Social pension expansions and health-care utilisation in China: cross-sectional evidence from the New Rural Pension Scheme

Abstract

BackgroundSocial pension programmes are used in many countries to better support the needs of the elderly. Improved understanding of the income-health gradient might lead to the development of more effective pension programmes and health policies. We aimed to evaluate the impact of social pension expansions on health-care utilisation in China. MethodsWe retrospectively enrolled respondents from the national China Health and Retirement Longitudinal Study in 2013 to estimate the impact of pension enrolment on health-care utilisation using China's New Rural Pension Scheme (NRPS), the largest existing pension programme in the world. We measured utilisation via outpatient visits in the past 2 weeks, inpatient visits in the past year, and preventative care utilisation in the past year. Using the age cutoff for pension eligibility as a strong instrumental variable and the estimation of two stage least square, we identified the causal impact of pension enrolment and pension income on health-care utilisation. Findings3984 respondents were enrolled from the database. Pension enrolment increased the use of outpatient health care (9·03%, p=0·064) and inpatient health care (3·91%, p=0·507), whereas pension income decreased the use of outpatient health care (–0·45%, p=0·844) and of inpatient health care (–1·92%, p=0·567). Pension enrolment drove 28·52% growth of preventative health-care utilisation in NRPS (p<0·001). Every 100 CNY increase in pension income led to a 8·72% increase in preventative health-care utilisation in NRPS (p=0·004). InterpretationEven a modest pension could help to improve the preventative health-care utilisation of the Chinese population. Given that preventative care helps people to stay healthy and access prompt treatment when necessary, it can also help to reduce overall medical expenses. Our findings highlight the promotion of public health through increasing the availability of economic resources and the profound impact of social pension reform in China. FundingChina Scholarship Council, the US PEPPER Center Scholar Award, and the US National Institutes of Health and the US National Institute of Aging.