医疗保险对农村中老年人精神健康的影响——基于CHARLS数据的实证分析

The Effect of the Social Health Insurance on the Mental Health of the Middle-Aged and Aged Residents in Rural China——An Empirical Analysis Based on CHARLS

在"优先发展农业农村"的新时代,要实现全民健康,需要重点关注农村居民的健康问题。基于CHARLS数据,本文以精神抑郁和认知健康为被解释变量实证分析了医疗保险对农村中老年人精神健康的影响。研究发现:(1)医疗保险对农村中老年人特别是弱势群体的精神健康有显著的促进作用,且显著体现在男性、60岁及以上老人和低收入群体。居住在农村的中老年人比居住在城镇的更显著受益于医疗保险;(2)分位数回归和更换被解释变量回归验证了结果的稳健性;(3)机制分析表明,医疗保险通过提高农村中老年人的安全预期和生活满意度来提升其精神健康水平。为此,应进一步扩大医疗保险的参保覆盖面,增进制度公平以提升农村居民的安全预期,并加大农村财政投入和加强健康教育,打破农村精神卫生服务"供需双冷"的困境,从根本上提升农村居民的精神健康水平。

In the new era of preferentially developing agriculture and rural areas,more attention should be paid to health of rural China’s residents to achieve universal health.However,little attention has been paid to mental health.Based on data of CHARLS,this paper discusses the effect of the social health insurance on the mental health of the middle-aged and aged residents in rural China by adopting two dependent variables of mental depression and cognitive health.The results reveal that health insurance significantly promotes the mental health of the insured residents,especially the vulnerable groups.The heterogeneity test indicates that the influence of health insurance on mental depression is significant in male people,group of people aged 60 years or more,low-income groups and residents live in rural areas.Quantile regression and regression after changing dependent variable proves the robustness of conclusions.The paper also tests the possible mechanisms that health insurance positively influences mental health by strengthening the insured residents’ safety expectation and life satisfaction.Hence,it is necessary to further extend coverage of the health insurance system,improve institutional equity to increase the safety expectation of the rural residents,expand government spending on countryside and stress health education to break the predicaments of low interest on both sides of supply and demand,thus fundamentally promote the mental health of the rural residents.