The protective paradox of intergenerational support: how Chinese families weather health crises

Based on the framework of household utility maximization and health capital decision-making, this study proposes that parental intergenerational nurturing may influence catastrophic health expenditures through two competing mechanisms: first, the "squeeze effect," wherein intensive resource investment in children may increase parental economic vulnerability; second, the "reverse flow effect," wherein intergenerational reciprocity can stabilize household health security. Within this theoretical tension, this study examines whether parental intergenerational investment ultimately strains their own health resources or paradoxically provides protective effects.

Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS), this study employs k-prototypes clustering to classify households into four intergenerational nurturing patterns. Panel modeling controls for intra-household correlations and individual heterogeneity over time. Causal mediation analysis and group heterogeneity tests evaluate the direct and indirect effects of parental intergenerational investment on catastrophic health expenditure (CHE) risk.

Contrary to the "squeeze effect" hypothesis, high-intensity, sustained parental support did not increase CHE risk but exhibited a buffering effect, particularly pronounced in urban households and those with higher educational attainment. Emotion-focused nurturing initially showed a slight risk increase without controlling variables, but this effect weakened after incorporating household and health characteristics, revealing the moral economy mechanism of self-sacrificial protection in Chinese families.

This study uncovers a "protective paradox" in contemporary Chinese families: within a social context of limited resources and inadequate institutional safeguards, parents' high-intensity intergenerational investments do not exacerbate household health risks. Instead, through the emotional bonding and reciprocal reward mechanisms of family contracts, they function as implicit insurance. This paradox not only deepens our understanding of Chinese families' health-related economic behaviors but also offers a new theoretical perspective for re-examining the role of informal support systems in risk governance.