Understanding the determinants of healthcare utilization among the elderly is crucial for optimizing resource allocation, controlling costs, and ensuring sustainable health systems. Current research mainly focuses on physical health status, economic resources, or healthcare supply factors, with less attention paid to psychosocial determinants, particularly age-related cognitions like age identity. This paper utilizes data from the China Longitudinal Aging Social Survey (CLASS) and adopts a value-based healthcare perspective to systematically examine the impact of age identity on healthcare utilization among older adults and the underlying mechanism.

The empirical findings reveal that older adults reporting more positive age identity exhibit significantly lower frequency and expenditure levels of healthcare utilization compared to their peers with negative age identity. Quantifying the macroeconomic effect, we estimate that the difference in age identity alone translates to an annual healthcare expenditure saving of approximately 57.9 billion RMB. Mechanism testing further suggests that positive age identity promotes more proactive health monitoring and disease prevention behaviors, improves lifestyle choices, increases the propensity to seek health information, and maintains a higher level of social engagement. These positive behaviors jointly contribute to enhanced self-management and preventive care awareness, thereby reducing excessive or unnecessary reliance on high-cost medical resources.

Theoretically, this paper enriches the understanding of the health production function within health economics by highlighting the crucial role of psychosocial factors in health maintenance and disease prevention. Practically, it offers a novel perspective on addressing the rising healthcare costs associated with population aging. Unlike solely focusing on increasing healthcare supply, promoting positive age identity effectively enhances older adults’ sense of health responsibility and stimulates health-promoting behaviors, thus lowering costs while improving health outcomes. The findings suggest that policymakers should prioritize and integrate psychosocial interventions aimed at fostering positive age perceptions when formulating aging-related health policies. Such interventions represent a more economically efficient public health investment compared to relying solely on high-cost clinical interventions for late-stage disease management. Ultimately, embracing the concept of positive aging and fostering older adults’ holistic physical and mental well-being are fundamental to effectively addressing the multifaceted challenges posed by population aging.