IDEAS home Printed from https://ideas.repec.org/a/eee/ecmode/v141y2024ics0264999324002621.html
   My bibliography  Save this article

Air pollution, healthcare use, and inequality: Evidence from China

Author

Listed:
  • Jin, Bohan
  • Li, Zheng

Abstract

This study provides the first investigation into the causal distributional effects of air pollution on healthcare utilization in China. Studies have addressed the average impact of air pollution in developed countries while overlooking its distributional effects in developing nations where inequality is evident. We obtained data from the China Health and Retirement Longitudinal Study and employed wind direction as an instrumental variable. The findings indicate that air pollution significantly increased inpatient care use among individuals aged 60 and above. Moreover, the study documents significant disparities between and within urban and rural populations. The mechanism analysis indicates that accessibility of healthcare services contributes to inequality. Contributing factors include China's Hukou system, health insurance system, and the distance to hospitals in rural areas. The findings indicate that air pollution intensifies health inequality in the developing world while suggesting that policies to increase healthcare equity could generate significant welfare benefits.

Suggested Citation

  • Jin, Bohan & Li, Zheng, 2024. "Air pollution, healthcare use, and inequality: Evidence from China," Economic Modelling, Elsevier, vol. 141(C).
  • Handle: RePEc:eee:ecmode:v:141:y:2024:i:c:s0264999324002621
    DOI: 10.1016/j.econmod.2024.106905
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0264999324002621
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.econmod.2024.106905?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Hanna, Rema & Oliva, Paulina, 2015. "The effect of pollution on labor supply: Evidence from a natural experiment in Mexico City," Journal of Public Economics, Elsevier, vol. 122(C), pages 68-79.
    2. Tatyana Deryugina & Garth Heutel & Nolan H. Miller & David Molitor & Julian Reif, 2019. "The Mortality and Medical Costs of Air Pollution: Evidence from Changes in Wind Direction," American Economic Review, American Economic Association, vol. 109(12), pages 4178-4219, December.
    3. Eva Arceo & Rema Hanna & Paulina Oliva, 2016. "Does the Effect of Pollution on Infant Mortality Differ Between Developing and Developed Countries? Evidence from Mexico City," Economic Journal, Royal Economic Society, vol. 126(591), pages 257-280, March.
    4. Jones, Benjamin A., 2022. "Dust storms and violent crime," Journal of Environmental Economics and Management, Elsevier, vol. 111(C).
    5. Olivier Deschênes & Michael Greenstone, 2011. "Climate Change, Mortality, and Adaptation: Evidence from Annual Fluctuations in Weather in the US," American Economic Journal: Applied Economics, American Economic Association, vol. 3(4), pages 152-185, October.
    6. Fernando Broner & Paula Bustos & Vasco Carvalho, 2011. "Sources of comparative advantage in polluting industries," Economics Working Papers 1331, Department of Economics and Business, Universitat Pompeu Fabra, revised Dec 2019.
    7. Chen, Xiaoguang & Chen, Luoye & Xie, Wei & Mueller, Nathaniel D. & Davis, Steven J., 2023. "Flight delays due to air pollution in China," Journal of Environmental Economics and Management, Elsevier, vol. 119(C).
    8. Fan, Maoyong & He, Guojun & Zhou, Maigeng, 2020. "The winter choke: Coal-Fired heating, air pollution, and mortality in China," Journal of Health Economics, Elsevier, vol. 71(C).
    9. Marta Bengoa & Christopher Rick, 2020. "Chinese Hukou Policy and Rural-to-Urban Migrants’ Health: Evidence from Matching Methods," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 46(2), pages 224-259, April.
    10. Xin Zhang & Xun Zhang & Yuehua Liu & Xintong Zhao & Xi Chen, 2023. "The morbidity costs of air pollution through the Lens of Health Spending in China," Journal of Population Economics, Springer;European Society for Population Economics, vol. 36(3), pages 1269-1292, July.
    11. Malvina Bondy & Sefi Roth & Lutz Sager, 2020. "Crime Is in the Air: The Contemporaneous Relationship between Air Pollution and Crime," Journal of the Association of Environmental and Resource Economists, University of Chicago Press, vol. 7(3), pages 555-585.
    12. Shr, Yau-Huo & Hsu, Wen & Hwang, Bing-Fang & Jung, Chau-Ren, 2023. "Air quality and risky behaviors on roads," Journal of Environmental Economics and Management, Elsevier, vol. 118(C).
    13. Timothy J Halliday & John Lynham & Áureo de Paula, 2019. "Vog: Using Volcanic Eruptions to Estimate the Health Costs of Particulates," The Economic Journal, Royal Economic Society, vol. 129(620), pages 1782-1816.
    14. Giaccherini, Matilde & Kopinska, Joanna & Palma, Alessandro, 2021. "When particulate matter strikes cities: Social disparities and health costs of air pollution," Journal of Health Economics, Elsevier, vol. 78(C).
    15. Pan, Siyu, 2023. "Health, air pollution, and location choice," Journal of Environmental Economics and Management, Elsevier, vol. 119(C).
    16. Avraham Ebenstein & Victor Lavy & Sefi Roth, 2016. "The Long-Run Economic Consequences of High-Stakes Examinations: Evidence from Transitory Variation in Pollution," American Economic Journal: Applied Economics, American Economic Association, vol. 8(4), pages 36-65, October.
    17. Olivier Deschênes & Michael Greenstone & Joseph S. Shapiro, 2017. "Defensive Investments and the Demand for Air Quality: Evidence from the NOx Budget Program," American Economic Review, American Economic Association, vol. 107(10), pages 2958-2989, October.
    18. Janet Currie & Matthew Neidell, 2005. "Air Pollution and Infant Health: What Can We Learn from California's Recent Experience?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(3), pages 1003-1030.
    19. Diane Alexander & Hannes Schwandt, 2022. "The Impact of Car Pollution on Infant and Child Health: Evidence from Emissions Cheating," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 89(6), pages 2872-2910.
    20. Janet Currie & John Voorheis & Reed Walker, 2023. "What Caused Racial Disparities in Particulate Exposure to Fall? New Evidence from the Clean Air Act and Satellite-Based Measures of Air Quality," American Economic Review, American Economic Association, vol. 113(1), pages 71-97, January.
    21. Janet Currie & Reed Walker, 2011. "Traffic Congestion and Infant Health: Evidence from E-ZPass," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 65-90, January.
    22. Kenneth Y. Chay & Michael Greenstone, 2003. "The Impact of Air Pollution on Infant Mortality: Evidence from Geographic Variation in Pollution Shocks Induced by a Recession," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 118(3), pages 1121-1167.
    23. Barreca, Alan I. & Neidell, Matthew & Sanders, Nicholas J., 2021. "Long-run pollution exposure and mortality: Evidence from the Acid Rain Program," Journal of Public Economics, Elsevier, vol. 200(C).
    24. He, Guojun & Liu, Tong & Zhou, Maigeng, 2020. "Straw burning, PM2.5, and death: Evidence from China," Journal of Development Economics, Elsevier, vol. 145(C).
    25. Tanaka, Shinsuke, 2015. "Environmental regulations on air pollution in China and their impact on infant mortality," Journal of Health Economics, Elsevier, vol. 42(C), pages 90-103.
    26. Deschenes, Olivier & Wang, Huixia & Wang, Si & Zhang, Peng, 2020. "The effect of air pollution on body weight and obesity: Evidence from China," Journal of Development Economics, Elsevier, vol. 145(C).
    27. Currie, Janet & Neidell, Matthew & Schmieder, Johannes F., 2009. "Air pollution and infant health: Lessons from New Jersey," Journal of Health Economics, Elsevier, vol. 28(3), pages 688-703, May.
    28. Michael L Anderson, 2020. "As the Wind Blows: The Effects of Long-Term Exposure to Air Pollution on Mortality," Journal of the European Economic Association, European Economic Association, vol. 18(4), pages 1886-1927.
    29. Joshua Graff Zivin & Matthew Neidell, 2012. "The Impact of Pollution on Worker Productivity," American Economic Review, American Economic Association, vol. 102(7), pages 3652-3673, December.
    30. Hering, Laura & Poncet, Sandra, 2014. "Environmental policy and exports: Evidence from Chinese cities," Journal of Environmental Economics and Management, Elsevier, vol. 68(2), pages 296-318.
    31. Batkeyev, Birzhan & DeRemer, David R., 2023. "Mountains of evidence: The effects of abnormal air pollution on crime," Journal of Economic Behavior & Organization, Elsevier, vol. 210(C), pages 288-319.
    32. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-475, March.
    33. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    34. Joshua Graff Zivin & Matthew Neidell, 2013. "Environment, Health, and Human Capital," Journal of Economic Literature, American Economic Association, vol. 51(3), pages 689-730, September.
    35. Janet Currie & Lucas Davis & Michael Greenstone & Reed Walker, 2015. "Environmental Health Risks and Housing Values: Evidence from 1,600 Toxic Plant Openings and Closings," American Economic Review, American Economic Association, vol. 105(2), pages 678-709, February.
    36. Ximing Wu & Jeffrey M. Perloff, 2005. "China's Income Distribution, 1985-2001," The Review of Economics and Statistics, MIT Press, vol. 87(4), pages 763-775, November.
    37. Ma, Shuang & Li, Xueluan & Li, Ding & Guo, Huanxiu, 2023. "Does air pollution induce international migration? New evidence from Chinese residents," Economic Modelling, Elsevier, vol. 120(C).
    38. H. Spencer Banzhaf & Randall P. Walsh, 2008. "Do People Vote with Their Feet? An Empirical Test of Tiebout," American Economic Review, American Economic Association, vol. 98(3), pages 843-863, June.
    39. John Mullahy & Edward C. Norton, 2022. "Why Transform Y? A Critical Assessment of Dependent-Variable Transformations in Regression Models for Skewed and Sometimes-Zero Outcomes," NBER Working Papers 30735, National Bureau of Economic Research, Inc.
    40. He, Guojun & Fan, Maoyong & Zhou, Maigeng, 2016. "The effect of air pollution on mortality in China: Evidence from the 2008 Beijing Olympic Games," Journal of Environmental Economics and Management, Elsevier, vol. 79(C), pages 18-39.
    41. Ma, Xinru & He, Jingbin, 2023. "Air pollution and corporate green innovation in China," Economic Modelling, Elsevier, vol. 124(C).
    42. Austin M. Williams & Daniel J. Phaneuf, 2019. "The Morbidity Costs of Air Pollution: Evidence from Spending on Chronic Respiratory Conditions," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 74(2), pages 571-603, October.
    43. Wangyang Lai & Shanjun Li & Yanan Li & Xiaohui Tian, 2022. "Air Pollution and Cognitive Functions: Evidence from Straw Burning in China," American Journal of Agricultural Economics, John Wiley & Sons, vol. 104(1), pages 190-208, January.
    44. Spencer Banzhaf & Lala Ma & Christopher Timmins, 2019. "Environmental Justice: The Economics of Race, Place, and Pollution," Journal of Economic Perspectives, American Economic Association, vol. 33(1), pages 185-208, Winter.
    45. Austin, Wes & Carattini, Stefano & Gomez-Mahecha, John & Pesko, Michael F., 2023. "The effects of contemporaneous air pollution on COVID-19 morbidity and mortality," Journal of Environmental Economics and Management, Elsevier, vol. 119(C).
    46. Wolfram Schlenker & W. Reed Walker, 2016. "Airports, Air Pollution, and Contemporaneous Health," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 83(2), pages 768-809.
    47. Chen, Shuai & Oliva, Paulina & Zhang, Peng, 2022. "The effect of air pollution on migration: Evidence from China," Journal of Development Economics, Elsevier, vol. 156(C).
    48. Aragón, Fernando M. & Miranda, Juan Jose & Oliva, Paulina, 2017. "Particulate matter and labor supply: The role of caregiving and non-linearities," Journal of Environmental Economics and Management, Elsevier, vol. 86(C), pages 295-309.
    49. Gupta, Aashish & Spears, Dean, 2017. "Health externalities of India's expansion of coal plants: Evidence from a national panel of 40,000 households," Journal of Environmental Economics and Management, Elsevier, vol. 86(C), pages 262-276.
    50. Xuna Zhang & Shijing Nan & Shanbing Lu & Minna Wang, 2022. "Spatial Effects of Air Pollution on the Siting of Enterprises: Evidence from China," IJERPH, MDPI, vol. 19(21), pages 1-18, November.
    51. Junsen Zhang, 2021. "A Survey on Income Inequality in China," Journal of Economic Literature, American Economic Association, vol. 59(4), pages 1191-1239, December.
    52. Meiping Sun, 2021. "The Potential Causal Effect of Hukou on Health Among Rural-to-Urban Migrants in China," Journal of Family and Economic Issues, Springer, vol. 42(3), pages 1-10, September.
    53. Federico Belotti & Partha Deb & Willard G. Manning & Edward C. Norton, 2015. "twopm: Two-part models," Stata Journal, StataCorp LP, vol. 15(1), pages 3-20, March.
    54. Panle Jia Barwick & Shanjun Li & Deyu Rao & Nahim Bin Zahur, 2018. "The Healthcare Cost of Air Pollution: Evidence from the World’s Largest Payment Network," NBER Working Papers 24688, National Bureau of Economic Research, Inc.
    55. Xia, Fan & Xing, Jianwei & Xu, Jintao & Pan, Xiaochuan, 2022. "The short-term impact of air pollution on medical expenditures: Evidence from Beijing," Journal of Environmental Economics and Management, Elsevier, vol. 114(C).
    56. Pullabhotla, Hemant K. & Souza, Mateus, 2022. "Air pollution from agricultural fires increases hypertension risk," Journal of Environmental Economics and Management, Elsevier, vol. 115(C).
    57. Enrico Moretti & Matthew Neidell, 2011. "Pollution, Health, and Avoidance Behavior: Evidence from the Ports of Los Angeles," Journal of Human Resources, University of Wisconsin Press, vol. 46(1), pages 154-175.
    58. repec:hal:journl:hal-04627021 is not listed on IDEAS
    59. Ya‐Ming Liu & Chon‐Kit Ao, 2021. "Effect of air pollution on health care expenditure: Evidence from respiratory diseases," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 858-875, April.
    60. Liao, Liping & Du, Minzhe & Chen, Zhongfei, 2021. "Air pollution, health care use and medical costs: Evidence from China," Energy Economics, Elsevier, vol. 95(C).
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Zhang, Cheng & Ling, Xiaohong & Weng, Xiyan, 2024. "Effect of low carbon policy on residents’ health: Evidence from China," Finance Research Letters, Elsevier, vol. 70(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Gillingham, Kenneth & Huang, Pei, 2021. "Racial disparities in the health effects from air pollution: Evidence from ports," ZEW Discussion Papers 21-058, ZEW - Leibniz Centre for European Economic Research.
    2. Sandra Aguilar-Gomez & Nathaly M. Rivera, 2024. "Air Pollution in the Global South: An Overview of Its Sources and Impacts," Working Papers wp561, University of Chile, Department of Economics.
    3. Xiaojing Jia & Xin Luo, 2023. "Residents’ Health Effect of Environmental Regulations in Coal-Dependent Industries: Empirical Evidence from China’s Cement Industry," Sustainability, MDPI, vol. 15(3), pages 1-16, January.
    4. Wang, Qinyun & Wang, Xuebin & Yan, Qianhui & Zhang, Lvqing, 2024. "Heavy industry regulations, hospitalization, and medical expenditures: Evidence from micro-level medical records in a northeast Chinese city," Energy Economics, Elsevier, vol. 129(C).
    5. Xin Zhang & Xun Zhang & Yuehua Liu & Xintong Zhao & Xi Chen, 2023. "The morbidity costs of air pollution through the Lens of Health Spending in China," Journal of Population Economics, Springer;European Society for Population Economics, vol. 36(3), pages 1269-1292, July.
    6. Ferro, Simone & Palma, Alessandro & Serra, Chiara & Stafoggia, Massimo, 2024. "Beyond birth: The medium-term health impact of prenatal exposure to air pollution," Journal of Environmental Economics and Management, Elsevier, vol. 127(C).
    7. Colmer, Jonathan & Lin, Dajun & Liu, Siying & Shimshack, Jay, 2021. "Why are pollution damages lower in developed countries? Insights from high-Income, high-particulate matter Hong Kong," Journal of Health Economics, Elsevier, vol. 79(C).
    8. Alessandro Palma & Inna Petrunyk & Daniela Vuri, 2022. "Prenatal air pollution exposure and neonatal health," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 729-759, May.
    9. Chen, Xiao & Guo, Gangxing, 2024. "Air pollution and online lender behavior: Evidence from Chinese peer-to-peer lending," Journal of Behavioral and Experimental Finance, Elsevier, vol. 42(C).
    10. Singh, Tejendra Pratap & Visaria, Sujata, 2021. "Up in the Air: Air Pollution and Crime – Evidence from India," SocArXiv hs4xj, Center for Open Science.
    11. Singh, Tejendra Pratap & Visaria, Sujata, 2021. "Up in the Air: Air Pollution and Crime – Evidence from India," SocArXiv hs4xj_v1, Center for Open Science.
    12. Mengna Luan & Zhigang Tao & Hongjie Yuan, 2023. "Alive but not well: The neglected cost of air pollution," Health Economics, John Wiley & Sons, Ltd., vol. 32(11), pages 2535-2567, November.
    13. Yao, Yao & Li, Xue & Smyth, Russell & Zhang, Lin, 2022. "Air pollution and political trust in local government: Evidence from China," Journal of Environmental Economics and Management, Elsevier, vol. 115(C).
    14. Balietti, Anca & Datta, Souvik & Veljanoska, Stefanija, 2022. "Air pollution and child development in India," Journal of Environmental Economics and Management, Elsevier, vol. 113(C).
    15. Tingting Xie & Yong Wang & Ye Yuan, 2024. "Health Benefits from Improved Air Quality: Evidence from Pollution Regulations in China’s “ $$2{+}26$$ 2 + 26 ” Cities," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 87(5), pages 1175-1221, May.
    16. Ju, Heng & Tang, Yao & Zhang, Meilan, 2024. "Air Pollution's Grip: Drug Cost and Its Heterogeneity in China," MPRA Paper 121154, University Library of Munich, Germany.
    17. Qiu, Yun & Liu, Yunning & Shi, Wei & Zhou, Maigeng, 2024. "The impact of ozone pollution on mortality: Evidence from China," Journal of Environmental Economics and Management, Elsevier, vol. 125(C).
    18. Wang, Yangjie & Chen, Xiaohong & Ren, Shenggang, 2019. "Clean energy adoption and maternal health: Evidence from China," Energy Economics, Elsevier, vol. 84(C).
    19. Liao, Liping & Du, Minzhe & Chen, Zhongfei, 2021. "Air pollution, health care use and medical costs: Evidence from China," Energy Economics, Elsevier, vol. 95(C).
    20. Xinming Du, 2023. "Symptom or Culprit? Social Media, Air Pollution, and Violence," CESifo Working Paper Series 10296, CESifo.

    More about this item

    Keywords

    Air pollution; Healthcare use; Environmental justice; Health inequality; China;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • Q51 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Environmental Economics - - - Valuation of Environmental Effects
    • Q53 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Environmental Economics - - - Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling
    • Q56 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Environmental Economics - - - Environment and Development; Environment and Trade; Sustainability; Environmental Accounts and Accounting; Environmental Equity; Population Growth

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:ecmode:v:141:y:2024:i:c:s0264999324002621. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/30411 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.