How and to what extent can pensions facilitate increased use of health services by older people: evidence from social pension expansion in rural China

BMC Health Services Research

Xi Chen¹  Shenlan Tang²  Stephen Law³  Qian Long⁴  Lei Xue⁵  Henry Lucas⁶  Zheng Wang⁷  Shanquan Chen⁸ 

[1] Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA;Department of Population Health Science, Duke Global Health Institute, Duke University, Durham, North Carolina, USA;Faculty of Medicine and Health, University of Sydney, Sydney, Australia;Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China;Institute for Hospital Management, Tsinghua University, Beijing, China;Institute of Development Studies, University of Sussex, Brighton, UK;Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, 550025, Guiyang, China;Research Center for Healthcare Management, School of Economic and Management, Tsinghua University, 100084, Beijing, China;The School of Clinical Medicine, University of Cambridge, Cambridge, UK;

关键词: Pension;    Health service utilization;    Regression discontinuity design;    Segmented regression;   

DOI  :  10.1186/s12913-020-05831-0

来源: Springer

【 摘 要 】

BackgroundThe proportion of people aged 60 years or over is growing faster than other age groups. Traditionally, retirement has been considered as both a loss to the labour market and an additional economic burden on the nation. More recently, it is widely accepted that retired people can still contribute to society in many ways, though the extent of their contributions will depend heavily on their state of health. In this context, a significant practical issue is how to encourage older people to use the health services they need. This study aims to evaluate the effects of pensions on older adults’ health service utilization, and estimate the level of pension required to influence such utilization.MethodsUsing data from a nationally representative sample survey, the China Health and Retirement Longitudinal Study, we adopted a fuzzy regression discontinuity design and undertook segmented regression analysis.ResultsIt was found that a pension did encourage low-income people to use both outpatient (OR = 1.219, 95% 1.018–1.460) and inpatient services (OR = 1.269, 95% 1.020–1.579); but also encouraged both low- and high-income people to choose self-treatment, specifically over-the-counter (OR = 1.208, 95% 1.037–1.407; OR = 1.206, 95% 1.024–1.419; respectively) and traditional Chinese medicines (OR = 1.452, 95% 1.094–1.932; OR = 1.456, 95% 1.079–1.955; respectively). However, receiving a pension had no effect on the frequency of outpatient and inpatient service use. Breakpoints for a pension to promote health service utilization were mainly located in the range 55–95 CNY (7.1–12.3 EUR or 8.0–13.8 USD).ConclusionsA pension was found to have mixed effects on health service utilization for different income groups. Our study enriches existing evidence on the impact of pensions on healthcare-seeking behaviour and can be helpful in policy design and the formulation of improved models relating to pensions and healthcare utilisation.

【 授权许可】

CC BY