How and to what extent can pensions facilitate increased use of health services by older people: evidence from social pe
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RESEARCH ARTICLE
Open Access
How and to what extent can pensions facilitate increased use of health services by older people: evidence from social pension expansion in rural China Shanquan Chen1, Xi Chen2, Stephen Law3, Henry Lucas4, Shenlan Tang5, Qian Long6, Lei Xue7 and Zheng Wang8,9*
Abstract Background: The 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. Methods: Using 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. Results: It 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 highincome 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). Conclusions: A 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. Keywords: Pension, Health service utilization, Regression discontinuity design, Segmented regression
* Correspondence: [email protected] 8 Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China 9 Research Center for Healthcare Management, School of Economic and Management, Tsinghua University, Beijing 100084, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link
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