健康不平等视角下医疗服务可及性对老年健康的影响——基于CLHLS数据的实证分析

The Association between Access to Healthcare and Health Outcomes among Older Adults in China from Health Disparity——Based on CLHLS Data

随着我国人口预期寿命的延长和人口老龄化进程的加剧,如何促进老年健康成为学术界及政策制定者亟需关注的重要议题。基于2005年、2008年、2011年及2014年"中国老年健康影响因素跟踪调查"(CLHLS)数据,以健康不平等理论为研究视角,探讨医疗服务可及性对老年健康的影响。研究结果表明,医疗服务可及性与老年健康之间呈显著相关,医疗服务不可及会显著增加老年人IADL、ADL及认知功能障碍和死亡风险;且这种关系随性别、年龄及城乡呈现出差异性。具体表现为医疗服务可及性对女性老人健康结果的影响大于男性老人;对低龄和中龄女性老人与中高龄男性老人的影响大于同性别的其他年龄组;与城镇老人相比,医疗服务可及性对农村老人健康结果的影响更大。医疗服务可及性对老年健康影响的性别、年龄及城乡差异,与其在整个生命周期中所遭遇的不公平制度环境有关。研究的政策意义在于,在我国人口快速老龄化的背景下,如何通过提升医疗保障制度在不同性别、年龄以及城乡之间的公平性来提高老年人医疗服务可及性,消弭由于制度不公平而带来的健康不平等,从而降低老年人IADL、ADL及认知障碍的发生率及死亡风险,实现老年群体的健康老龄化。

With the prolonged life expectancy and the rapid population aging worldwide,how to promote health outcomes among older adults has been a focus for researchers and policymakers.Four waves of data(2005,2008/2009,2011/2012,and 2014)from the largest national longitudinal survey of adults aged 65 and older in China's Mainland(n=26,604)were used for analysis.The association between inadequate access to healthcare(y/n)and health outcomes among older adults were examined—including instrumental activities of daily living(IADL)disability,ADL disability,cognitive impairment,and all-cause mortality.A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes.All models were stratified by gender,age group,and urban-rural residence.The results showed that inadequate access to healthcare was associated with higher odds of disability and cognitive impairment,and with higher risk of mortality.The associations were generally stronger in women than in men and varied across age groups,and stronger among older adults in rural areas than in urban areas.These findings have important implications for improving access to healthcare and improving healthy aging among older adults in China.