医疗补偿与健康保障公平视角下的长期护理保险政策效应

Policy Effect of Long-Term Care Insurance from the Perspective of Medical Compensation and Health Insurance Equity

2016年以来实施的国家级长期护理保险政策试点对试点地区居民带来了重要影响。以医疗补偿与健康保障公平性为视角,选取CHARLS数据库2013年、2015年及2018年追踪调查数据,运用双重差分法,实证考察了长期护理保险政策试点效果,并利用集中指数与泰尔指数测量了处理组与未处理组的经济分配与健康公平性。结果显示,处理组城乡老年人在医疗消费补偿与健康水平的群体异质性上表现出缩小特征。政策效果比较显示:长期护理保险政策试点显著影响了老年人的门诊、住院消费补偿及住院天数,户籍、收入等级及基本医保发挥了显著的调节作用,长期护理保险政策试点显著提升了老年人的整体健康水平。不平等测量结果表明,长期护理保险政策试点为低收入人群带来了更大收益,其门诊及住院报销费的不平等程度更低,ADL与重疾数的集中指数也明显降低,但重疾数不平等程度却更高。根据研究结论,提出优化长期护理保险政策试点的建议。

The national pilot scheme of long-term care insurance(LTCI) policy since 2016 has brought an important impact on people in the pilot areas. From the perspective of medical compensation and health insurance equity, this paper selected the tracking survey data of China Health and Retirement Longitudinal Study(CHARLS) in 2013, 2015 and 2018, used the double difference method to empirically investigate the effect of the pilot scheme, and used the concentration index(CI) and Theil index(TI) to measure the economic distribution and health equity of the treatment group and the untreated group. The results show that the group heterogeneity of medical consumption compensation and health level of urban and rural elderly in the treatment group is narrowing. Policy comparison shows that the pilot scheme significantly affects the outpatient, hospital consumption compensation and length of stay, whereas household registration,income level and basic medical insurance play a significant regulatory role, and the pilot scheme significantly improves the overall health of the elderly. The results of inequality measurement show that the scheme has improved the income of low-income people: their inequality level of outpatient and inpatient reimbursement is lower, ADL disability and severe illness CI are also significantly reduced, but their inequality of severe illness is higher. Based on this, we put forward some suggestions to optimize the policy pilot of LTCI.