Impacts of Community-Based Rehabilitation on Healthcare Utilization and Costs Among People With Schizophrenia in China: A Cluster Randomized Controlled Trial

BACKGROUND: Schizophrenia is a leading global disability, with severe treatment gaps in low-resource settings. Community-based rehabilitation (CBR) is promising but lacks robust evidence on its impacts on healthcare utilization. STUDY METHODS: We conducted a cluster-randomized controlled trial across 18 urban and rural subdistricts in Weifang City, Shandong province, China, enrolling 334 participants with schizophrenia. Communities were randomly assigned to receive either facility-based care (FBC) enhanced with CBR (n = 172) or standard FBC alone (n = 162). The main outcomes of this study included outpatient/inpatient utilization, costs, and self-treatment over 6- and 12-month follow-up periods, collected through medical insurance claims and structured questionnaires. We systematically monitored intervention quality using the validated Comprehensive Psychotherapeutic Interventions Rating Scale. STUDY RESULTS: At 6 months, CBR participants had significantly lower outpatient costs vs. controls (total: -CNY748.6 82.4% reduction, 95%CI, -1124.3 to -373.0; schizophrenia-specific: -CNY529.0 79.1% reduction, -833.5 to -224.4) and reduced out-of-pocket (OOP) costs (total: -CNY216.9; schizophrenia-related: -CNY113.2). By 12 months, inpatient cost reductions emerged (total: -CNY1710.4 78.2% reduction; OOP: -CNY405.8 78.1% reduction) despite similar admission rates. Self-treatment increased (0.77 more episodes) with no cost differences. Higher quality predicted greater outpatient visit reductions at 12 months (β = -0.10) and inpatient visit reductions at 6 months (β = -0.21), with group dynamics and directive behaviors most beneficial. CONCLUSION: CBR significantly reduces healthcare costs and improves self-management. Quality-driven effects on utilization support scaled implementation in resource-limited settings, particularly via group-based approaches. Integrating high-quality CBR is critical to curb the rising economic burden in low-resource countries. TRIAL REGISTRATION: ClinicalTrials.gov identifier: ChiCTR2200066945.