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Healthcare utilization at retirement in China

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  • Qin Zhou
  • Karen Eggleston
  • Gordon G. Liu

Abstract

Previous studies, mostly analyzing data from high‐income economies, present mixed evidence on the relationship between retirement and healthcare utilization. This study leverages administrative data for over 80,000 urban Chinese workers to explore the effect of retirement on outpatient and inpatient care utilization using a fuzzy regression discontinuity design. The analyses of medical claims from a large city in China complement and extend the current literature by providing evidence of potential mechanisms underlying increased short‐run utilization. In this relatively well‐insured population, annual total healthcare expenditures significantly increase primarily because of more intensive use of outpatient care at retirement, especially at the right tail of the distribution of outpatient visits. This increase in outpatient care appears to stem from a decline in the patient cost‐sharing rate and the reduced opportunity cost of time upon retirement, interacting with supplier‐induced demand, not from any sudden impact on health. We do not find evidence of change in inpatient care at retirement. The results hold for both females and males, and are robust to a number of sensitivity analyses.

Suggested Citation

  • Qin Zhou & Karen Eggleston & Gordon G. Liu, 2021. "Healthcare utilization at retirement in China," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2618-2636, November.
  • Handle: RePEc:wly:hlthec:v:30:y:2021:i:11:p:2618-2636
    DOI: 10.1002/hec.4400
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    as
    1. Currie, Janet & Lin, Wanchuan & Zhang, Wei, 2011. "Patient knowledge and antibiotic abuse: Evidence from an audit study in China," Journal of Health Economics, Elsevier, vol. 30(5), pages 933-949.
    2. Frandsen, Brigham R. & Frölich, Markus & Melly, Blaise, 2012. "Quantile treatment effects in the regression discontinuity design," Journal of Econometrics, Elsevier, vol. 168(2), pages 382-395.
    3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    4. Gary V. Engelhardt & Jonathan Gruber, 2011. "Medicare Part D and the Financial Protection of the Elderly," American Economic Journal: Economic Policy, American Economic Association, vol. 3(4), pages 77-102, November.
    5. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
    6. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 597-636.
    7. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    8. Müller, Tobias & Shaikh, Mujaheed, 2018. "Your retirement and my health behavior: Evidence on retirement externalities from a fuzzy regression discontinuity design," Journal of Health Economics, Elsevier, vol. 57(C), pages 45-59.
    9. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    10. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    11. Claudio Lucifora & Daria Vigani, 2018. "Health care utilization at retirement: The role of the opportunity cost of time," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 2030-2050, December.
    12. Toshiaki Iizuka, 2007. "Experts' agency problems: evidence from the prescription drug market in Japan," RAND Journal of Economics, RAND Corporation, vol. 38(3), pages 844-862, September.
    13. Gary V. Engelhardt & Jonathan Gruber, 2011. "Does Medicare Part D Protect the Elderly from Financial Risk?," Issues in Brief ib2011-8, Center for Retirement Research, revised Jun 2011.
    14. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 1-37.
    15. Zhang, Yi & Salm, Martin & van Soest, Arthur, 2018. "The effect of retirement on healthcare utilization: Evidence from China," Journal of Health Economics, Elsevier, vol. 62(C), pages 165-177.
    16. Eibich, Peter, 2015. "Understanding the effect of retirement on health: Mechanisms and heterogeneity," Journal of Health Economics, Elsevier, vol. 43(C), pages 1-12.
    17. Andrew Gelman & Guido Imbens, 2019. "Why High-Order Polynomials Should Not Be Used in Regression Discontinuity Designs," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(3), pages 447-456, July.
    18. Atalay, Kadir & Barrett, Garry F., 2014. "The causal effect of retirement on health: New evidence from Australian pension reform," Economics Letters, Elsevier, vol. 125(3), pages 392-395.
    19. Nielsen, Nick Fabrin, 2019. "Sick of retirement?," Journal of Health Economics, Elsevier, vol. 65(C), pages 133-152.
    20. Disney, Richard & Emmerson, Carl & Wakefield, Matthew, 2006. "Ill health and retirement in Britain: A panel data-based analysis," Journal of Health Economics, Elsevier, vol. 25(4), pages 621-649, July.
    21. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    22. Toshiaki Iizuka, 2012. "Physician Agency and Adoption of Generic Pharmaceuticals," American Economic Review, American Economic Association, vol. 102(6), pages 2826-2858, October.
    23. Titus Galama & Arie Kapteyn & Raquel Fonseca & Pierre‐Carl Michaud, 2013. "A Health Production Model With Endogenous Retirement," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 883-902, August.
    24. Hahn, Jinyong & Todd, Petra & Van der Klaauw, Wilbert, 2001. "Identification and Estimation of Treatment Effects with a Regression-Discontinuity Design," Econometrica, Econometric Society, vol. 69(1), pages 201-209, January.
    25. Stefanie Behncke, 2012. "Does retirement trigger ill health?," Health Economics, John Wiley & Sons, Ltd., vol. 21(3), pages 282-300, March.
    26. Horn, S.D., 1983. "Measuring severity of illness: Comparisons across institutions," American Journal of Public Health, American Public Health Association, vol. 73(1), pages 25-31.
    27. Hongbin Li & Xinzheng Shi & Binzhen Wu, 2015. "The Retirement Consumption Puzzle in China," American Economic Review, American Economic Association, vol. 105(5), pages 437-441, May.
    28. Anikó Bíró, 2016. "Outpatient visits after retirement in Europe and the US," International Journal of Health Economics and Management, Springer, vol. 16(4), pages 363-385, December.
    29. Hult, Carl & Stattin, Mikael & Janlert, Urban & Järvholm, Bengt, 2010. "Timing of retirement and mortality - A cohort study of Swedish construction workers," Social Science & Medicine, Elsevier, vol. 70(10), pages 1480-1486, May.
    30. Anikó Bíró & Péter Elek, 2018. "How does retirement affect healthcare expenditures? Evidence from a change in the retirement age," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 803-818, May.
    31. Che, Yi & Li, Xin, 2018. "Retirement and health: Evidence from China," China Economic Review, Elsevier, vol. 49(C), pages 84-95.
    32. Johannes Hagen, 2018. "The effects of increasing the normal retirement age on health care utilization and mortality," Journal of Population Economics, Springer;European Society for Population Economics, vol. 31(1), pages 193-234, January.
    33. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2014. "Addressing antibiotic abuse in China: An experimental audit study," Journal of Development Economics, Elsevier, vol. 110(C), pages 39-51.
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