IDEAS home Printed from https://ideas.repec.org/p/iza/izadps/dp18384.html

Health Perception Biases and Healthcare Utilization in China: A Longitudinal Approach

Author

Listed:
  • Nie, Peng

    (Xi'an Jiaotong University)

  • Spitzer, Sonja

    (Department of Demography, University of Vienna, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna))

  • Sousa-Poza, Alfonso

    (University of Hohenheim)

Abstract

Using panel data on over 17,000 adults from the China Health and Retirement Longitudinal Study (CHARLS), this paper investigates the role of health perception biases for healthcare utilization and related expenditure in China. We measure health perception biases as the difference between objective health outcomes from physical examinations and self-reported health. Leveraging the longitudinal dimension of the data, we address unobserved individual heterogeneity in the relationship between perception biases and healthcare use. We find that individuals who underestimate their health visit the doctor more often and have more hospital stays, while those who overestimate their health are less likely to use those healthcare services. Health perception biases are also strongly associated with total and out-of-pocket expenditures for both outpatient and inpatient care. Importantly, family support - especially the presence of co-resident sons - mitigates the tendency of those underestimating their health to seek more care, highlighting the role of family dynamics in healthcare decisions. Moreover, differences in China's heterogeneous health insurance schemes appear to influence how health misperception translates into healthcare spending.

Suggested Citation

  • Nie, Peng & Spitzer, Sonja & Sousa-Poza, Alfonso, 2026. "Health Perception Biases and Healthcare Utilization in China: A Longitudinal Approach," IZA Discussion Papers 18384, IZA Network @ LISER.
    • Handle: RePEc:iza:izadps:dp18384
    as

    Download full text from publisher

    File URL: https://docs.iza.org/dp18384.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Goette, Lorenz & Tiefenbeck, Verena & Degen, Kathrin & Fleisch, Elgar & Tasic, Vojkan & Lalive, Rafael & Staake, Thorsten, 2016. "Overcoming Salience Bias: How Real-Time Feedback Fosters Resource Conservation," CEPR Discussion Papers 11480, C.E.P.R. Discussion Papers.
    2. Lei, Xiaoyan & Yin, Nina & Zhao, Yaohui, 2012. "Socioeconomic status and chronic diseases: The case of hypertension in China," China Economic Review, Elsevier, vol. 23(1), pages 105-121.
    3. Verbeek, Marno & Nijman, Theo, 1992. "Testing for Selectivity Bias in Panel Data Models," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 33(3), pages 681-703, August.
    4. Hou, Shehong & Niu, Yingjie & Yang, Jinqiang, 2018. "Optimal consumption-portfolio rules with biased beliefs," Economics Letters, Elsevier, vol. 173(C), pages 152-157.
    5. Nie, Peng & Li, Qiaoge & Sousa-Poza, Alfonso, 2021. "Energy poverty and subjective well-being in China: New evidence from the China Family Panel Studies," Energy Economics, Elsevier, vol. 103(C).
    6. Friehe, Tim & Pannenberg, Markus, 2019. "Overconfidence over the lifespan: Evidence from Germany," Journal of Economic Psychology, Elsevier, vol. 74(C).
    7. Caliendo, Frank & Huang, Kevin X.D., 2008. "Overconfidence and consumption over the life cycle," Journal of Macroeconomics, Elsevier, vol. 30(4), pages 1347-1369, December.
    8. Spitzer, Sonja & Shaikh, Mujaheed, 2022. "Health misperception and healthcare utilisation among older Europeans," The Journal of the Economics of Ageing, Elsevier, vol. 22(C).
    9. Peng Nie & Qiaoge Li, 2024. "Does energy poverty increase health care expenditures in China?," Applied Economics, Taylor & Francis Journals, vol. 56(35), pages 4209-4235, July.
    10. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    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. Peng Nie & Alfonso Sousa-Poza & Jianhong Xue, 2016. "Fuel for Life: Domestic Cooking Fuels and Women’s Health in Rural China," IJERPH, MDPI, vol. 13(8), pages 1-22, August.
    2. Valerie Albouy & Laurent Davezies & Thierry Debrand, 2009. "Dynamic Estimation of Health Expenditure: A new approach for simulating individual expenditure," Working Papers DT20, IRDES institut for research and information in health economics, revised Jan 2009.
    3. Chee‐Ruey Hsieh & Xuezheng Qin, 2018. "Depression hurts, depression costs: The medical spending attributable to depression and depressive symptoms in China," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 525-544, March.
    4. Zhao, Shuangling & Wang, Yunmin & Cao, Guohua, 2025. "Overconfident investors, Predictable Returns, and optimal consumption-portfolio rules," The North American Journal of Economics and Finance, Elsevier, vol. 75(PA).
    5. Nie, Peng & Wang, Lu & Dragone, Davide & Lu, Haiyang & Sousa-Poza, Alfonso & Ziebarth, Nicolas R., 2022. "“The better you feel, the harder you fall”: Health perception biases and mental health among Chinese adults during the COVID-19 pandemic," China Economic Review, Elsevier, vol. 71(C).
    6. Seshamani, Meena & Gray, Alastair M., 2004. "A longitudinal study of the effects of age and time to death on hospital costs," Journal of Health Economics, Elsevier, vol. 23(2), pages 217-235, March.
    7. Samuel Sebsibie & Workineh Asmare & Tessema Endalkachew, . "Agricultural Technology Adoption and Rural Poverty: a Study on Smallholders in Amhara Regional State, Ethiopia," Ethiopian Journal of Economics, Ethiopian Economics Association, vol. 23(2).
    8. Thorvaldur Gylfason & Inmaculada Martínez-Zarzoso & Per Magnus Wijkman, 2015. "Free Trade Agreements, Institutions and the Exports of Eastern Partnership Countries," Journal of Common Market Studies, Wiley Blackwell, vol. 53(6), pages 1214-1229, November.
    9. Patrick Richard & Regine Walker & Pierre Alexandre, 2018. "The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-13, June.
    10. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    11. Eijffinger, S.C.W. & Gruijters, A.P.D., 1989. "On the effectiveness of daily interventions by the Deutsche Bundesbank and the federal reserve system in the U.S. Dollar-Deutsche Mark exchange market," Other publications TiSEM cd65eff1-5f9e-4262-8f38-b, Tilburg University, School of Economics and Management.
    12. Agostino Capponi & Zhaonan Qu, 2025. "Handling Sparse Non-negative Data in Finance," Papers 2509.01478, arXiv.org.
    13. Schaak, Henning, 2015. "The Impact of Free Trade Agreements on International Agricultural Trade: A Gravity Application on the Dairy Product Trade and the ASEAN-China-FTA," 55th Annual Conference, Giessen, Germany, September 23-25, 2015 211619, German Association of Agricultural Economists (GEWISOLA).
    14. Buntin, Melinda Beeuwkes & Zaslavsky, Alan M., 2004. "Too much ado about two-part models and transformation?: Comparing methods of modeling Medicare expenditures," Journal of Health Economics, Elsevier, vol. 23(3), pages 525-542, May.
    15. Haiyang Lu & Peng Nie & Alfonso Sousa-Poza, 2021. "The Effect of Parental Educational Expectations on Adolescent Subjective Well-Being and the Moderating Role of Perceived Academic Pressure: Longitudinal Evidence for China," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 14(1), pages 117-137, February.
    16. Anand Acharya & Lynda Khalaf & Marcel Voia & Myra Yazbeck & David Wensley, 2021. "Severity of Illness and the Duration of Intensive Care," Working Papers 2021-003, Human Capital and Economic Opportunity Working Group.
    17. Wu, Libo & Zhou, Yang, 2025. "Social norms and energy conservation in China," Resource and Energy Economics, Elsevier, vol. 82(C).
    18. Judite Gonçalves & France Weaver, 2017. "Effects of formal home care on hospitalizations and doctor visits," International Journal of Health Economics and Management, Springer, vol. 17(2), pages 203-233, June.
    19. María Fernanda García & Philipp Hessel & Paul Rodríguez-Lesmes, 2022. "Wealth and inequality gradients for the detection and control of hypertension in older individuals in middle-income economies around 2007-2015," PLOS ONE, Public Library of Science, vol. 17(7), pages 1-17, July.
    20. Head, Keith & Mayer, Thierry, 2014. "Gravity Equations: Workhorse,Toolkit, and Cookbook," Handbook of International Economics, in: Gopinath, G. & Helpman, . & Rogoff, K. (ed.), Handbook of International Economics, edition 1, volume 4, chapter 0, pages 131-195, Elsevier.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D83 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Search; Learning; Information and Knowledge; Communication; Belief; Unawareness
    • P46 - Political Economy and Comparative Economic Systems - - Other Economic Systems - - - Consumer Economics; Health; Education and Training; Welfare, Income, Wealth, and Poverty

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:iza:izadps:dp18384. 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: Mark Fallak (email available below). General contact details of provider: https://edirc.repec.org/data/izaaalu.html .

    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.