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  • Three Essays on Health, Health Care, and Healthy Ageing
    (2023) Si, Yafei
    Thesis
    This thesis consists of three empirical studies focusing on the health and health care utilisation of older adults using the healthy ageing framework proposed by the World Health Organization in 2015. In Essay 1, I examine the relationships between life-course factors and intrinsic capacity, a break-through and strengths-based composite measure of ageing. I find that unfavourable early-life factors directly decrease late-life intrinsic capacities, particularly cognitive, sensory and psychological capacities rather than locomotor functioning and vitality, and these effects are exacerbated by the cumulative socioeconomic inequalities over a person’s life course. In Essay 2, I employ the method of standardised patients to identify the overuse of health care, document its patterns, and quantify its financial impact on patients in primary care in China. My findings suggest that overuse is pervasive in primary care in China and leads to a significant increase in health care expenditure. The overuse in my setting seems unlikely to be attributable to physician incompetence. My findings shed light on the cost escalation of primary care in China, which is a form of medical inefficiency that should be urgently addressed. In Essay 3, I further investigate the impact of physician over-service on the quality of care provided, since physician over-service can also contribute to physicians’ learning and therefore better health care. I report new evidence that physician over-service is associated with a significant increase in physicians’ investment in learning, such as consultation length, adherence to checklists, and patient-centred communication, but no significant change in giving a correct diagnosis, correct drug prescriptions or a referral. Moreover, over-service in drugs is associated with a significant increase in physicians’ better learning and the provision of correct drugs. However, my findings imply that physician over-service does not improve the accuracy of physicians’ decisions. The higher rate of correct drug prescriptions was mainly explained by the prescription of more drugs.