Hospital workload and adaptation under climate change: evidence from the people’s Republic of China
Climate change-induced increases in the intensity and frequency of extreme temperatures impose
considerable challenges on healthcare systems. In addition to physical damage to public
infrastructure and electricity systems in various sectors (Rode et al. 2021), healthcare systems
face particularly severe capacity constraints, driven by surging demand. Extreme temperatures
adversely affect population health, leading to increased healthcare utilization. This surge in
demand exacerbates shortages and the uneven distribution of healthcare resources, complicating
efforts to achieve universal healthcare (Salas and Jha 2019, IPCC 2023). Strains on healthcare
provision can thus result in poorer health outcomes, magnifying the global health impacts of
climate change (WHO 2024).
The impacts of climate change on healthcare systems have yet to be fully investigated. Most
previous studies have documented that population mortality rises during extremely cold and hot
weather events. 1 However, this U-shape relationship between temperature and all-cause
mortality may not uniformly reflect the impact of extreme temperature on healthcare utilization
and the corresponding workload for healthcare providers. There are at least three reasons for
such inconsistency.
First, a larger proportion of healthcare demand is driven by non-fatal health deterioration rather
than acute fatal conditions. Existing work has suggested a temperature–morbidity relationship
different from the U-shape temperature–mortality relationship. Some studies have found morbidity
linearly impacted by temperature (White 2017, Karlsson and Ziebarth 2018, Mullins and White
2019, Agarwal et al. 2021, Aguilar-Gomez et al. 2024, Gould et al. 2024), while others have
observed morbidity increases on extreme cold and hot days (Weinberger et al. 2018; Iniguez,
Roye, and Tobias 2021).
Second, healthcare demand is influenced not only by health status but also by behavior
preferences, which are highly shaped by weather conditions. For instance, extreme temperatures
may encourage people to stay indoors to avoid exposure, making individuals with mild symptoms
or lower health risks less likely to seek hospital care (Deschenes and Moretti 2009, Graff-Zivin
and Neidell 2014).
Third, climate change can impact healthcare demand via income channels, particularly for
individuals whose work depends on mild outdoor conditions. Restricted work opportunities under
extreme cold and hot climates may lead to lower income and tighter budgets, limiting access to
healthcare services (Colmer 2021, Ebi et al. 2021). As these factors can counteract one another
in their influence on healthcare demand, they contribute to a complex and nuanced relationship
between climate change and the need for healthcare services.
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