Can sports consumption cities reduce residents' medical expenditures? Evidence from China

The relentless rise in healthcare expenditures poses a severe challenge to the sustainable development of global societies. In China, a pilot program for Sports Consumption Cities (SCC) represents a pioneering strategic effort to align growth in the sports industry with public health promotion. This study aims to examine the causal impact of this city-level non-medical intervention on residents' medical expenditures and to elucidate how active lifestyle policies function as a cost-control strategy.

Using longitudinal data from the China Family Panel Studies (CFPS) from 2014 to 2022, we employed a Difference-in-Differences (DID) strategy to evaluate the impact of SCC construction on residents' medical expenditures. Additionally, a mediation model was applied to examine four parallel pathways: sports consumption, physical exercise frequency, self-rated health, and depression levels. The findings were validated using instrumental variable methods with historical data and rigorous robustness tests.

The construction of the SCC significantly reduced residents' medical expenditures by 10.86% (β = -0.115, P < 0.05). This cost-saving effect was primarily driven by optimized health behaviors and psychological wellbeing, as evidenced by increased sports consumption (β = 0.211, P < 0.01), higher physical activity frequency (β = 0.124, P < 0.05), improved self-rated health (β = 0.034, P < 0.1), and lower depression levels (β = -0.026, P < 0.1). Heterogeneity analysis indicates that residents aged 60 and above (β = -0.134, P < 0.05), those without chronic diseases (β = -0.098, P < 0.1), those without mortgage burdens (β = -0.208, P < 0.01), and residents living in central cities (β = -0.315, P < 0.01) or in areas with relatively scarce medical resources (β = -0.245, P < 0.1) exhibited a more pronounced reduction in medical expenditures due to SCC construction.

This study provides compelling empirical evidence that the SCC construction effectively validates the "exercise as medicine" hypothesis at the urban governance level. By optimizing the urban health environment, the pilot project has driven a paradigm shift from passive medical treatment to proactive health management. However, the identified structural heterogeneity underscores the need for future policies to embrace inclusive precision governance. Targeted subsidies for mobility-constrained households and the integration of exercise prescriptions into chronic disease management are crucial to ensuring the equitable distribution of health dividends across all socioeconomic strata.