The effect of China’s Integrated Medical and Social Care Policy on functional dependency and care deficits in older adults: a nationwide quasi-experimental study

BACKGROUND: With population ageing, the development and implementation of pragmatic care strategies for older people with functional dependencies have become critical issues. In alliance with WHO's Integrated Care for Older People framework, China implemented the Integrated Medical and Social Care Policy (IMSCP) in several cities in 2016. This study aims to evaluate whether and to what extent the IMSCP has achieved its primary objectives of reducing functional dependency and addressing care needs in Chinese older adults aged 65 years and older. METHODS: The IMSCP was initiated in 2016 in several pilot cities from various provinces. We did a quasi-experimental study with a difference-in-differences analysis by using the data collected in the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Participants from pilot cities constituted the intervention group, whereas participants from non-pilot cities were assigned into the control group. Functional dependency was measured based on activities of daily living and instrumental activities of daily living. Care deficits were recorded for those who were functionally dependent, and for whom care needs were unmet. We used fixed-effects models to examine between-group differences in functional dependency and care deficits. FINDINGS: 3080 individuals who participated in both the 2014 and 2018 surveys were included (mean age 81·7 years [SD 9·1] in 2014; 1621 [52·6%] were female and 1459 [47·4%] were male). Of these, 1146 (37·2%) were in the intervention group and 1934 (62·8%) were in the control group. Implementing the IMSCP was associated with a reduced risk of functional dependency (odds ratio [OR] 0·72 [95% CI 0·58-0·89], p=0·0024). Among those who were functionally dependent, the IMSCP was also associated with less care deficits (0·62 [0·41-0·95], p=0·029). We also examined the relatively long-term impact of the IMSCP with duration from 2014 to 2021; the influence of the IMSCP on mitigating functional dependency remained in male participants (OR 0·45 [95% CI 0·23-0·87], p=0·017) but not in female participants (0·85 [0·52-1·39], p=0·524); while its association with bridging care deficits remained among the total participants. INTERPRETATION: Implementing integrated medical and social care policy could reduce the risk of both functional dependency in older adults and care deficits in those who need care. These findings support the continued and expanded implementation of the IMSCP to address the growing care needs of China's ageing population. FUNDING: National Natural Science Foundation of China, National Key Research and Development Project of China, and National Science and Technology Major Project of China.