How and to What Extent Can Pensions Facilitate Increased Use of Health Services by Older People: Evidence From Social Pension Expansion in Rural China

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 background, a significant practice issue is how to promote older people utilizing health service they need in via of pension. 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 a nationally representative sample survey, China Health and Retirement Longitudinal Study, we conducted fuzzy regression discontinuity and segmented regression.Results: It was found that a pension did facilitate low-income people in utilizing outpatient income (OR = 1.219, 95% 1.018-1.460) and inpatient services income (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 recipients’ health service utilization were mainly located in the range 55-95 CNY.Conclusions: The pension has mixed effects on recipients' health service utilization from different income groups. Our study enriches related evidence on the impact of pension on healthcare-seeking behaviour and can be helpful in policy design. The information our study presents can also allow economists to formulate models relating to pensions and healthcare utilisation with greater precision.