Main Results gender differences in health-care utilization: evidence from urban employee basic medical insurance (uebmi) in china

Fig 3, which displays the average total medical expenses for females by age, offers two interesting findings. Firstly, there is a discrete jump in average total medical expenses around age 50; indeed, the total medical expenses increase significantly by roughly 900 RMB after age 50.

Secondly, there is a significant difference in average medical expenses between females aged 50 years or older, and younger females. Also, an increase in total medical expenses after age 50 is observed.Fig 4 shows the average medical expenses that are covered by health insurance for females by age. A similar salient increase in health insurance payment appears around age 50. Is the increase in total medical expenses fully covered by health insurance? Or do females pay more out-of-pocket to utilize their health-care? Fig 5 displays the pattern of average out-of-pocket ex­penditures by age. A slight decrease in these expenditures appears among females younger than 50. However, a noticeable increase in out-of-pocket expenses occurs in females around age 50. In addition, out-of-pocket expenses begin to increase for females older than 50. These figures super­impose a linear regression, allowing for both a discontinuity at the threshold and linear trends in the running variable (age) on both sides of the threshold.

Fig 6 through Fig 8 shows the average medical expenses and out-of-pocket expenditures that are covered by health insurance for males by age. In contrast to females, the figures reveal a smooth, consistent pattern as age increases. Though the three medical expenses of interest each increase as the males age, no distinct changes are observed around age 60.

To show the econometric estimates of the effects that appear in these figures, Table 5 (for female) and Table 6 (for male) present the results of the three key measures of medical expendi­tures, including: total medical expenditures, medical expenditures that are covered by health insur­ance, and out-of-pocket expenditures. A deeper inspection of the numerical estimates of medical expenses between males and females reveal a significant difference in health service utilization before and after retirement.

The RD estimates of the first row in column 1 and column 2 of Table 5 suggest that the age 50 threshold is associated with a significant increase in total medical expenditures; indeed, about

836 RMB (column 1) and 784 RMB (column 2) in expenditures are covered by health insurance for women. Medical expenditures increase at retirement according to the second row of column 1 and 2 of Table 5. To estimate the impact of retirement on medical expenses, the indicator for being older than age 50 is chosen as an IV for the indicator for retirement, the robust standard errors for which are displayed in parentheses. The estimate of total medical expenses is 3872 RMB and the estimate of the amount covered by health insurance is 3782 RMB. As evidenced at the 1% level, a statistical and economical increase occurs at retirement for females.

Furthermore, the willingness of females to pay out-of-pocket in order to utilize increased health care is indicated in column 3 of Table 5. A modest increase in out-of-pocket expenditures (about 1852 RMB) occurs when they retire; the results of this phenomenon are particularly signif­icant at the 5% level.

Unlike the estimates for females, the RD estimates in columns 1 and 2 of Table 6 indicate that, for males, the age 60 threshold is unassociated with any significant change in either the total medical expenditures or expenditures covered by health insurance. Additionally, males do not increase their out-of-pocket expenditures as they retire in order to utilize increased health care, as shown in column 3 of Table 6.