Health Effect Of Intergenerational Support On The Elderly And Their Medical Consumption

This dissertation explores the impact of the two-way intergenerational support between the elderly and their adult children on the medical consumption of the elderly,as well as the health effects of the intergenerational support.Besides,we further research the mechanism of the influence of the intergenerational support on the elderly medical consumption.According to the process of observing the phenomenon--putting up the question-solving the problem,in the aim of exploring the role of intergeneration support for the elderly in active ageing and healthy ageing,this dissertation contains seven chapters,which are organized as follows:The first chapter describes the research background and puts up the research subjects.The second chapter systematically summarizes the relevant theories and reviews the literature at home and abroad.In the third chapter,by using the 2011 CHARLS data,we establish a two-part model to illustrate the influence of the intergenerational support on the probability and the amount of the elderly medical expenditure.The forth chapter discusses the health effect of intergenerational economic transfer and its influence on elderly medical consumption.In chapter five,we establish a propensity score model and a seemingly unrelated bivariate joint Probit model to identify the heterogeneous health improvement as well as the health selection effect of the intergenerational caregiving support to the old.The sixth chapter studies the effect of the taking cae of the grandchildren on the health of the elderly,and further analyzes the mechanism of the influence of caring grandchildren on the medical consumption of the elderly.Chapter seven is the conclusion and policy recommendations for the above search,and the shortcomings of this research as well as possible extensions of this subject are also discussed.The main conclusions of this research could be summarized as follows:Intergenerational transfer from the adult children increases the probability of medical utilization of the old and its health effect if positive,but its impact on the elderly medical expenditure is not significant.Intergenerational transfer effect the medical consumption of the old mainly through "income effect" and "health effect".The former means the demand of health capital increase as the income rise,which further leads to the increase of medical consumption;the latter means the marginal output of health increase as the income rise,which means the discount of health capital decrease and further the medical consumption fall.As the results of the two-part model show,the income effect of intergenerational transfer is greater than the health effect,therefore it can boost the probability of the utilization of the old.The health effect of the intergenerational transfer reduced the hazard of the elderly death,and there also exists "mortality crossover" effect in the protection of the intergenerational transfer on the elderly death hazard.Moreover,the compensation of high medical expenditure is one of the most important motive of intergenerational transfer form adult children to the old.Intergenerational care support from the adult children to the old has little impact on the medical consumption of the elderly,but it has a significant positive health effect for the old.The heterogeneous health effect exists in the intergenerational care support,which indicates that intergenerational care support promotes the degree of the health of the elderly differently and the intergenerational care support plays a greater role in an old man with poorer physical condition.Therefore,adult children are more likely to provide care support to the less well-off elderly.It is the heterogeneous health promotion and selection effect tihat offset the influence of intergenerational care support for the elderly health care consumption.However,this conclusion does not deny that there is positive effect of intergenerational care on the health of the elderly;what is more,the negligence of heterogeneity underestimates the degree of this positive effect.Taking care of grandchildren increases the probability of medical utilization of the old and its health effect is positive,but it has little impact on the elderly medical expenditure.By using the adult children’s information as instrumental variable for taking care of grandchildren,results of 2SLS and Ⅳ-Probit model indicate that taking care of grandchildren can enhance the subjective and objective health of the old;what is more,ignoring the endogeneity underestimate the health effect of taking care of grandchildren.The "time-for-money" effect exists in the intergenerational support between the old and their adult children.The mechanism of the impact of caring grandchildren on the old medical consumption lies in two ways:one the one hand,caring grandchildren has direct positive health effect;on the other hand,it can increase the economic transfer from the adult children and further influence the medical consumption through "income effect" and "health effect".The research improves the current study of related subject in three ways:Firstly,our study takes innovative perspectives on this subject.The current research of medical consumption and medical resources are mainly from the perspective of age,education,income and medical insurance and other socio-economic factors to examine the impact of individual medical consumption,and existing literature rarely study the medical consumption from the perspective of intergenerational support.Moreover,the current researches related to intergenerational support usually treat the old as the vulnerable group,therefore the study take the old as the recipients of the intergenerational support.However,the old people can also contribute under the concept of active and health ageing.Based on the concept of generalized intergenerational support,this dissertation studies the influence and health effect of the two-way intergenerational support between the elderly and the adult children on the medical consumption of the elderly.Secondly,this study established a solid theoretical foundation.Based on the theory of health capital and intergenerational support,this paper establishes a theoretical framework of the mechanism of the two-way intergenerational support between the elderly and their adult children on the impact of the elderly medical consumption.Thirdly,this study exploits the cutting-edge econometric methods.Specifically,a negative binomial model and percentile regression are adopted to detect the influence of intergenerational support on the frequency of medical utilization as well as the percentile of medical expenditure.A survival analysis model is utilized to estimate the influence of economic support on the death hazard of the old.Propensity Score Matching(PSM)model and seemingly unrelated bivariate Probit model are used to explore the heterogeneous effect of the intergenerational care support.All these techniques are seldom applied by domestic researchers on the study of health care.