Health perception biases and healthcare utilization in China: a longitudinal approach

This article investigates the role of health perception biases for healthcare utilization and related expenditure in China, an underexplored context characterized by rapid population ageing and fragmented healthcare coverage. Using panel data on over 17,000 adults from the China Health and Retirement Longitudinal Study (CHARLS), we measure health perception biases as the difference between objective health outcomes from physical examinations and self-reported health. We find that health underestimation is associated with more doctor visits, while health overestimation is correlated with less doctor services. The positive association between underestimation and hospital stays is present in random-effects and correlated random-effects Poisson estimates but is not supported by the FE Poisson estimates. 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 – moderates the association between health underestimation and doctor visits, highlighting the role of family dynamics in healthcare decisions.