提早退休對醫療費用之影響

The effect of early retirement on health care expenditure

目標：探討退休者與相同條件的未退休者醫療費用差異，及此差異是否因退休年齡不同而有所不同。方法：利用1997年至2009年全民健保承保歸人檔資料（LHID2005），分析50－69歲退休與未退休者在退休者退休日期前三年及後六年醫療費用差異情形。未退休者考慮個人特性與健康狀況，利用傾向分數（propensity score）與退休者進行1：1貪婪配對（Greedy Match）。退休與未退休者醫療費用差異以Wilcoxon符號序位檢定分析；隨後並控制相關影響因素而以混合模型（mixed model）分析每年醫療費用差異與退休前一年是否有所差異。結果：配對後樣本共12,262人，50－59歲者即退休者（N=4,634）退休後六年內門診醫療費用及退休後五年內的整體醫療費用均顯著高於未退休者；60－69歲退休者（N=1,497）退休後的門診或整體醫療費用與未退休者之差異並不顯著。經控制影響因素後發現，50－59歲退休與未退休者之門診及整體醫療費用差異在退休後有顯著增加的情形。結論：提早退休者醫療費用顯著高於未退休者，延遲退休者與未退休者的醫療費用則無顯著不同。因此，未來的退休政策實宜將退休年齡對於全民健保財務的不同影響納入考量。

Objectives: This study aimed to compare the health care expenditure between the retirees of various retirement age and non-retirees with similar characteristics. Methods: Data for this analysis came from Taiwan's Longitudinal Health Insurance Data set (LHID 2005). The health care expenditure three years before and six years after retirement were measured for people who retired at the age between 50 and 69 and compared to non-retirees during the same periods. Propensity score with greedy match method was used to select the comparison group who were not retired. The differences in health care expenditure between the matched pairs were tested using Wilcoxon's signed rank test. Mixed models with various control covariates were used to compare the difference in health care expenditure before and after retirement between the pairs. Results: The total sample consisted of 12,262 subjects. There were 9,268 subjects aged between 50 and 59. Those who retired between the age of 50 and 59 had higher outpatient health care expenditure than the comparison group within six years after their retirement. Retirees also had higher total health care expenditure than the comparison group within five years after their retirement. The differences in outpatient health care expenditure of those who retired between the age of 60 and 69 and non-retirees were non-significant. Compared to one year before their retirement, the outpatient and total health care expenditure for the retirees who retired between the age of 50 and 59 and non-retirees were significantly higher after their retirement. Conclusions: Those who retired before the age of 60 had higher health care expenditure than non-retirees. There was no difference in health care expenditure between those who retired after the age of 60 and non-retirees. The impact of retirement age on the financial viability of national health insurance system should be taken into account in future policy debate.