社会医疗保险对老年人医疗消费与健康的影响——制度效应评估与作用机制分析

The Effect of Social Medical Insurance on Medical Consumption and Health of the Elderly:An Evaluation of Institutional Effects and Analysis of Mechanisms

基于2014年中国老年健康长寿影响因素追踪调查(CLHLS)数据,采用倾向得分匹配(PSM)方法,分析社会医疗保险对老年人医疗消费和健康的促进效应,并探讨该制度对老年人健康的作用机制。实证结果表明:社会医疗保险能显著提高老年人的医疗消费水平,并改善其健康状况;社会医疗保险制度效应具有明显的群体差异性,对高龄、农村、低收入等弱势老年人群医疗消费和健康的促进作用不明显,制度的公平性仍有待提高;社会医疗保险影响老年人健康状况的可能渠道包括医疗消费水平提高和健康/就医行为改变,但不包括医疗负担减轻。据此,深化社会医疗保险制度改革应强化福利性,提高公平性以及维护弱势群体的医疗保障权益。

Based on the 2014 data collected by the Chinese Longitudinal Healthy Longevity Survey,this study applied the propensity score matching method to analyze the promotion effect of social medical insurance on the medical consumption and health of the elderly,and to explore the mechanism by which the insurance system affects the elderly’s health.Empirical results show that social medical insurance can significantly improve the medical consumption level of the elderly as well as improve their health.The institutional effect of social medical insurance displays clear group differences,and its promotion effect on the medical consumption and health of different vulnerable groups(including the aged,rural,and low-income populations) is insignificant.The fairness of the insurance system is yet to be improved.The possible channels through which social medical insurance influences the health of the elderly include improvement in the medical consumption level and change in health/medical behaviors;however,a reduction in medical expenses is not one of these channels.Accordingly,to strengthen the reform of the social medical insurance system,we should improve welfare and fairness and safeguard the medical protection rights of vulnerable groups.