摘要
针对中国的经验研究均发现,退休导致职工医疗服务利用增加和医药费用上涨。本文基于城镇职工基本医疗保险住院患者报销明细数据,使用按日度量的年龄作配置变量的断点回归设计,得出了相反的结论。具体而言,首先,退休对住院次数和住院天数没有显著影响,但导致患者次均住院费用下降16.5%。其次,患者退休后住院费用下降不是因为医生为患者选择了低自付费用的治疗方案,而是患者身体健康状况改善或个人支付能力下降所导致的。最后,异质性分析结果显示,公共部门职工和男职工退休后次均住院费用下降,而民营部门职工和女职工的次均住院费用退休后没有下降。由于职工退休后不会多消费住院医疗服务、不会多花住院医药费用,延迟退休不一定能抑制医药费用上涨。
China is witnessing a trend of population aging,at a speed even faster than all OECD countries.According to the retirement policy formulated by China in 1978,the statutory(full)retirement age(SRA)is 60 for male workers,55 for female workers in management and scientific research,and 50 for other female workers.Considering the extended life expectancy and the aging of population,the Chinese government is about to increase the retirement age.The debates over the impact of delayed retirement policy on human capital and financial viability grow in intensity.Extending the retirement age may create unintended effects on health and medical costs,and disrupt Urban Employee's Basic Medical Insurance(UEBMI)fund,which currently covers more than 354 million workers.The disruption will be dramatic because health expenditure in China has grown rapidly in recent years.Although theoretical studies and empirical research on many countries find mixed evidence about the effect of retirement on healthcare utilization,existing studies on Chinese workers concluded that retirement enhances healthcare utilization.Therefore,delayed retirement can reduce healthcare expenditures.Using high-quality administrative data and regression discontinuity designs(RDD),our study draws a refreshingly different conclusion.Retirement has no effect on inpatient admissions and length of hospital stay,and the expenditures of inpatients are significantly lowered after retirement.The city-wide administrative data on UEBMI inpatient claims were sourced,which contains a list of UEBMI enrollees and inpatient claims for five years.The list of UEBMI enrollees includes over 476 thousand insureds and their information on identity,gender,date of birth,district or county of residence,and whether retired.The inpatient data comprise over 245 thousand inpatient stays and it contains information on the patient identity,gender,date of birth,job types,whether retired,district or county of residence,date of admission and discharge,hospital name,and expenditures.With these detailed data,we set the age in days as the running variable in the RDD.Using sharp RDD,we found no significant change in the number and frequency of hospitalization after workers reached the SRAs.Using fuzzy RDD,we found no significant effect of retirement on the length of stay,but a decrease of 16.5%in patients'average hospitalization expenditure.This decrease was the result of patients'improved health status or reduced ability to pay,instead of physicians choosing low out-of-pocket cost treatment options for patients.The heterogeneity analysis showed that the average post-retirement inpatient cost decreased for public sector workers and male workers,while the average post-retirement inpatient cost did not drop for private sector workers and female workers.According to our findings,workers do not enhance the number and frequency of hospitalization or spend more on hospitalization after retirement;thus we conclude that delayed retirement does not necessarily curb the rise in medical costs.This paper contributes to the existing literature in three ways.First,we improve the RDD estimation of the retirement effect.Unlike the existing literature that uses age in months or years,we take age in days as the running variable to ensure enough values of the running variable in the sample,so that the local polynomial framework of RDD is applicable.Second,the bandwidths we use are much narrower than that of similar studies;therefore the estimation results are more accurate.Third,this paper provides the first empirical analysis of the role of physician behavior in the“retirement-healthcare utilization”relationship using two proxies,the claimable cost share and the actual reimbursement rate.In addition,the thorough and conscientious examination and analysis of health insurance reimbursement data in this paper is a source of enlightenment for subsequent empirical studies using Chinese healthcare data.This paper has the following policy implications.First,delayed retirement will not curb the rise in health expenditures.Policymakers should reform health insurance payments,and optimize the medical delivery system to slow the growth of healthcare costs.Second,the government should improve the sick leave rules to avoid a surge in healthcare demand prompted by reduced opportunity cost of time after retirement.
作者
付明卫
徐文慧
FU Mingwei;XU Wenhui(Institute of Economics,Chinese Academy of Social Sciences;Antai College of Economics and Management,Shanghai Jiao Tong University)
出处
《经济研究》
CSSCI
北大核心
2023年第2期141-157,共17页
Economic Research Journal
关键词
退休
医药费用
医疗服务利用
健康
Retirement
Healthcare Utilization
Medical Expenditure
Health
