Hospital Workload and Adaptation Under Climate Change: Evidence from the People’s Republic of China

Climate change poses significant challenges to healthcare systems. This research estimates temperature impacts on hospital workload, using inpatient records from more than 1,000 emergency departments (EDs) in the People’s Republic of China between 2013 and 2022. We find inpatient admissions in EDs 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 with a temperature reference of 12°C to 15°C. Heterogeneity analysis indicates that specific departments such as internal medicine, surgery, and pediatrics experience more substantial increases in workload during extreme heat. Temperature also reshapes the patient structure: male patients, child patients, and patients with injuries or respiratory diseases take up a larger proportion of total admissions on extremely hot days. Considering adaptation methods, we show that hospitals temporarily allocate more junior physicians to EDs when the temperature is hot. Hospitals in cities where people have higher incomes and better-heated homes are less sensitive to temperature changes. In terms of monetary burden, we estimate corresponding healthcare expenditures, which suggest that the impact of extreme temperatures is larger on the insured portion of expenditures than it is on out-of-pocket payments. This research highlights the relationship between temperature and workload burden faced by the major healthcare facilities, providing suggestions for the healthcare system to increase personnel and adjust resource allocation in response to climate change.