with a view to reflecting the policy intervention effect of home-based care service from the demand side and identifying key intervention groups, so as to make suggestions for better implementation of the relevant contents of the “14th five-year plan”. Research shows that:
Firstly, the utilization rate of home-based care services for the elderly in China is high and mainly focuses on the utilization of medical care services, and the utilization of life care services is seriously insufficient. Previous research showed that the utilization rate of home-based care service for the elderly aged 60 and above in China was 23.80%, which was similar to the results of this study [15]. There are two reasons on the utilization rate of life care service is far lower than that of medical care service: on the one hand, from the supply side, the supply quantity and scope of life care service such as day care centers, nurseries and elderly tables are far lower than those of medical care services such as regular physical examination, door-to-door inspection and health management. Therefore, the availability of life care service for the elderly is lower than that of medical care service. On the other hand, from the demand side, the elderly’s ability to pay for life care service is limited or even seriously insufficient. The results of this study showed that at the demographic level, the education level of the elderly was positively related to the use of life care service by the elderly. The higher the education level of the elderly, the higher their social status and economic level, and the more able they were to pay for life care service. Therefore, the policy guidance of home-based care service should start from three aspects of “strong supply”, “promotion fee” and “subdivided payment” [27]: Build a supply system of cooperation between the government and the society; Giving play to the advantages of the socialist system in which the land is publicly owned and the government controls more resources, and reduce the service costs of living care service providers and organizations; Promote the sustainable development of enterprise pension and encourage the development of individual pension plans, so as to enhance the consumption ability and anti-risk ability of the elderly in their old age. The home-based care service payment is subdivided into five categories: the “three noes” population payment, the low-income population payment, the middle-income population payment, the high-income population payment, and the worth population payment. The government pays for the “three noes” population and provides affordable services for the low-income population [28].
Secondly, home-based care service has significantly improved the QoL of the elderly, and life care service have a significant effect on improving the QoL of the elderly, while medical care service have a relatively weak effect on improving the QoL of the elderly. The utilization of life care service can improve the QoL of the elderly by 0.035 standard points, and the adoption of medical care service can improve the QoL of the elderly by 0.030 standard points. This result has also been similarly confirmed in previous studies [29, 30]. However, in the process of further heterogeneity analysis, we found that there were great differences in the improvement of the QoL of the elderly at different ages by using home-based care service, especially for the elderly aged 85 and above, the improvement of the QoL by medical care service was not significant, but the use of life care service could improve the QoL by 0.078 standard points. It could be seen that there were obvious differences in the needs of home-based care service for the elderly of different ages due to different physical conditions. The low-age elderly had the ability to take care of themselves in daily life. This group was a relatively low demand for life care service. Moreover, the low-age elderly was more likely to have spouse care and companionship than the high-age elderly. According to previous studies, 85.54% of the low-age elderly aged 60–64 in China had a spouse, while only 34.85% of the elderly aged over 80 had a spouse [31]. The results of this study also declared that the utilization of home-based care service can improve the QoL of the elderly without spouse more obviously. Therefore, life care service is of greater significance to the elderly. The policy guidance of home-based care service should include the high-age elderly, single, widowed or divorced as the key population, optimize the life care service items, improve the coverage of life care service, and provide the elderly with “medical, caring and nursing services” throughout the life cycle.
In addition, there were obvious differences between urban and rural areas in the improvement effect of home-based care service on the QoL of the elderly. The improvement effect of home-based care service on the QoL of the rural elderly was significantly higher than that of the urban elderly. In this study, the model explanation degree of urban-rural differences is below 20%, which indicates that in addition to the impact of home-based care service on the QoL of the elderly, the development of other public service industries and the construction of living environment infrastructure are also important influencing factors, such as the rapid and convenient development of urban domestic service, catering service and health service industry, so urban residents have more choices, Therefore, the degree of dependence on home-based care service is obviously lower than that of the rural elderly. However, the construction of rural public infrastructure is not perfect and the development level of medical service is low, so the ability to resist risks is weaker and the dependence on home-based care service is stronger. Moreover, the actual effect gap between urban and rural areas is even larger than the research results of this study. The unique urban-rural dual structure in China has led to the grass-roots service groups of rural home-based care service lagging far behind the cities and towns in terms of personnel quality, business ability and qualification access, which will lead to a potentially larger gap. Therefore, the construction and development of rural home-based care service, especially life care services, brooks no delay.
Finally, from the perspective of each province, there is still a huge gap in the demand for home-based care service in provinces including Fujian, Hebei, Jilin and Neimenggu. The utilization of home-based care service improves the QoL of the elderly by more than 0.050 in Fujian, Hebei, Jilin and Neimenggu, but their utilization rate of home-based care service is below the average level, indicating that the demand of the elderly in these areas for home-based care service cannot be fully met. In terms of the utilization of life care service, the QoL of Henan and Jiangxi has improved significantly, but the utilization rate of life care service is also below the average level. Therefore, in order to promote the high-quality development of home-based care service according to the key groups, the urban-rural differences and regional differences should be fully considered. For key groups, the government should play its role to provide policy support. For cities and towns, we should enrich the service content on the basis of tamping the construction of home-based care service. For rural areas, it is necessary to seize the sensitive period of intervention effect, expand the coverage and scale of home-based care service, introduce social forces, and make up for the government’s lack of resource operation and service supply in the field of home-based care service [32]. Overall plans and measures should be taken according to local conditions to promote the steady development of home-based care services in regions.
In addition, it is necessary to further point out the shortcomings of this study: firstly, this study analyzed the impact of medical care and life care service on the QoL the elderly, but lacked the analysis of the impact of specific service content on the QoL; Secondly, the data samples selected in this study were panel data, which lack of long-term dynamic analysis of the effects of home-based care service policies using time-series data, which needed to be further explored in future research.