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Rural pensions, intra‐household bargaining, and elderly medical expenditure in China
Abstract
China's rural elderly spend less on medical expenditures as they age despite declining health, raising welfare concerns. This paper investigates the role of intrahousehold bargaining power on health expenditures of the elderly by evaluating the impact of cash transfers from a new social pension program. The program provided windfall payments to those above age 60, making it possible to employ a regression discontinuity design based on age of eligibility to estimate causal effects. Using data from the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study, we find that receiving pension payments increases both the utilization of outpatient care and outpatient expenditures by the elderly who experienced illness. This result is robust to controlling for total household expenditures per capita, ruling out income effects as the main channel. Consistent with pensions increasing elderly bargaining power, we find that pensions significantly increase medical expenditures only for those elderly who co‐reside with children or grandchildren but have no effect on those who live independently.
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Early appraisal of China's huge and complex health-care reforms
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Metadata
- Authors
- Chen, Z., & Park, A.
- Affiliations
- Southwestern University of Finance and Economics (CN)
- Hong Kong University of Science and Technology (HK)
- Corresponding author
- Park, Albert
- Venue
- Health Economics
- Publisher
- Wiley
- Published
- 2023-07-07
- Volume
- 32
- Issue
- 10
- Pages
- 2353-2371
- ISSN
- 1057-9230 (ISSN-L)
- 1099-1050
- OpenAlex
- W4383480567
- Cited by
- 15
- References
- 2
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 4
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Economics (publishedVersion)
- PubMed (publishedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- Funders
- National Natural Science Foundation of China (72204201)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Financial Literacy, Pension, Retirement Analysis
- Keywords
- rural pension insurance, cash transfers, outpatient care utilization, elderly living arrangements
- MeSH terms
- Aged, Child, China, Health Expenditures, Humans, Income, Longitudinal Studies, Middle Aged, Pensions, Rural Population
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- CoChat. (2026). Citation check: Rural pensions, intra‐household bargaining, and elderly medical expenditure in China. https://app.cochat.ai/papers/10.1002/hec.4725
- The paper
- Chen, Z., & Park, A. (2023). Rural pensions, intra‐household bargaining, and elderly medical expenditure in China. Health Economics. https://doi.org/10.1002/hec.4725
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
