【Paper】Insurance in name only? Cardiovascular shocks, bereavement, and intergenerational transfers in China

Journal: The Journal of the Economics of Ageing

Publication Date: December 2026

Abstract: Whether the family substitutes for missing formal insurance acquires particular force where coverage is nominally universal but financially shallow. This study asks whether spousal labour supply and intergenerational cash transfers respond when a middle-aged or older adult suffers an acute cardiovascular event. Five waves of the China Health and Retirement Longitudinal Study (2011 to 2020) provide an event-study panel of 13,445 adults aged 45 to 75 free of heart disease and stroke at baseline. Events are dated from the self-reported year of diagnosis rather than from the interval between interviews, a correction that reclassifies a third of events, removes spurious pre-trends and eliminates an apparent spousal employment decline. Effects are estimated with the Callaway and Sant'Anna estimator, community-clustered bootstrap inference and Romano-Wolf correction. Non-fatal events raise hospitalisation, functional limitation and out-of-pocket cost and reduce the patient's own employment, mostly non-agricultural work. Spouses provide more care, but neither their employment nor cash transfers from children respond detectably, and a household-level design that does not condition treatment classification on the patient's survival confirms both nulls. A benchmark within the same design weighs against the interpretation that the shock is too small: after a partner's death the survivor withdraws from employment, depressive symptoms rise and per-capita financial assets are depleted, yet transfers from children remain unchanged. Family risk sharing is therefore channel-specific: labour, care and wealth adjust to severe shocks, whereas no state-contingent increase in cash transfers is detectable even after bereavement, although intensive-margin estimates are less precise.