Home- and community-based elderly care reform and mental health: evidence from China’s middle-aged and older adults

This study examines the mental health effects of China’s home- and community-based elderly care reform pilot among middle-aged and older adults. Using nationally representative panel data from the China Health and Retirement Longitudinal Study (2011–2020) and employing a multi-period difference-in-differences approach, the analysis finds that the reform is associated with significant improvements in mental health outcomes. Mechanism analysis suggests that these improvements occur through enhanced social participation, increased physical exercise, and a higher share of leisure expenditure in total household expenditure. Additionally, the heterogeneity analysis shows that the reform has a stronger impact on the mental health of urban residents, individuals younger than 60, and those with higher educational attainment.