Scarcity, cognition, and health decision-making: evidence from a lab-in-the-field experiment in rural China

Abstract Understanding how financial scarcity impacts health-related decision-making is vital for designing interventions to break the cycle between poverty and poor health. We conducted a lab-in-the-field experiment with 479 rural adults in two low-income regions of China, Yunnan and Shaanxi, to examine the cognitive and behavioural consequences for health-related preferences and choices. Participants were randomly assigned to an acute financial scarcity intervention consisting of three hypothetical scenarios featuring either a heavy financial burden (the Hard prime, e.g., raising 20,000 yuan within a week) or a minimal cost (the Easy control, 1,000 yuan). We measured cognitive function using a 12-item Raven’s Progressive Matrices task, time and risk preferences across monetary and health domains using multiple price lists and ordered lottery menus, and spending decisions using a 100-yuan budget allocation task. In the moderately poor region of Yunnan, the scarcity prime significantly reduced cognitive performance by 8.4% points and increased health-related risk aversion, driving individuals toward safer vaccine options. In contrast, no cognitive or behavioural preference shifts were observed in the more severely impoverished region of Shaanxi. Intertemporal time preferences remained stable across both regions and choice domains. Budget allocations showed limited overall shifts, though specific resource-scarce subgroups reallocated spending more toward health items. These findings demonstrate that the cognitive and behavioural consequences of scarcity are not universal but highly context-dependent, shifting with the chronic depth of underlying deprivation.