Living arrangement, health insurance and welfare at old age in China

Abstract

This thesis investigates (1) the associations between living arrangements and different types of intergenerational transfers from adult children, (2) the associations among health insurance, health behavior and health care utilization, and (3) the associations between different measures of health and socioeconomic status. It uses the latest three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2005, 2008-2009, and 2011-2012, which are nationally representative. Chapter 2 uses both actual living arrangements and the discrepancy between actual and preferred living arrangements as potential determinants of different types of intergenerational transfers, including monetary transfers, contact, informal care, and emotional support. Chapter 3 explores the role of health insurance on total health expenditures (THE), out of-pocket expenditures (OOP), smoking, drinking and exercising. Chapter 4 investigates two dependent dummy variables of self-rated health and functional health and employs subjective and objective measures of socioeconomic status as explanatory variables. Panel-data methods, e.g. fixed-effects instrumental-variable linear models, fixed-effects instrumental-variable linear probability models, and fixed-effects instrumental-variable logistic models, are used, addressing potential endogeneity bias. This thesis finds that co-residence serves as a substitute for monetary transfers and is positively associated with the probability that parents would receive contact, informal care and emotional support from adult children. It also finds that health insurance increases THE and reduces OOP, suggesting that it increases access to health services while minimizing financial burden, and health insurance leads to increased probabilities of smoking and drinking as well as exercising. Finally, the thesis finds that socioeconomic status positively affects both self-rated health and functional health of Chinese older people. The positive impact holds true across different gender and age groups, but it is sensitive to the choice of health and socioeconomic status measures. This thesis provides a better understanding of elderly and the role of the family amidst ongoing social security reforms in China.