ArticleFrontiers in public health2026
The impact of home- and community-based services on life satisfaction among older adults: evidence from marginal treatment effect framework.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
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.
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