Abstract
BACKGROUND: The global rise in elderly populations and chronic disease patients has increased the demand for hospital-at-home (HaH) services, which could help reduce hospitalization costs. OBJECTIVE: To assess the impact of two policies on the implementation of HaH services in Shanghai. METHODS: A two-stage interrupted time series (ITS) analysis with a control group was conducted to examine changes in three areas-institutional capacity, home-based medical services, and HaH beds-using 11 indicators from 2007 to -2022 across all community health service centres and hospitals providing HaH services. RESULTS: After the first policy was implemented, the number of institutions providing HaH services significantly increased (β1 + β3 + β5 + β7 =8.200, P <0.001). HaH beds in hospitals increased after the first policy was implemented (β3 = 247.717 , P < 0.01) but decreased after the second policy was implemented ( β1 + β3 + β9 = -76.500, P < 0.01). In community health service centres (stations), the number of active HaH beds per 10,000 population at year-end (beds/10,000 people) increased significantly after the first policy implementation ( β1 + β3 + β5 + β7 = 0.406 , P < 0.001), with a significant increase in the slope difference compared with hospitals ( β5 + β7 =0.429 , P < 0.001). CONCLUSION: These policies may increase the number of HaH institutions and beds but decrease home-based medical visits, likely due to the risks of home care and a shortage of health care personnel. Further policy support is needed to meet the growing demand for home-based services in China.