Wanrui Wu

Working Papers:

• “Hospital under Climate Change: Evidence from China”, with Gordon Liu and Yuhang Pan

Abstract: Climate change poses significant challenges to healthcare systems. Aside from the physical damage to infrastructure resembling other sectors, healthcare system faces additional threat to capacity brought by demand deviation. This research investigates the impacts of extreme temperature on hospital workload, utilizing inpatient records from more than one thousand Emergency Departments (ED) in China between 2013 and 2022. We find inpatient admissions from ED decrease by 12.3% on days with a mean temperature below -6°C, while increasing by 7.7% on days with a mean temperature exceeding 30°C, compared to a benchmark temperature of 12°C–15°C. A large variation over 11°C of temperature within a day additionally increase hospital workload by 27%. Accounting for the temperature in the preceding 7-day period, we find greater cumulative effects than contemporaneous effects. Heterogeneity analysis indicates that tier-3 hospitals and specific departments such as internal medicine, surgery, and pediatrics experience the most substantial increases in workload during extreme heat. Patient structure changes during extreme temperature — male, child patients, and patients with injuries or respiratory diseases takes up a larger proportion of total admissions on extreme hot days. Considering adaptation methods, we show that hospitals temporarily allocate more junior physicians to emergency department is a feasible adaptation to the extreme high temperature. Hospitals locate in cities with higher income and winter heating are less sensitive to extreme temperatures. In terms of monetary burden, we estimate a 7.1% increase in the total medical expenditure on the hottest days, and a 10.4% decrease on the coldest days. Extreme temperatures exert a larger impact on the insured portion of expenditures compared to out-of-pocket payments. This research highlights the relationship between extreme temperature and workload burden faced by the major healthcare facilities, provides suggestions for healthcare system to increase personnel and adjust resources allocation in the context of climate change.

• “Healthcare Utilization and Informal Care in the Aging Era: Comparative Analysis of China, Japan, and South Korea”, with Gordon Liu and Yuhang Pan