IDEAS home Printed from https://ideas.repec.org/a/eee/chieco/v90y2025ics1043951x25000185.html
   My bibliography  Save this article

The effect living arrangements and intergenerational support have on the incidence of catastrophic health expenditure: A microeconomic analysis for China

Author

Listed:
  • Bridges, Sarah
  • Liu, Lefan

Abstract

This paper uses data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015 and 2018 to examine the effect recent health and societal changes have had on the ability of households to manage the financial burden of disease. Although health insurance in China has undergone significant reforms over the past decade, out-of-pocket health spending is still widespread. In light of these gaps in the provision of health insurance, households are forced to rely on their adult children for support. We find that the type of support matters, with the incidence of catastrophic health expenditure being the lowest for parents who live in multigenerational households, where it is easier for children to provide directly accessible instrumental and emotional support. For households where there is no co-residence, local support (of the type provided by children who live in the same village/neighbourhood as their parents) is no substitute for the type of assistance (usually financial) that households receive when all their children live beyond the village/neighbourhood.

Suggested Citation

  • Bridges, Sarah & Liu, Lefan, 2025. "The effect living arrangements and intergenerational support have on the incidence of catastrophic health expenditure: A microeconomic analysis for China," China Economic Review, Elsevier, vol. 90(C).
    • Handle: RePEc:eee:chieco:v:90:y:2025:i:c:s1043951x25000185
    DOI: 10.1016/j.chieco.2025.102360
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S1043951X25000185
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.chieco.2025.102360?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Francisca M. Antman, 2010. "Adult Child Migration and the Health of Elderly Parents Left behind in Mexico," American Economic Review, American Economic Association, vol. 100(2), pages 205-208, May.
    2. Mohammadreza Amiresmaili & Zahra Emrani, 2019. "Investigating the exposure of Iranian households to catastrophic health expenditure due to the need to purchase medicines," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-11, April.
    3. Merril Silverstein & Zhen Cong & Shuzhuo Li, 2006. "Intergenerational Transfers and Living Arrangements of Older People in Rural China: Consequences for Psychological Well-Being," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 61(5), pages 256-266.
    4. Stock, James H & Wright, Jonathan H & Yogo, Motohiro, 2002. "A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments," Journal of Business & Economic Statistics, American Statistical Association, vol. 20(4), pages 518-529, October.
    5. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    6. Young Kyung Do & Chetna Malhotra, 2012. "The Effect of Coresidence With an Adult Child on Depressive Symptoms Among Older Widowed Women in South Korea: An Instrumental Variables Estimation," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 67(3), pages 384-391.
    7. Lance Lochner, 2010. "Non-Production Benefits of Education: Crime, Health and Good Citizenship," University of Western Ontario, Centre for Human Capital and Productivity (CHCP) Working Papers 20107, University of Western Ontario, Centre for Human Capital and Productivity (CHCP).
    8. Ye Li & Qunhong Wu & Chaojie Liu & Zheng Kang & Xin Xie & Hui Yin & Mingli Jiao & Guoxiang Liu & Yanhua Hao & Ning Ning, 2014. "Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    9. Mansuri, Ghazala, 2006. "Migration, school attainment, and child labor : evidence from rural Pakistan," Policy Research Working Paper Series 3945, The World Bank.
    10. Wei Yang & Bo Hu, 2022. "Catastrophic Health Expenditure and Mental Health in the Older Chinese Population: The Moderating Role of Social Health Insurance," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 77(1), pages 160-169.
    11. Böhme, Marcus H. & Persian, Ruth & Stöhr, Tobias, 2015. "Alone but better off? Adult child migration and health of elderly parents in Moldova," Journal of Health Economics, Elsevier, vol. 39(C), pages 211-227.
    12. Yongjian Xu & Jie Ma & Na Wu & Xiaojing Fan & Tao Zhang & Zhongliang Zhou & Jianmin Gao & Jianping Ren & Gang Chen, 2018. "Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-13, March.
    13. Yang, Wei & Hu, Bo, 2022. "Catastrophic health expenditure and mental health in the older Chinese population: the moderating role of social health insurance," LSE Research Online Documents on Economics 110968, London School of Economics and Political Science, LSE Library.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Sarah Bridges & Lefan Liu, 2022. "The impact of child migration on the health and well‐being of parents left behind," Journal of International Development, John Wiley & Sons, Ltd., vol. 34(6), pages 1145-1164, August.
    2. Hien, Nguyen Thi Thu, 2019. "Consequences of urban migration of adult children for the elderly left-behind in rural Vietnam," OSF Preprints zxyf8, Center for Open Science.
    3. Kumar, Sneha, 2021. "Offspring's labor migration and its implications for elderly parents' emotional wellbeing in Indonesia," Social Science & Medicine, Elsevier, vol. 276(C).
    4. Lucia Rizzica, 2018. "When the Cat’s Away The Effects of Spousal Migration on Investments on Children," The World Bank Economic Review, World Bank, vol. 32(1), pages 85-108.
    5. Irene Mosca & Alan Barrett, 2016. "The impact of adult child emigration on the mental health of older parents," Journal of Population Economics, Springer;European Society for Population Economics, vol. 29(3), pages 687-719, July.
    6. Guangsheng Wan & Zixuan Peng & Yufeng Shi & Peter C. Coyte, 2020. "What Are the Determinants of the Decision to Purchase Private Health Insurance in China?," IJERPH, MDPI, vol. 17(15), pages 1-15, July.
    7. Paulone, Sara & Ivlevs, Artjoms, 2019. "Emigration and alcohol consumption among migrant household members staying behind: Evidence from Kyrgyzstan," Social Science & Medicine, Elsevier, vol. 221(C), pages 40-48.
    8. Yi, Fujin & Liu, Chang & Xu, Zhigang, 2019. "Identifying the effects of migration on parental health: Evidence from left-behind elders in China," China Economic Review, Elsevier, vol. 54(C), pages 218-236.
    9. Lingguo Cheng & Hong Liu & Ye Zhang & Zhong Zhao, 2018. "The heterogeneous impact of pension income on elderly living arrangements: evidence from China’s new rural pension scheme," Journal of Population Economics, Springer;European Society for Population Economics, vol. 31(1), pages 155-192, January.
    10. Artjoms Ivlevs & Milena Nikolova & Carol Graham, 2019. "Emigration, remittances, and the subjective well-being of those staying behind," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(1), pages 113-151, January.
    11. Feiyan Yang & Li Wei, 2023. "The impact of tax-subsidized health insurance on health and out-of-pocket burden in China," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 48(1), pages 194-246, January.
    12. Böhme, Marcus H. & Persian, Ruth & Stöhr, Tobias, 2015. "Alone but better off? Adult child migration and health of elderly parents in Moldova," Journal of Health Economics, Elsevier, vol. 39(C), pages 211-227.
    13. Bo Kyong Seo & Ji Hye Kim, 2022. "Intergenerational Coresidence and Life Satisfaction in Old Age: The Moderating Role of Homeownership," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 17(5), pages 3199-3216, October.
    14. Yiyue Huangfu & Jenna Nobles, 2022. "Intergenerational support during the rise of mobile telecommunication in Indonesia," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 46(36), pages 1065-1108.
    15. Xiaocui Ren & Chen Lu, 2021. "Effect of Children’s Support on Depression among Older Adults Living Alone or with a Spouse: A Comparative Analysis between Urban and Rural Areas of China," Sustainability, MDPI, vol. 13(11), pages 1-15, June.
    16. Agadjanian, Victor & Hayford, Sarah R. & Jansen, Natalie A., 2021. "Men's migration and women's mortality in rural Mozambique," Social Science & Medicine, Elsevier, vol. 270(C).
    17. Chen, Simiao & Jin, Zhangfeng & Prettner, Klaus, 2020. "Can I live with you after I retire? Retirement, old age support, and internal migration of older adults in China," Department of Economics Working Paper Series 303, WU Vienna University of Economics and Business.
    18. Nikolova, Milena & Roman, Monica & Zimmermann, Klaus F., 2017. "Left behind but doing good? Civic engagement in two post-socialist countries," Journal of Comparative Economics, Elsevier, vol. 45(3), pages 658-684.
    19. Maruyama, Shiko, 2015. "The effect of coresidence on parental health in Japan," Journal of the Japanese and International Economies, Elsevier, vol. 35(C), pages 1-22.
    20. Juliane Scheffel & Yiwei Zhang, 2019. "How does internal migration affect the emotional health of elderly parents left-behind?," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(3), pages 953-980, July.

    More about this item

    Keywords

    Catastrophic health expenditure; Living arrangements; Non-communicable diseases; Support networks; Migration;
    All these keywords.

    JEL classification:

    • D10 - Microeconomics - - Household Behavior - - - General
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:chieco:v:90:y:2025:i:c:s1043951x25000185. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/chieco .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.