Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 12:70:1607160.
doi: 10.3389/ijph.2025.1607160. eCollection 2025.

Extreme Temperatures, Hospital Utilization and Public Health Insurance Spending

Yusun Kim  1 , Qing Miao  2 , Ling Zhu  3
Affiliations

Extreme Temperatures, Hospital Utilization and Public Health Insurance Spending

Yusun Kim et al. Int J Public Health. .

Abstract

Objectives: This study examines the impact of extreme temperatures on hospital utilization and public health insurance program spending in a country with no universal health coverage.

Methods: Using nationwide U.S. county-level panel data and a fixed effects model, we estimate the impact of annual variations in the number of hot and cold days on hospital utilization and medical reimbursements for low-income and elderly beneficiaries of public health insurance.

Results: Our results show that extreme heat and mild cold increase medical reimbursements to low-income beneficiaries, while extreme cold increases benefit transfer to the elderly. We find that extreme temperatures have particularly stronger positive effect on hospital admission and inpatient care utilization among old and poor patients. The fiscal impact of extreme temperatures is greater in areas with more generous income eligibility criteria for public health insurance.

Conclusion: The study advances our understanding of how extreme temperatures affect healthcare utilization of low-income and elderly populations and the roles public health insurance plays in supporting them from increasing weather risks. Our findings suggest that climate change can augment the financial burden on governments.

Keywords: United States; climate change; extreme temperature; health expenditure; healthcare utilization; hospitalization; public health insurance; public health spending.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Historical trend of Medicaid and Medicare transfer (United States, 2021). Note: Panel (A) shows the trend in the national sum of annual Medicaid and Medicare transfer payments. Panel (B) plots the county-level annual average amount of transfer payments during the sample period from 2000 until 2019.
FIGURE 2
FIGURE 2
Distribution of daily mean temperatures (United States, 2020). Note: Panel (A) figure shows the distribution of daily mean temperatures across ten temperature bins. The horixontal axis denotes the temperature bin separated by 10°F (or 12.2°C). Panel (B) shows the national average number of days in each temperature bin over the sample period.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Barreca AI. Climate Change, Humidity, and Mortality in the United States. J Environ Econ Manag (2012) 63(1):19–34. 10.1016/j.jeem.2011.07.004 - DOI - PMC - PubMed
    1. Basu R, Pearson D, Malig B, Broadwin R, Green R. The Effect of High Ambient Temperature on Emergency Room Visits. Epidemiology (2012) 23:813–20. 10.1097/EDE.0b013e31826b7f97 - DOI - PubMed
    1. Cheng J, Zhu R, Xu Z, Xu X, Wang X, Li K, et al. Temperature Variation Between Neighboring Days and Mortality: A Distributed Lag Non-Linear Analysis. Int J Public Health (2014) 59:923–31. 10.1007/s00038-014-0611-5 - DOI - PubMed
    1. Deschênes O, Greenstone M. Climate Change, Mortality, and Adaptation: Evidence From Annual Fluctuations in Weather in the US. Am Econ J Appl Econ (2011) 3(4):152–85. 10.1257/app.3.4.152 - DOI
    1. Deschênes O, Moretti E. Extreme Weather Events, Mortality, and Migration. Rev Econ Stat (2009) 91(4):659–81. 10.1162/rest.91.4.659 - DOI

LinkOut - more resources