过度需求还是有效需求？--城镇老人健康与医疗保险的实证分析

Excess Demand or Appropriate Demand?——Health Insurance,Medical Care and Mortality of the Elderly in Urban China

本文利用2002—2005年"中国老年人健康长寿影响因素调查数据"(CLHLS)来估计医疗保险对我国城镇老年人总医疗支出和家庭自付医疗支出,以及老年人死亡风险的影响。利用两部模型和扩展的样本选择模型研究医疗支出发现,在过去一年中享受医疗保险的老人,家庭自付医疗支出比无保险的老人低43%(约合1149元),而总医疗支出则比无保险的老人高28%—37%(约合1072元—1264元)。Cox比例风险模型的结果表明,享受医疗保险的老人,死亡风险比无保险的老人低19%;利用扩展的Kaplan-Meier生存函数估计平均生存时间发现,享受医疗保险的老人的平均生存时间比无保险的老人多5年。研究表明,享受医疗保险的老人按生存概率加权的平均总医疗支出为64689元,无医疗保险的老人的医疗支出为42198元,总医疗支出相差22491元,预期寿命相差5年,医疗支出对健康的边际效应较高。我国公共医疗保险制度的选择应侧重于满足老年人的医疗需求,进一步提高老年人的健康和寿命,建立病有所医、老有所养的和谐社会。

The paper investigates the relationship between health insurance,medical expenditure and mortality among the elderly in urban China.Using the latest waves of Chinese Longitudinal Healthy Longevity Survey(CLHLS),we find that the out-of-pocket medical expenditures of insured elderly are 43 percent lower than that of the uninsured elderly;but the total medical expenditures are 28—37 percent higher compared to uninsured.Based on Cox proportional hazard model,the insured elderly face a hazard 19% lower than the uninsured.According to extended Kaplan-Meier survival curve,the extended mean survival time of the insured elderly is 154 months and is noticeably larger than mean of uninsured,94 months.Those findings suggest that increased medical expenditures significantly and effectively improved the health and longevity of the insured old people.Therefore,the public health insurance policy should make more effort to meet the reasonable medical care demand.