TY  - RPRT
        AU  - Nie, Peng
AU  - Spitzer, Sonja
AU  - Sousa-Poza, Alfonso
        TI  - Health Perception Biases and Healthcare Utilization in China: A Longitudinal Approach
        PY  - 2026/Mar/
        PB  - Institute of Labor Economics (IZA)
        CY  - Bonn
        T2  - IZA Discussion Paper
        IS  - 18384
        UR  - https://www.iza.org/index.php/publications/dp18384
        AB  - 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.
        KW  - health perception bias
KW  - overconfidence
KW  - underconfidence
KW  - healthcare utilization
KW  - China
        ER  -