The Impact of Basic Public Health Services Provision on Elderly Health in China

China launched huge health-care reforms in 2009, and invested 850 billion Renminbi (US$123 billion) in following three years, with the priorities of provision of free basic public health services (BPHS) equal for all. The package of basic public health services includes health records creation for every resident, health education, immunization, chronic disease (hypertension and diabetes) management, severe mental diseases patient management, maternal and child health care services, elderly health care, and so forth. To ensure the provision of those services, the Chinese Government explicitly set the goal of building a strong primary-care-based delivery system in community health centers in cities, and in township health centers, and in village clinics in rural areas.

This study examines the impact of universal, free basic public health services on elderly health outcomes and investigates underlying mechanisms. We utilize the variation in primary care provision generated by the reform across communities and over time to isolate the causal health effects of those services. Using difference-in-differences and instrumental variable approaches, we find that basic public health services have had a significant beneficial impact on objective measures of physical health and cognitive function of the elderly. Furthermore, the effects appears to strengthen among those vulnerable populations (eg, elderly people with low income, low education). The provision of basic public health services has also contributed toward reducing the disparity in elderly health across groups.