我国老年人自我药疗对医疗支出、健康状况的影响——基于2018年CHARLS数据的实证分析

Influence of self-medication on medical expenditure and health status of the elderly in China:empirical analysis based on 2018 CHARLS data

目的探究我国老年人自我药疗对医疗支出及健康状况的影响,为老龄化背景下老年患者的医疗服务选择和健康状况改善提供理论参考。方法基于2018年中国健康与养老追踪调查(CHARLS)数据,分别利用Tobit回归模型和有序Probit回归模型实证研究老年人自我药疗对医疗支出及健康状况的影响,并进行稳健性检验和异质性分析,以分析模型结果的稳健性和不同个体自我药疗对医疗支出、健康状况影响的差异性。结果9770位受访者的平均年龄为68.8岁,74.5%为小学及以下文化程度,多居住在农村地区或户口类型为农业户口;近半数受访者的自评健康状况为“一般”,85.0%的受访者患有慢性疾病,近半数受访者存在不同程度的失能;有60.7%的受访者进行过自我药疗;受访者医疗支出的对数平均值为8.8。Tobit回归结果显示,老年人的自我药疗行为会使医疗支出(取对数值)显著降低0.116个单位(P<0.05)。有序Probit回归结果显示,自我药疗对健康状况有显著负向影响(P<0.01)。稳健性检验结果与Tobit回归和有序Probit模型结果基本一致;异质性分析结果表明,小学及以下文化程度、患有慢性疾病人群的自我药疗虽能降低医疗支出,但其健康风险更高。结论自我药疗虽能够缓解医疗负担、降低医疗费用,但在一定程度上损害了老年人的健康状况;可通过采取鼓励合理的自我药疗、加强居民自我用药教育等措施来尽量避免其带来的健康损害,使其在医疗保健系统中发挥积极作用。

OBJECTIVE To explore the influence of self-medication on medical expenditure and health status of the elderly in China,so as to provide theoretical reference for the selection of medical services and the improvement of health status of elderly patients under the background of aging.METHODS Based on the 2018 China Health and Retirement Longitudinal Study(CHARLS)data,Tobit regression model and ordered Probit regression model were adopted to empirically study the influence of self-medication on medical expenditure and health status of the elderly.In addition,a robustness test was performed to verify the robustness of the model results,and a heterogeneity analysis was conducted to explore the difference of the influence of selfmedication on medical expenditure and health status among different individuals.RESULTS The average age of the 9770respondents was 68.8 years old,74.5%of whom had primary school education or less,and most of them lived in rural areas or had a agricultural household registration type;nearly half of the respondents rated their health status as“fair”,85.0%of respondents suffered from chronic diseases,and virtually half had varying degrees of disability.A total of 60.7%of respondents had selfmedicated,and the log mean of the respondents’medical expenditures was 8.8.Tobit regression results showed that self-medication behaviors in the elderly significantly reduced medical expenditure(logarithmically)by 0.116 units(P<0.05).The results of ordered Probit regression showed that self-medication had a significant negative impact on health status(P<0.01).The results of the robustness test were consistent with the results of the Tobit regression and ordered Probit models.The results of the heterogeneity analysis suggested that the self-medication of people with primary education or less and chronic diseases may reduce medical expenditure,but at a higher health risk.CONCLUSIONS While self-medication can alleviate the medical burden and reduce medical expenditure,it damages the health of the elderly to a certain extent.Therefore,it can play a positive role in the health care system by encouraging rational self-medication and enhancing self-medication education to avoid health damage.