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

Peng Nie (), Sonja Spitzer () and Alfonso Sousa-Poza ()
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Peng Nie: Xi’an Jiaotong University
Sonja Spitzer: Department of Demography, University of Vienna, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)
Alfonso Sousa-Poza: University of Hohenheim

No 18384, IZA Discussion Papers from IZA Network @ LISER

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.

Keywords: health perception bias; overconfidence; underconfidence; healthcare utilization; China (search for similar items in EconPapers)
JEL-codes: D83 I10 I12 I18 P46 (search for similar items in EconPapers)
Date: 2026-03
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