退休对医疗卫生服务利用的影响——基于断点回归的实证研究

目的 研究退休对医疗卫生服务利用的影响程度及其机制,为延迟退休政策提供参考。方法 基于2013和2015年中国健康与养老追踪调查数据,采用模糊断点回归设计方法研究退休对医疗卫生服务利用水平的影响。结果 退休对医疗卫生服务有正向影响,特别是对住院情况(β=0.159,P=0.015)和自我治疗(β=0.387,P=0.046)影响显著。退休后人们的健康生活方式会发生变化,男性会减少一定强度的娱乐活动和体育锻炼(β=-0.249,P=0.416),女性会增加这方面的活动(β=0.510,P=0.331);男性同时会增加吸烟数量(β=12.754,P=0.427)和饮酒概率(β=1.130,P=0.235)。退休后时间机会成本也会影响医疗卫生服务的使用,相对于在政府部门工作的人员来说,退休对非政府工作人员医疗卫生服务利用水平影响更大。结论 为了缓解医保基金支付压力、提高基金使用效率、促进健康老龄化,应尽快出台具体延迟退休政策,并根据职业类型和职工自身特点做适当弹性调整。

The impact of retirement on healthcare utilization: an empirical analysis based on regression discontinuity design

Objective To empirically analyze the impact of retirement on the utilization of medical services and its mechanism in China, and to provide reference for delayed retirement policy. Methods Based on the China Health and Retirement Longitudinal Study (CHARLS) data of 2013 and 2015, this paper used regression discontinuity design to analyze the influence of retirement on healthcare utilization. Results Retirement had a positive impact on medical and health services, especially on hospitalization (β=0.159, P=0.015) and self-treatment (β=0.387, P=0.046). People’s healthy lifestyle changed after retirement, with men decreasing recreational activities and physical exercise at a certain intensity (β=-0.249, P=0.416) and women increasing this activity (β=0.510, P=0.331). Men also increased the number of cigarettes (β=12.754, P=0.427) and the probability of alcohol consumption (β=1.130, P=0.235). The opportunity cost of time after retirement also affected health care utilization, with retirement having a greater impact on the level of health care utilization among nongovernmental workers compared with those working in the government sector. Conclusion In order to alleviate the pressure of health insurance fund payments, improve the efficiency of fund use, and promote healthy aging, a specific delayed retirement policy should be introduced as soon as possible, with appropriate flexible adjustments according to the type of occupation and workers’ own characteristics.