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Nip it in the bud: the impact of China’s large-scale free physical examination program on health care expenditures for elderly people

Author

Listed:
  • Qingshan Ma

    (Xiamen University)

  • Yuanmeng Zhang

    (Tsinghua University)

  • Feng Hu

    (Shanghai University of International Business and Economics)

  • Haiyan Zhou

    (Nueva Ecija University of Science and Technology)

  • Hao Hu

    (Shanghai University)

Abstract

In this study, we take China’s large-scale free physical examination program for people aged 65 and above as an entry point and use data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018 to construct a staggered difference-in-differences (DID) model to examine whether the free physical examination program affected elderly individuals’ health care expenditures. We find that the program increased the probability of attending a physical examination by 4.3%, reduced overall medical expenditures by 28.4%, and reduced hospitalization costs by 22.1% for persons over 65 years of age but did not have a significant effect on outpatient expenditures. The program produces results through two mechanisms: disease prevention and disease screening. The program is more effective in reducing medical expenses for older adults who live in rural areas, are younger, have lower educational levels, and have chronic illnesses. The benefits of the program’s implementation far outweigh its costs.

Suggested Citation

  • Qingshan Ma & Yuanmeng Zhang & Feng Hu & Haiyan Zhou & Hao Hu, 2025. "Nip it in the bud: the impact of China’s large-scale free physical examination program on health care expenditures for elderly people," Humanities and Social Sciences Communications, Palgrave Macmillan, vol. 12(1), pages 1-16, December.
    • Handle: RePEc:pal:palcom:v:12:y:2025:i:1:d:10.1057_s41599-024-04295-5
    DOI: 10.1057/s41599-024-04295-5
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    1. Ye, Zihan & Zou, Xiaopeng & Post, Thomas & Mo, Weiqiao & Yang, Qianqian, 2022. "Too old to plan? Age identity and financial planning among the older population of China," China Economic Review, Elsevier, vol. 73(C).
    2. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    3. Masaki Takahashi, 2023. "Insurance coverage, long-term care utilization, and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(8), pages 1383-1397, November.
    4. Qing Luo & Haichao Ma & Huinan Wang, 2023. "The Impact of Population Aging on the Economic Growth of China," Springer Books, in: Yining Li & Qiuyun Zhao & Zhiqiang Cheng (ed.), China's Road and Aging Population, pages 73-93, Springer.
    5. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    6. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    7. Davide Cantoni & Yuyu Chen & David Y. Yang & Noam Yuchtman & Y. Jane Zhang, 2017. "Curriculum and Ideology," Journal of Political Economy, University of Chicago Press, vol. 125(2), pages 338-392.
    8. Yongzheng Liu & Jie Mao, 2019. "How Do Tax Incentives Affect Investment and Productivity? Firm-Level Evidence from China," American Economic Journal: Economic Policy, American Economic Association, vol. 11(3), pages 261-291, August.
    9. Kranker, Keith, 2016. "Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia," Journal of Health Economics, Elsevier, vol. 46(C), pages 52-69.
    10. Shi, Xinjie & Shen, Yu & Song, Ran, 2023. "Living with particles: Disclosure of pollution information, individual responses, and health consequences," Journal of Health Economics, Elsevier, vol. 92(C).
    11. Thorsten Beck & Ross Levine & Alexey Levkov, 2010. "Big Bad Banks? The Winners and Losers from Bank Deregulation in the United States," Journal of Finance, American Finance Association, vol. 65(5), pages 1637-1667, October.
    12. Kim, Hyuncheol Bryant & Lee, Suejin A. & Lim, Wilfredo, 2019. "Knowing is not half the battle: Impacts of information from the National Health Screening Program in Korea," Journal of Health Economics, Elsevier, vol. 65(C), pages 1-14.
    13. Franz Hackl & Martin Halla & Michael Hummer & Gerald J. Pruckner, 2015. "The Effectiveness of Health Screening," Health Economics, John Wiley & Sons, Ltd., vol. 24(8), pages 913-935, August.
    14. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    15. Lange, Fabian, 2011. "The role of education in complex health decisions: Evidence from cancer screening," Journal of Health Economics, Elsevier, vol. 30(1), pages 43-54, January.
    16. Nicole Maestas & Kathleen J. Mullen & David Powell, 2023. "The Effect of Population Aging on Economic Growth, the Labor Force, and Productivity," American Economic Journal: Macroeconomics, American Economic Association, vol. 15(2), pages 306-332, April.
    17. Baker, Andrew C. & Larcker, David F. & Wang, Charles C.Y., 2022. "How much should we trust staggered difference-in-differences estimates?," Journal of Financial Economics, Elsevier, vol. 144(2), pages 370-395.
    18. Iizuka, Toshiaki & Nishiyama, Katsuhiko & Chen, Brian & Eggleston, Karen, 2021. "False alarm? Estimating the marginal value of health signals," Journal of Public Economics, Elsevier, vol. 195(C).
    19. German, P.S. & Burton, L.C. & Shapiro, S. & Steinwachs, D.M. & Tsuji, I. & Paglia, M.J. & Damiano, A.M., 1995. "Extended coverage for preventive services for the elderly: Response and results in a demonstration population," American Journal of Public Health, American Public Health Association, vol. 85(3), pages 379-386.
    20. Li, Pei & Lu, Yi & Wang, Jin, 2016. "Does flattening government improve economic performance? Evidence from China," Journal of Development Economics, Elsevier, vol. 123(C), pages 18-37.
    21. James J. Heckman & Hidehiko Ichimura & Petra Todd, 1998. "Matching As An Econometric Evaluation Estimator," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 65(2), pages 261-294.
    22. Ding, Xiangyuan & Yuan, Luoqi & Zhou, Yi, 2023. "Internet access and older adults' health: Evidence from China," China Economic Review, Elsevier, vol. 82(C).
    23. Chen, Yu & Shi, Shaobin & Tang, Yugang, 2019. "Valuing the urban hukou in China: Evidence from a regression discontinuity design for housing prices," Journal of Development Economics, Elsevier, vol. 141(C).
    24. Davide Cantoni & Yuyu Chen & David Y. Yang & Noam Yuchtman & Y. Jane Zhang, 2017. "Curriculum and Ideology," Journal of Political Economy, University of Chicago Press, vol. 125(2), pages 338-392.
    25. Zhao, Meng & Konishi, Yoshifumi & Glewwe, Paul, 2013. "Does information on health status lead to a healthier lifestyle? Evidence from China on the effect of hypertension diagnosis on food consumption," Journal of Health Economics, Elsevier, vol. 32(2), pages 367-385.
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