School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
Asian Development Bank, Mandaluyong, Philippines.
Health Econ. 2023 Oct;32(10):2353-2371. doi: 10.1002/hec.4725. Epub 2023 Jul 7.
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.
中国农村老年人随着年龄的增长，健康状况每况愈下，但医疗支出却减少，这引起了福利方面的担忧。本文通过评估一项新的社会养老金计划的现金转移支付对老年人健康支出的影响，研究了家庭内讨价还价能力对老年人健康支出的影响。该计划为 60 岁以上的人提供意外之财，这使得我们可以根据资格年龄采用回归不连续性设计来估计因果效应。利用中国健康与退休纵向研究 2011 年和 2013 年的数据，我们发现领取养老金会增加那些有疾病经历的老年人门诊护理的使用和门诊支出。这一结果在控制人均家庭总支出后仍然稳健，排除了收入效应是主要渠道的可能性。与养老金增加老年人讨价还价能力一致的是，我们发现养老金仅显著增加了与子女或孙辈同住的老年人的医疗支出，而对那些独立生活的老年人没有影响。
