Does informal care reduce health care utilisation in older age? Evidence from China

Abstract

Studies in Western countries suggest that receiving informal care from family members may reduce utilisation of health care services. This hypothesis has not been examined in China, where the population is ageing rapidly. We assess the impact of informal care from offspring (children and grandchildren) on health care utilisation and expenditures among older people in China. Data are drawn from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Using lagged model with the instrumental variable approach, we find that the impact of informal care is different by type of health care: More hours of informal care from offspring reduces overall health care utilisation, and in particular, outpatient care utilisation, but it increases inpatient care utilisation and expenditures. Our results suggest that informal care reduces the demand for outpatient care but increases the demand for inpatient care, possible reflecting the fact that the latter involves more advanced procedures for which informal care is not a substitute but a complement. Results highlight the need for incorporating health care impacts in the analysis and evaluation of policies that affect informal care provision.

Keywords: China; Health care utilisation; Informal care receipt; Instrumental variable approach; Older people.