补充医疗保险对老年人死亡率的影响:以大病保险为例

The Impact of Supplemental Health Insurance on the Mortality Rate of the Elderly: Evidence from Critical Illness Insurance

医疗保险对健康的影响一直是卫生经济学研究的热点。本文基于中国老年人健康影响因素跟踪调查数据,利用地级市层面实施城乡居民大病保险的时间差异,运用双重差分法估计大病医疗保险对老年人死亡率的影响。研究结果表明,大病保险使老年人月死亡率显著降低了0.22个百分点,相当于使得死亡人数下降15%左右。并且,这一效果在起付线较低的城市,在子女数少、未与配偶居住和年龄较大的老年人中更为明显。在大病保险可能影响死亡率的渠道中,我们发现大病保险能够改善参保者的心理状态,改善身体健康,并且增加医疗服务利用。本文的研究结果对于完善中国医保政策具有启示意义。

The impact of health insurance on people’s health status has long been a popular area of study in the field of health economics. Drawing on temporal variations in Critical Illness Insurance implementation for urban and rural residents at the prefectural city level and using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS), this paper estimates the impact of Critical Illness Insurance on elderly mortality through the difference-in-differences(DID) technique. The results of the study show that Critical Illness Insurance significantly reduces the monthly mortality rate of the elderly by 0.22%. This effect is even more pronounced in elderly people who reside in cities with a lower level of deductibles in Critical Illness Insurance, who have fewer children, who live without spouses and who are older. A more detailed analysis of the potential mechanisms of influence shows that Critical Illness Insurance leads to an improvement in the mental state of insured persons, healthier physical condition and increased utilisation of medical services. These findings have important policy implications for improving the design of social insurance schemes in China.