Impact of the First-Wave COVID-19 Pandemic on Medical Expenditure for Older Adults in China: Lessons from a Natural Experiment

ABSTRACT

Older adults’ access to healthcare services may have been affected by the COVID-19 pandemic. This study explored the effect of the first wave pandemic on the medical expenditure of older adults in China. Difference-in-Difference models captured both temporal and geographical variation in COVID-19 exposure to estimate the impacts of the pandemic on medical expenditure through a quasi-natural experiment. Data derived from the China Family Panel Studies. Results indicate that exposure to the pandemic significantly decreased total medical expenditures, hospital expenditures, and non-hospital medical expenditures of Chinese older adults by 15% (95% CI 12%–17%), 5% (95% CI 2%–7%), and 15% (95% CI 13%–16%), respectively, for each standardized severity increment. Females, less well-educated people, and individuals without internet access were most susceptible to experiencing these reductions. This study revealed that COVID-19 exerted a detrimental influence on the medical expenditure of older adults in mainland China. The “hidden epidemic” of non-COVID-19 medical needs of older adults deserves more attention on the part of policymakers.

KEYWORDS:

• China
• COVID-19
• medical expenditure
• older adults

Key Points

• Medical expenditure declined markedly among older adults after exposure to the first-wave pandemic.

• The decline in medical expenditure was more notable among females, individuals with lower educational attainment, and those without internet access.

• We need to reconsider the important public health issues about how to ensure the supply of medical services in addition to COVID-19, how to meet the medical needs of the older adults facing different dilemmas, and how to address the needs of the even vulnerable group of the older adults.

Abbreviations

TE	=	Total Expenditure
HE	=	Hospitalization Expenditure
NE	=	Non-hospitalization Expenditure

Acknowledgments

The authors thank all the interviewees, researchers, and related staff in the CFPS. We also thank the support of Peking University for initiating the authors’ research. Special thanks are extended to the three anonymous reviewers for their valuable suggestions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Concept and design: Chao Guo, Xiyuan Hu. Analysis and interpretation of data: Xiyuan Hu, Dianqi Yuan, and Chao Guo. Writing-original draft: Xiyuan Hu. Writing-review and editing: Xiyuan Hu, Dianqi Yuan, Yuyu Zeng, and Chao Guo.

Data availability statement

Data are available upon reasonable request. This study is based on publicly available datasets, and the original data can be accessed after registration and application from the website: http://www.isss.pku.edu.cn/cfps/en/data/public/index.htm.

Ethics approval

The survey was reviewed and approved by the Peking University Biomedical Ethics Review Committee (Approval number: IRB00001052–14010).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08959420.2024.2348967

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was funded by the National Social Science Foundation of China (grant number Q6 22AZD077).