Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Padmaja Ayyagari, Ph.D.

Committee Member

Xin Jin, Ph.D.

Committee Member

Giulia La Mattina, Ph.D.

Committee Member

Gabriel Picone, Ph.D.

Committee Member

Hongdao Meng, Ph.D.


Aging, Inpatient out-of-pocket expenditures, Precautionary savings, Self-reported health


Although China has made considerable progress towards universal health insurance coverage, high out-of-pocket medical expenditures due to catastrophic illnesses (e.g., cancer, heart attack, or stroke) remain a concern. To address this concern, the Critical Illness Insurance (CII) program providing additional coverage for high medical expenditures was introduced in 2012. We combine data on the timing of CII implementation across prefecture cities in China with the China Health and Retirement Longitudinal Study (CHARLS) to examine its impact on medical expenditures, inpatient utilization, health outcomes, household consumption and savings. To account for the staggered implementation across regions, we employ the Difference-in-Differences (DiD) approach proposed by Callaway and Sant'Anna (2020). We find that the CII significantly reduced out-of-pocket inpatient expenditures, but the effect on health care utilization was limited. We also find improvements in self-reported health and the number of activities of daily living limitations. In addition, the intervention of the CII program stimulates household consumption and reduces savings. Results from event-study specifications and placebo tests support the causal interpretation of our estimates. Our findings suggest that the CII program was successful in improving the financial protection and health outcomes of older adults.The dissertation is structured as follows. Chapter one provides background on the CII program and examines the impact of the CII program on health care utilization and medical expenditures for middle-aged and older adults. Chapter two analyzes the impact of the CII program on health outcomes. Chapter three presents the effects of the CII program on households’ consumption and savings.

Included in

Economics Commons