上医治未病:免费体检计划对老年人医疗服务与健康福利的影响

Prevention is Better than Cure:The Effect of the Plan for Free Health Check-up on the Health Care Utilization and Health Benefits of the Elderly

如何在保障老年人健康福利的前提下合理控制医疗费用的快速上涨,是新医改进程中的巨大挑战。正在推行的面向65岁及以上老年人的“免费体检计划”是解决这一难题的潜在方案。本研究利用中国健康与养老追踪调查2011~2018年4期微观数据,在动态双重差分框架下首次考察了该计划的政策效果。研究发现,该计划的实施能使65岁及以上老年人享受免费体检的比率增加16.4个百分点,并能减少他们0.118次月门诊次数和24.1%的月门诊费用,最终使得全年医疗总花费显著下降32.3%。更重要的是,该计划还能够提升老年人的健康福利。在此基础上,本研究利用政策交错进行带来的冲击,创新性地在动态双重差分—工具变量框架下,测算了体检的价值。本文还结合格罗斯曼模型,从理论上提示了健康信息这一机制。最后,本研究通过成本—收益分析,肯定了“免费体检计划”带来的巨大经济收益,提示要在“上医治未病”的哲学理念下,坚持预防为主的健康策略,让医疗资源得到更有效率地运用;并在对依从者特征分析的基础上,建议政策在推广中应加强宣传教育及对低收入群体的引导。

How to control the rapid rise of medical costs reasonably under the premise of protecting the health welfare of the elderly is a huge challenge in the process of the new health care reform.A potential solution to this problem is the ongoing Plan for Free Health Checkup(PFHC)for individuals aged 65 and above.This study examines the policy effects of the program for the first time in a dynamic differencein-difference framework using the micro-data of the China Health and Retirement Longitudinal Study from 2011 to 2018.We found that the implementation of the program could increase the rate of free health check-ups for the elderly aged 65 and above by 16.4 percentage points,reduce the number of monthly outpatient visits and outpatient expenses by 0.118 and 24.1 percent,resulting in a significant decrease of 32.3 percent in the total annual medical expenditure.More importantly,the program enhanced the health benefits of seniors.Furthermore,we inno⁃vatively measured the value of health check-up using shocks from staggering policy under the framework of DD-IV.Combined with Grossman Model,we suggested a health information mechanism conceptually.Finally,through cost-benefit analysis,this research underscores the sub⁃stantial economic benefits of PFHC.It suggests that grounded in the philosophical principle of"prevention is better than cure",we should pri⁃oritize prevention as a central tenet within our healthcare strategy,so as to make more efficient use of medical resources.On the basis of the analysis of the characteristics of the compliers,it is recommended that publicity and education should be strengthened and that guidance should be given to low-income groups during the policy promotion process.