Effects of retirement on inpatient healthcare utilisation: an observational study in China

Abstract

Objective Previous studies have presented mixed evidence on retirement and inpatient healthcare utilisation. We aimed to examine the causal effect of retirement on inpatient healthcare utilisation in China and explore the heterogenous effects of sex, disease types and ways of hospital admission.Design This was a retrospective observational study from the electronic medical record at 376 tertiary hospitals in China between 2013 and 2018.Setting Nationwide data from China.Participants We included the male sample aged between 50 and 70, and the female sample aged between 40 and 60 and with basic medical insurance system or public medical insurance. Observations with total expenditures per visit at the top or bottom 1% were excluded.Primary and secondary outcome measures Inpatient expenditures per visit and inpatient days per visit.Methodology We examined the effects by a non-parametric fuzzy regression discontinuity design, exploiting the mandatory retirement age as a source of exogenous variation in retirement status.Results Retirement reduced drug expenditures (β=−467.46, p<0.05) and inpatient days per visit (β=−0.99, p<0.05). The mitigation effect was concentrated on people admitted into hospital due to chronic diseases (β=−551.28, p<0.05 for drug expenditures; β=−1.08, p<0.05 for inpatient days per visit) and people admitted into hospital through outpatient services (β=−353.75, p<0.001 for drug expenditures). For males, retirement significantly reduced diagnostic tests expenditures (β=−302.38, p<0.05) and drug expenditures (β=−728.31, p<0.05). Retirement significantly reduced inpatient days per visit (β=−1.13, p<0.05) for females.Conclusion The empirical findings suggested that retirement may lead to a reduction in inpatient healthcare utilisation, which underlined the importance for policy-makers to consider the externalities of retirement policies on inpatient healthcare utilisation.