中国医疗保险对城镇老年人死亡率的影响

Estimating the Effects of Public Health Insurance on Mortality of the Elderly in Urban China

本研究的目的是考察医疗保险对中国城镇老年人健康,即死亡率的影响。利用最新的具有全国代表性的微观数据集——2002—2005年"中国老年人健康长寿影响因素调查数据",借助工具变量法,通过极大似然估计,来解决离散选择模型中二元内生解释变量的问题。研究发现,医疗保险显著降低了老年人的死亡概率。控制人口、社会经济、健康等个人特征,与无医疗保险的老人相比,享受医疗保险的老人三年间隔的死亡率降低了25.3%。医疗保险对我国城镇老年人的健康保护作用存在明显的性别和地区差异。本文对于医疗保险的保护作用的定量研究,为当前不断推进的医疗保险改革,提供了决策参考。

This paper investigates how health insurance influences the mortality among the elderly in urban China. On the basis of the latest waves of Chinese Longitudinal Healthy Longevity Survey （CLHLS）, maximum likelihood estimation method is applied to identify the insurance coverage effect, using instrumental variables to account for the binary endogenous explanatory variable. We find that all else equal, being covered by public health insurance decreases the risks of dying in the following three years by 25.3%.When the three- year mortality is modeled using subgroups, clear gender and regional differences emerge. This quantitative study of protective effect of health insurance provides some sights on ongoing health care and insurance reform for policy makers.