养老金与照护支出“以养节医”的经济绩效研究

Economic Performance of "Aged Care to Reduce Medical Expense" with Respect to Old-age Pension and Nursing Expense

使用CLHL2014年数据测评养老金与照护支出的"以养节医"经济绩效,路径模型估计结果显示,养老金与自付医疗支出呈倒U型关系,养老金低于拐点值时,自付医疗支出随养老金增加而增加,超过拐点值之后,自付医疗支出趋于下降;养老金还显著增加了老人的照护支出,照护支出则与自付医疗支出呈U型关系,在老人身体状况较好时,自付医疗支出随照护支出的增加而减少,但当老人身体状况较差时,照护支出对降低自付医疗支出的作用有限。这说明养老金水平要尽量高,照护的介入则要尽量早,才能取得更优的"以养节医"经济绩效。使用2011、2014两期数据的多组比较显示,养老金、照护支出对自付医疗支出的影响作用具有稳健性。建议遵循养、护、医影响健康的内在机理和传导路径,从"治病"转向"治未病";并建议养老金支付方式从递增型生存年金改为递减型生存年金。

Based on the CLHL data of 2014,we measured the economic performance of "aged care to reduce medical expense" with respect to pension and nursing expense. Path model estimation showed that there was an inverted U-shaped relationship between old-age pension and self-paid medical expense. When the old-age pension was below the inflection point,the self-paid medical expense increased with the rise in the old-age pension;when the old-age pension was above the inflection point,the self-paid medical expense tended to decrease. Moreover,the old-age pension caused a significant increase in the nursing expenses of older people,and there was a U-shaped relationship between nursing expenses and self-paid medical expenses. When older people were in good physical condition,self-paid medical expenses decreased with the increase in nursing expenses;when older people were in poor physical condition,nursing expenses could only reduce the self-paid medical expense to a limited extent. Therefore,the old-age pension level should be as high as possible,and older people should receive nursing care as early as possible,so as to attain higher economic performance through " aged care to reduce medical expense". According to the multi-group comparison based on the data of 2011 and 2014,the old-age pension and nursing expenses had a robust effect on the self-paid medical expenses.Therefore,we offer the following suggestions: 1) considering the internal mechanisms and transmission path by which health is affected by care,nursing,and medical treatment,the treatment of diseases should be transformed into the prevention of diseases;2) old-age pensions should be paid in the form of decreasing life annuities rather than increasing life annuities.