医疗服务可及性与社会资本对老年人自评健康的影响--基于CLHLS数据的分析

Analyzing the Impact of Medical Service Accessibility and Social Capital on the Self-rated Health of The Elderly Based on CLHLS Data

目的:探讨医疗服务可及性与社会资本对老年人自评健康的影响,为老年人健康促进提供对策建议。方法:基于中国老年健康影响因素跟踪调查(CLHLS)2018年数据,建立Ordered Logit模型分析医疗服务可及性、社会资本及其交互作用对老年人自评健康的影响,并使用Shapley值分解法解释医疗服务可及性和社会资本对老年人自评健康的贡献程度。结果:共纳入65岁及以上老年人8621名,回归分析显示,纳入控制变量后,医疗服务可及性与社会资本均正向影响老年人自评健康(P<0.05);Shapley值分解结果显示,医疗服务可及性与社会资本对老年人健康差异的贡献率分别为40.99%和39.04%;可获性与人际信任的交互项对老年人自评健康有显著的正向影响(P<0.05)。结论:医疗服务可及性对老年人自评健康有显著影响,其中经济可及性对老年人自评健康差异的贡献率最大;社会资本对老年人自评健康有显著促进作用,其中社会参与对老年人自评健康差异的解释度最强;较高的人际信任水平能强化医疗服务可及性对老年人健康的影响。建议通过建立健全多层次的医疗保障体系和构建高质量社区医养结合服务模式促进老年人健康。

Objective To explore the impact of medical service accessibility and social capital on self-rated health of the elderly,and propose suggestions for health promotion of the elderly.Methods Based on the data of Chinese Longitudinal Healthy Longevity Survey(CLHLS)in 2018,the Ordered Logit model was established to analyze the effects of medical service accessibility,social capital and their interactions on the self-rated health of the elderly.The Shapley decomposition method was used to explain the contribution of medical service accessibility and social capital to self-rated health of the elderly.Results A total of 8621 elderly people aged 65 and above were included.Regression analysis showed that after the inclusion of control variables,medical service accessibility and social capital both positively affected self-rated health of elderly people(P0.05).The results of Shapley decomposition showed that the contribution rates of medical service accessibility and social capital to the health difference of the elderly was 40.99%and 39.04%,respectively.The interaction term of availability and social trust had a positive effect on self-rated health of the elderly(P0.05).Conclusion The accessibility of medical services has a significant impact on the self-rated health of the elderly,among which affordability contributes the most to the difference in self-rated health of the elderly.Social capital has a significant effect on self-rated health of the elderly,in which social participation has the strongest explanation for the difference in self-rated health of the elderly.A higher level of interpersonal trust can strengthen the influence of accessibility of medical services on the health of the elderly.It is suggested to promote the health of the elderly by establishing a multi-level medical security system and high quality community medical and nursing service mode.