摘要
目的在退休医疗负担巨大、医疗保险基金支出紧张背景下,深入探究退休对住院服务利用及住院费用的影响。方法基于G市2021—2022年城镇职工医疗保险结算数据,运用模糊断点回归的设计,分析退休对男性职工住院服务利用及住院费用的影响,并基于具体病种及操作探讨潜在影响机制。结果退休使男性职工住院总人次显著增加22.63%(P<0.01),住院总费用未有明显影响(P>0.1)。退休使糖尿病和冠状动脉粥样硬化性心脏病患者的住院人次分别增加26.24%(P<0.01)和25.12%(P<0.01),住院总费用分别增加31.65%(P<0.01)和23.37%(P<0.01)。退休使膝/髋关节置换术及腹股沟疝气修补术患者住院总人次增加20.08%(P<0.05),住院总费用虽增加但不显著(P>0.1)。退休使消化性溃疡患者住院总人次减少29.95%(P<0.01),住院总费用下降36.12%(P<0.05)。连续性检验、变换退休年龄、变换带宽的稳健性检验结果表明,主回归所得结果稳健可靠。结论退休使男性职工住院总人次增加,住院总费用未有明显变化。G市城镇职工退休后存在利用更高的住院报销比、择期治疗、职业压力减小等退休效应。
Objective With growing substantial retirement-related medical burdens and strained healthcare fund expenditures,to investigate the impact of retirement on inpatient service utilization and hospitalization costs.Methods This study utilized urban employee medical insurance claims data from City G from 2021 to 2022,employing a fuzzy regression discontinuity design to empirically analyze the effects of retirement on inpatient service utilization and costs among male employees.Disease-specific and procedure-based mechanisms were further explored.Results Retirement substantially increases hospital admissions for male employees by 22.63%(P<0.01),while no significant impact on total hospitalization costs is observed(P>0.1).Retirement increases admissions by 26.24%(P<0.01)for diabetes mellitus patients and 25.12%(P<0.01)for coronary heart disease patients,with corresponding total hospitalization costs rising by 31.65%(P<0.01)and 23.37%(P<0.01),respectively.For elective treatments(e.g.,knee/hip replacement and inguinal hernia repair),admissions increase by 20.08%(P<0.05),though cost increases remain statistically insignificant(P>0.1).Conversely,retirement reduces admissions by 30.79%(P<0.01)and total hospitalization costs by 42.25%(P<0.05)for stress-related conditions like peptic ulcers.Robustness checks,including continuity tests,alternative retirement age thresholds,and bandwidth adjustments,have been conducted to confirm the reliability of the findings.Conclusions Retirement elevates hospitalization frequency among male employees without significantly altering overall costs.The results reveal that after retirement,urban employees in City G have retirement effects such as leveraging higher inpatient reimbursement rates,pursuing elective treatments,and reduced occupational stress.
作者
周四娟
应晓华
ZHOU Sijuan;YING Xiaohua(School of Public Health,Fudan University,Shanghai 200032,China)
出处
《健康发展与政策研究》
北大核心
2025年第3期251-259,共9页
Health Development and Policy Research
基金
国家自然科学基金项目(72074051)。
关键词
退休
城镇职工
住院服务
真实世界数据
模糊断点回归
retirement
urban employees
inpatient service
real-world data
fuzzy regression discontinuity design(RDD)
