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Navigating healthcare for older adults after a chronic illness diagnosis: Evidence from China

Author

Listed:
  • Ma, Yuanyuan
  • Zheng, Wenyuan
  • Huang, Zhiyong

Abstract

Chronic illnesses require lifelong medical treatment and significantly impact healthcare utilization. Newly diagnosed individuals often face challenges in navigating decisions between inpatient care, outpatient care, and self-care. This study examines the effects of chronic illness diagnosis on healthcare utilization among middle-aged and older adults using nationally representative longitudinal data from China. Using an event study approach, we find that a diagnosis leads to significant increases in inpatient and outpatient service use, as well as self-medication. Over time, reliance on inpatient care and self-medication intensifies. Healthcare access and affordability play a critical role, with individuals in low cost-sharing programs experiencing higher expenditures. Supplemental insurance plans are associated with lower inpatient service use, while cashless payment settlement is linked to higher inpatient utilization. Better access to primary healthcare reduces inpatient service use and overall healthcare expenditures, underscoring the gatekeeping role of primary care.

Suggested Citation

  • Ma, Yuanyuan & Zheng, Wenyuan & Huang, Zhiyong, 2025. "Navigating healthcare for older adults after a chronic illness diagnosis: Evidence from China," The Journal of the Economics of Ageing, Elsevier, vol. 31(C).
    • Handle: RePEc:eee:joecag:v:31:y:2025:i:c:s2212828x25000234
    DOI: 10.1016/j.jeoa.2025.100568
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    as
    1. Liu, Kai, 2016. "Insuring against health shocks: Health insurance and household choices," Journal of Health Economics, Elsevier, vol. 46(C), pages 16-32.
    2. Schurer, Stefanie, 2017. "Bouncing back from health shocks: Locus of control and labor supply," Journal of Economic Behavior & Organization, Elsevier, vol. 133(C), pages 1-20.
    3. Liu, Yaxuan & Hao, Yu & Lu, Zhi Nan, 2022. "Health shock, medical insurance and financial asset allocation: evidence from CHFS in China," LSE Research Online Documents on Economics 117277, London School of Economics and Political Science, LSE Library.
    4. Carlos Dobkin & Amy Finkelstein & Raymond Kluender & Matthew J. Notowidigdo, 2018. "The Economic Consequences of Hospital Admissions," American Economic Review, American Economic Association, vol. 108(2), pages 308-352, February.
    5. Jia, Peng & Wang, Youfa & Yang, Min & Wang, Limin & Yang, Xuchao & Shi, Xinyu & Yang, Lijian & Wen, Jin & Liu, Yi & Yang, Maokang & Xin, Junguo & Zhang, Fengying & Jiang, Lihua & Chi, Chunhua & Zhang,, 2022. "Inequalities of spatial primary healthcare accessibility in China," Social Science & Medicine, Elsevier, vol. 314(C).
    6. Manoj Mohanan, 2013. "Causal Effects of Health Shocks on Consumption and Debt: Quasi-Experimental Evidence from Bus Accident Injuries," The Review of Economics and Statistics, MIT Press, vol. 95(2), pages 673-681, May.
    7. Wang, Xiuli & Yang, Huazhen & Duan, Zhanqi & Pan, Jay, 2018. "Spatial accessibility of primary health care in China: A case study in Sichuan Province," Social Science & Medicine, Elsevier, vol. 209(C), pages 14-24.
    8. Zhou, Zhongliang & Su, Yanfang & Gao, Jianmin & Xu, Ling & Zhang, Yaoguang, 2011. "New estimates of elasticity of demand for healthcare in rural China," Health Policy, Elsevier, vol. 103(2), pages 255-265.
    9. Ackley, Calvin A., 2022. "Tiered cost sharing and health care demand," Journal of Health Economics, Elsevier, vol. 85(C).
    10. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    11. Srivastava, Divya & McGuire, Alistair, 2015. "Patient access to health care and medicines across low-income countries," Social Science & Medicine, Elsevier, vol. 133(C), pages 21-27.
    12. Verbrugge, Lois M. & Jette, Alan M., 1994. "The disablement process," Social Science & Medicine, Elsevier, vol. 38(1), pages 1-14, January.
    13. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, April.
    14. Terence C. Cheng & Jing Li & Rhema Vaithianathan, 2019. "Monthly spending dynamics of the elderly following a health shock: Evidence from Singapore," Health Economics, John Wiley & Sons, Ltd., vol. 28(1), pages 23-43, January.
    15. Syed Hasan & Tasnima Akter & Musharrat Jahan & Ashraf Dewan, 2023. "Proximity to healthcare centres and service use: The case of Community Clinics in Bangladesh," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(3), pages 819-849, July.
    16. Yaxuan Liu & Yu Hao & Zhi-Nan Lu, 2022. "Health shock, medical insurance and financial asset allocation: evidence from CHFS in China," Health Economics Review, Springer, vol. 12(1), pages 1-14, December.
    17. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    18. Peter Sivey, 2012. "The effect of waiting time and distance on hospital choice for English cataract patients," Health Economics, John Wiley & Sons, Ltd., vol. 21(4), pages 444-456, April.
    19. Islam, Asadul & Maitra, Pushkar, 2012. "Health shocks and consumption smoothing in rural households: Does microcredit have a role to play?," Journal of Development Economics, Elsevier, vol. 97(2), pages 232-243.
    20. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    21. Zhiyuan Hou & Ellen Van de Poel & Eddy Van Doorslaer & Baorong Yu & Qingyue Meng, 2014. "Effects Of Ncms On Access To Care And Financial Protection In China," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 917-934, August.
    22. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    23. Jiang, Yawen & Ni, Weiyi, 2020. "Impact of supplementary private health insurance on hospitalization and physical examination in China," China Economic Review, Elsevier, vol. 63(C).
    24. Nada Wasi & Jirawat Panpiemras & Wanwiphang Manachotphong, 2021. "The Impact of a Billing System on Healthcare Utilization: Evidence from the Thai Civil Servant Medical Benefit Scheme," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 83(1), pages 228-251, February.
    25. Carlos Alberto Belchior & Yara Gomes, 2022. "Liquidity constraints, cash transfers and the demand for health care in the Covid‐19 pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2369-2380, November.
    26. 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.
    27. Wang, Yajie & Jin, Zhenjie & Yuan, Ye, 2023. "The consequences of health shocks on households: Evidence from China," China Economic Review, Elsevier, vol. 79(C).
    28. Otto Lenhart, 2019. "The effects of health shocks on labor market outcomes: evidence from UK panel data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 83-98, February.
    29. Natalia Serna, 2021. "Cost sharing and the demand for health services in a regulated market," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1259-1275, June.
    30. Pilar García-Gómez & Hans van Kippersluis & Owen O’Donnell & Eddy van Doorslaer, 2013. "Long-Term and Spillover Effects of Health Shocks on Employment and Income," Journal of Human Resources, University of Wisconsin Press, vol. 48(4), pages 873-909.
    31. Jeffrey M Wooldridge, 2023. "Simple approaches to nonlinear difference-in-differences with panel data," The Econometrics Journal, Royal Economic Society, vol. 26(3), pages 31-66.
    32. Shen, Menghan & He, Wen & Li, Linyan, 2020. "Incentives to use primary care and their impact on healthcare utilization: Evidence using a public health insurance dataset in China," Social Science & Medicine, Elsevier, vol. 255(C).
    33. Ellis, Randall P. & Martins, Bruno & Zhu, Wenjia, 2017. "Health care demand elasticities by type of service," Journal of Health Economics, Elsevier, vol. 55(C), pages 232-243.
    34. Decker, Simon & Schmitz, Hendrik, 2016. "Health shocks and risk aversion," Journal of Health Economics, Elsevier, vol. 50(C), pages 156-170.
    35. Tiantian Tao & Lili Hou & Rong Shao, 2021. "Factors associated with the choice of primary treatment at the community level among the middle‐aged and elderly in China," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 442-458, March.
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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models

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