Unhealthy consumption behaviors and their intergenerational persistence: The role of education

As one of the countries sharing the world's largest population of smokers and drinkers, China has been facing serious health-related problems from smoking and drinking in recent decades. This paper attempts to investigate the impact of education on unhealthy consumption behaviors (smoking, binge drinking, and drinking) and their intergenerational persistence, using data from the China Health and Nutrition Survey (CHNS) for the period from 1991 to 2011. Estimation results suggest that there exists significantly positive intergenerational persistence of unhealthy consumption behaviors in China, and this persistence seems to be higher from the mother than from the father. After introducing two institutional changes as instruments to address the endogeneity problem of education in unhealthy consumption equations, we find that education has a significantly negative impact on smoking and binge drinking according to the results from instrumental variable estimation. Specifically, an additional year of education decreases the probability of smoking and binge drinking by 4.1% and 3.4%, respectively. Although the health effect of drinking is ambiguous, we also find that the likelihood of drinking decreases by 1.6% with one additional schooling year. Interestingly, an additional year of education could counteract intergenerational persistence of smoking and binge drinking from the father, but it has no impact on intergenerational persistence from the mother. Our results suggest that education might be an efficient way to control unhealthy consumption behaviors in China, but it might not be an efficient way to prevent intergenerational persistence of unhealthy consumption behavior from the mother.     

Effects of public health policies on the health status and medical service utilization of Chinese internal migrants

This paper examines the effects of the “Equalization Program of Basic Public Health and Family Planning Services for Migrants” (EHFPSM), a novel internal migrant-targeted public health policy, of China implemented in 2013. By combining the individual-level data from the “China Migrants Dynamic Survey” and city-level statistical data, we find that EHFPSM contributes to a 6.9% statistically significant increase in the probability of electronic health records coverage and a 7.2% increase in the probability of reimbursement in the last inpatient visit, as well as a 1.2% decrease in the probability of one-year prevalence. The mechanism test shows that this program promotes the migrants' understanding of the policies and social insurance coverage to enhance their health status. EHFPSM brings about more significant decreases in disease prevalence for male and less-educated migrants, and higher reimbursement probability for urban hukou migrants. Our paper facilitates better understanding of the role of public health policies in promoting the internal migrants' health from the perspective of China.     

Retirement and health: Evidence from China

One typical feature of China's pension system is that retirement is mandatory. By exploiting the exogenous change created by this mandatory retirement policy, we use the mandatory retirement age as an instrument for retirement status to examine the effect of retirement on individual health using data from the China Health and Nutrition Survey (CHNS). Our main finding is that the probability of “fair” or “poor” self-reported health among white-collar workers decreases by 34 percentage point after retirement. This result is generally robust to different model specifications, alternative measures of health, and different subsamples. In addition, we deliver evidence that increased health-related exercises and the cultivation of a better lifestyle are two possible channels through which retirement affects health.     

Effects of quantity of education on health: A regression discontinuity design approach based on the Chinese Cultural Revolution

In this paper, we exploit the negative educational shock caused by the Chinese Cultural Revolution to apply a regression discontinuity method in identifying the causal effects of education on health. While we find that better education reduces the probability of having poor self-assessed health and disabilities, we do not find statistically significant effects of education on the probability of having poor physical functioning status or uncomfortable body pains in the previous four weeks. Moreover, we find an interesting result that better education increases the probability of having chronic diseases. While most existing studies only identify the effect of education at a particular level, one contribution of our paper is that it provides estimates much closer to the population average effect. Moreover, our results imply that the underlying mechanism behind the effect of education on health might be different in developing countries from that in developed countries.     

The consequences of health shocks on households: Evidence from China

Unexpected health shocks may bring catastrophic consequences for households. This paper examines the effect of unexpected adverse health shocks on household members' physical and mental health, labor supply, household income and asset, and health behaviors in China by analyzing two nationally representative datasets and adopting a difference-in-differences method augmented with coarsened exact matching. We find that an unexpected health shock results in a discounted out-of-pocket medical expenditure of 16,943 RMB (US$ 2647) over five years for an average household, a reduction of household income per capita of 841 RMB per year (US$ 131, or 6.0% of household annual income per capita), and a loss of net household asset per capita of 13,635 RMB (US$ 2130, or 9.7% of household asset per capita). It raises the probability of an average household applying for public poverty relief allowance by 2.8 percentage points. In addition, we document a strong intra-household spillover effect of health shocks on mental health and health behaviors. A simple back-of-envelope calculation shows that the health shock induces a private cost of 34,966 RMB (US$ 5463) over 5 years for an average household, and incurs a social financial burden of 6066 RMB (US$ 948) in 5 years per household in medical reimbursement and social welfare transfers. At a national scale, the total social burden of health shocks from cardiovascular and cerebrovascular diseases amounts to 1.1 trillion RMB (US$ 172.1 billion) over 5 years.     

The impact of education on health in China

In this paper, we investigate the causal effect of education on health using an instrumental variable approach. The instruments we employ consist of two institutional changes in China that generated discontinuities in educational attainment among individuals. To ensure the validity of the instruments and obtain prudent conclusions, we adopt more restrictive identification tests than previous studies. The results indicate no causal impact of education on either perceived health or anthropometric health. With regard to the impact of education on male health behavior, namely smoking, we cannot provide conclusive results due to a violation of the exogeneity of our instruments. Nevertheless, we can confirm that education has no causal effect on female health behavior. To overcome the widely documented shortage of quasi-experimental identification, we also employ spouse's education as an alternative instrument to examine the causal effect of education. Identical results are obtained, with the exception that the impact of education on the reduction of overweight among women becomes significant. We conclude that this provides some evidence of a causal impact of education on health.     

Does health insurance decrease health expenditure risk in developing countries? The case of China

This article studies the impact of health insurance on individual out‐of‐pocket health expenditures in China. Using China Health and Nutrition Survey data between 1991 and 2006, we apply two‐part and sample selection models to address issues caused by censored data and selection on unobservables. We find that, although the probability of accessing health care increases with the availability of health insurance, the level of out‐of‐pocket health expenditure decreases. Our results from a selection model with instrumental variables suggest that having health insurance reduces the expected out‐of‐pocket health expenditure of an individual by 29.42% unconditionally. Meanwhile, conditional on being subjected to positive health expenditure, health insurance helps reduce out‐of‐pocket spending by 44.38%. This beneficial effect of health insurance weakens over time, which may be attributable to increases in the coinsurance rates of health insurances in China.     

Impact of urban-rural health insurance integration on health care: Evidence from rural China

In recent years, Chinese local governments have experimented with integrating the social health insurance system segmented between rural and urban areas to unify the administration, policy, and funds of various health insurance programs. In this study, we take advantage of the staggered implementation of the urban-rural health insurance integration across cities over time to examine the impacts of the integration on rural residents' health care utilization and health outcomes. Based on an original city-year level policy dataset and the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, we find that the integration significantly increases the middle-aged and older rural residents' inpatient care utilization and this positive effect is particularly salient in poor areas. Moreover, we find that the positive policy effect of integration is attributed to enhanced health insurance benefits, such as a higher reimbursement rate for inpatient care. However, the integration has limited impacts on the middle-aged and older rural residents' health outcomes. This study reveals the partial success of urban-rural health insurance integration to reduce health care inequality in China.     

Education and family health care spending

Michael Grossman's seminal work on the demand for health extended the concept of a household production function to the commodity “good health.” In this framework, education represents an “environmental variable” that enhances the monetary returns to investments in health through the use of time and medical care in health production. Using data from the 2004 to 2012 Medical Expenditure Panel Survey (MEPS), we examine the association between parental education and family health care spending in single-mother and two-parent families. We estimate one- and two-part expenditure models for total family health care spending, for specific components of such spending, and also examine the impact of parental education on selected measures of family health. Controlling for family income and health insurance status, we find consistent evidence that parental education beyond 12 years of schooling is associated with increases in family health care spending and with reductions in the likelihood of adverse health conditions.     

The effect of family planning exposure on fertility choices and reproductive health care in rural Pakistan

This paper investigates whether family planning exposure mainly through the Lady Health Worker Program has had any effect on women’s fertility choices and use of reproductive health care service in rural Pakistan, using the 2013 Pakistan Demographic and Health Survey (PDHS). Exploiting variations in the program intensity across regions, we conduct instrumental variables (IV) estimation on the impact of family planning exposure on women’s fertility preferences and reproductive behaviors. Our analysis shows that even in the presence of strong son preferences in Pakistan, increasing family planning exposure reduces women’s incentive to have additional children. Moreover, family planning exposure is associated with more antenatal care visits, more deliveries performed by skilled professionals, and a greater chance of delivery at the health center. Finally, we examine the heterogeneity in the effect on fertility preference by age group and education level, and find that the effect is mainly significant for the educated and young women.     

医保支付方式与乡村医生行为

长期以来，我国农村地区的初级医疗保健服务由乡村医生提供，然而新农合制度以按服务付费为主的支付方式导致了乡村医生供应短缺、行为扭曲等一系列供方市场问题，进而严重制约了农村地区初级医疗保健服务体系建设与社会福利提升。基于改革医保支付方式是从供方角度合理控制医疗成本的有效措施这一基本前提，文章通过构建理论模型，分析了按服务付费、按人头付费、固定工资，以及混合付费等四种支付方式下乡村医生给予不同疾病状态患者的治疗数量、治疗质量，以及职业道德的决策问题。考虑新农合与城乡居民医保制度的地区差异性、发展不均衡等特点，研究发现：（1）无论政府采用哪一种支付方式，都无法一次性将医生行为调控至最优期望目标，通过支付方式的选择与优化来调控医生行为需要与医保发展阶段相互匹配；（2）作为主要行为指标，医生给予患者的治疗数量与治疗质量之间存在反比关系，医生职业道德与患者疾病状态之间也呈现类似反比关系；（3）随着医保体系的不断完善，激励方式合理的混合支付可能是调控医生行为的一种占优选择。在城乡居民医保制度整合背景下，文章将为如何通过改革乡村医生支付方式来控制医疗成本提供一定理论支撑。     

Human Capital Development and Its Influence on FDI Withdrawal: An Empirical Analysis

This paper examines the causal effect of human capital expansion on the exit of foreign-owned firms using the difference-in-differences method together with a quasi-natural experiment involving the expansion of higher education in China in 1999. The expansion of human capital reduces the probability of the exit of foreign-owned firms significantly. This conclusion remains robust under a series of tests, including changing the sample range, adjusting the identification method, and considering the trade liberalization. Analysis of the mechanism indicates that human capital expansion reduces the exit probability of foreign-owned firms by stimulating innovation, improving production efficiency, and optimizing the quality of input and output goods. Industries with higher asset specificity are also more likely to restrain the exit of foreign-owned firms through human capital expansion. Overall, the findings of this study provide a good insight into the exit behavior of FDI in China from the perspective of human capital.     

Does children’s marriage matter for parents' mental health？Evidence from China

How to effectively alleviate mental disorders among elderly individuals is an important issue. Children are important financial and spiritual supporters of parents. However, whether there are upward spillovers from children to parents remains understudied. Using the instrumental variable (IV) method and data from the China Health and Retirement Longitudinal Study, this paper estimates the causal effect of children's marriage on the mental health of older parents. The IV estimation results demonstrate that having unmarried children is associated with a significant deterioration in parental mental health, especially in older, less educated, poor and male groups. Further evidence suggests that having unmarried children leads to significant changes in parents' economic behaviors, including labor supply, consumption, and savings; this indicates that parents are more likely to actively respond to their children’s unmarried status by increasing labor supply, reducing consumption and increasing savings rather than by engaging in negative behaviors.     

One-child policy and childhood obesity

This paper investigates the effect of only children on childhood obesity in China. We use implementation measures of family planning policies as instrumental variables in the estimations, and find that being raised in a one-child family significantly increases the weight, body mass index, and probability of being overweight or obese for children. By examining mothers' care-taking behaviors and their children's dietary habits and nutritional intake, we identify the following channels linking one-child families with childhood obesity. (a) In one-child families, parents prefer spending money to using their time to care for their children. (b) In one-child families, children eat more high-sugar, high-fat, and high-protein food. A time–money trade-off could be a plausible mechanism of the effects we document.     

Large-scale school meal programs and student health: Evidence from rural China

Reducing urban-rural gaps in child health is one of the most difficult challenges faced by many countries. This paper evaluates the impact of a large-scale school meal program in rural China on the health and nutritional status of students aged 6–16 in compulsory education. We use data from the China Health and Nutrition Survey corresponding to four pre-treatment years (2004, 2006, 2009, and 2011) and one post-treatment year (2015) and find that program participation is, on average, associated with a higher child height-for-age. The impacts are larger among students in a better health condition but small or not significant among the most disadvantaged. We do not observe heterogeneous effects across several individual and household characteristics. We also find positive but not significant effects on Body Mass Index-for-age and weight-for-age. The results suggest that NIP partially improved students' health over the first years of implementation, but more support is needed to achieve broader impacts that effectively reach all vulnerable students.     

Too old to plan? Age identity and financial planning among the older population of China

We study how age identity (measured by the difference between chronological age and perceived old age), influences financial planning among the older population (60+) in China. Using data from three waves of the China Longitudinal Aging Social Survey, we show that individuals who feel younger have a significantly higher probability of making financial plans. That such an effect exists in sub-samples divided by age and retirement status implies the relevance of financial planning even for individuals with advanced ages. It is consistent with the hypothesis that old individuals who feel younger have higher perceived cognitive abilities and hence higher motivation to make financial plans. However, an unfavorable perception of social aging culture moderates such a positive effect. Age identity can further impact the downstream economic behaviors of saving and investing, either directly or indirectly, through financial planning. Finally, a younger age identity also increases an individual's willingness to internalize the responsibility of eldercare. Our findings imply that it is important to consider individuals' age identity when crafting and implementing old-age policies.     

Higher education expansion and domestic value added in exports: Theory and evidence from China

This paper analyzes the impact of China’s higher education expansion on domestic value added in exports. To be specific, we firstly construct a nested CES production function model, with import inputs being complementary to skilled labors, and substitutable to unskilled labors. By exploiting China’s higher education expansion as a quasi-natural experiment, this paper accurately examines the causal effect of the human capital expansion on the domestic value-added in exports. The results show that human capital expansion has negative effects on the domestic value-added in exports, and this result is driven by import inputs increase and processing trade engagement. We also find that the effect is more prominent for processing trade, foreign-invested firms, high-tech firms and disciplines of science and engineering.     

The effect of health insurance reform: Evidence from China

This paper estimates the impact of a health insurance reform on health outcomes in urban China. Using the China Health and Nutrition Survey¹ we find that this reform increases the rate of health insurance coverage significantly among workers in Non-State Owned Enterprises. The double difference (DD) estimations show that the reform also leads to better health outcomes: workers are less likely to get sick and more likely to use preventive care. Using an instrumental variable (IV) approach to look at the causal effect of health insurance, we find those with health insurance use more preventive care but do not report significantly better health outcomes, an increase in health care utilisation, or an increase in out-of-pocket medical expenditure.     

我国中老年人健康需求影响因素的实证研究——基于CHARLS数据的分析

本文依据中国健康与养老追踪调查(CHARLS)2012年的数据,运用Probit有序选择模型,对影响我国中老年人健康需求的因素进行实证研究。由模型估计结果得出结论:1男性的健康水平高于女性的健康水平,城镇居民的健康水平高于农村居民;2综合来看,年轻时良好的健康水平和稳定的婚姻状况对中老年健康有正向的显著影响。年龄和教育对健康需求的影响比较符合Grossman模型的预测结果,且显著,收入对健康的影响不太符合Grossman模型的预测;3以性别做为分组变量的模型估计结果显示,教育对女性的健康影响更大,婚姻状况和收入对男性的影响更显著;以城乡为分组变量的模型估计结果表明,收入和教育对农村居民的健康水平有更大的影响。     

城镇居民的大学教育收益率估计:倾向指数匹配方法

本文利用全国综合社会调查数据(CGSS2003),首先使用Probit模型估计了个体上大学的概率,然后运用倾向指数匹配方法估计了2002年我国城镇居民的大学教育收益率.Probit估计结果表明家庭背景及地区对个人上大学的概率具有显著影响.匹配方法估计结果显示,大学毕业相对于高中毕业的教育收益率在79.1%以上,年均超过19.8%.传统的OLS方法估计的大学教育收益率仅为56.1%,低于匹配方法的估计结果.另外,高中组个体的潜在大学教育收益率可能高于大学组的大学教育收益率.