Abstract
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.
Highlights
The proportion of people aged 60 years or over is growing faster than other age groups
Using a fuzzy regression discontinuity design, a sub-sample of 14,922 China Health and Retirement Longitudinal Study (CHARLS) participants was selected based on the following inclusion and exclusion criteria: a. the participant was a rural resident, aged 50–70; b. the participant was not covered by other pension schemes; c. to exclude interaction with medical insurance, the participant was enrolled in the new rural cooperative medical system (NCMS), a national social health insurance covering almost 95% of rural residents; d. to exclude the influence of retirement on income, the participant was not engaged in economic activity influenced by reaching the age of 60; this criterion restricted the analysis to those selfemployed or participating in a family business
By comparing the disposable income and the pension income shown in Table 1, we inferred that poor people would be more sensitive to additional cash transfers by retirement pension, which would improve the affordability of outpatient services, non-prescription medicines, and traditional medicines
Summary
The proportion of people aged 60 years or over is growing faster than other age groups. 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. 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 [4]. Rhee and colleagues [6] explore three theoretically plausible mechanisms based on previous evidence: financial control, family relationships, and social integration, and conclude that financial control was the dominant factor linking retirement and well-being
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