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The impact of fertility on older adults’ healthcare utilization: The roles of health and wealth channels

Author

Listed:
  • Xie, Mingjia
  • Yin, Ting
  • Zhang, Yi
  • Oshio, Takashi

Abstract

This study investigates how fertility affects healthcare utilization among older adults. Departing from the literature's primary focus on health outcomes, it addresses a key gap in understanding family-level determinants of health spending in aging societies. Using data from rural China and an instrumental variable strategy, we find that having more children increases healthcare utilization and spending, but also the likelihood of forgoing costly inpatient care, reflecting unmet healthcare needs among older adults. The health cost burden is particularly pronounced for women, less-educated parents, and families with limited resources or weak insurance. Two mechanisms explain these effects: the “health channel”, where higher fertility worsens parental health and increases demand for healthcare, and the “wealth channel”, where children provide support that facilitates healthcare use. These findings reveal an overlooked cost of fertility: birth-encouraging policies, while easing demographic pressures, can increase older generations' financial burdens, underscoring the importance of equitable and affordable healthcare.

Suggested Citation

  • Xie, Mingjia & Yin, Ting & Zhang, Yi & Oshio, Takashi, 2026. "The impact of fertility on older adults’ healthcare utilization: The roles of health and wealth channels," Economic Modelling, Elsevier, vol. 156(C).
    • Handle: RePEc:eee:ecmode:v:156:y:2026:i:c:s026499932500450x
    DOI: 10.1016/j.econmod.2025.107455
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    Keywords

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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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