Cream skimming: how does health deprivation affect older adults’ access to community services?

The growing aging population in China has significantly increased the demand for community services among older adults. However, risk selection in service supply continues to plague the premature long-term care market, and existing theories fail to adequately explain this phenomenon. Using an unbalanced panel of 14,762 respondents aged 60 or older from three waves of the Chinese Longitudinal Health Longevity Survey (2011, 2014, and 2018), fixed effects models were employed to examine the relationship between health deprivation and unmet needs for community services. Health deprivation among older adults was found to be associated with greater unmet needs for community services. Additionally, these unmet needs were further associated with an increased care burden on families. These findings support an explanatory interpretation in which health deprivation serves as a signal for selecting service recipients, corresponding to lower accessibility to community services and a “re-familization” pattern from the demand side.