中国基层医疗服务发展对老年人健康的影响

The Impact of the Development of Primary Medical Services on the Health of the Elderly in China

实现健康老龄化是我国积极应对人口老龄化的一项重要战略任务。老年人的健康状况和医疗服务需求特点决定了基层医疗服务在促进老年健康中的重要地位。基层医疗服务发展对老年人健康具有重要影响。分析评估我国基层医疗服务发展的成就和不足,更好地发挥基层医疗服务在促进健康老龄化和建设健康中国中的作用具有重要的现实意义。本文从老年人感知的基层医疗服务可及性、服务可得性和服务适配性三个维度构建反映基层医疗服务发展水平的综合指标,利用2015年和2018年中国健康与养老追踪调查(CHARLS)数据,实证检验和分析我国基层医疗服务发展水平对老年人健康的影响及其作用机制。研究发现老年人感知的基层医疗服务发展水平越高,自评健康水平就越高,自评健康改善状况也越好,说明基层医疗服务发展对老年人健康具有积极作用,且结论具有稳健性。基层医疗服务发展会改善医疗服务便利性,降低医疗服务费用,促进老年人的医疗服务利用,降低老年人医疗服务需求未满足的程度;基层医疗服务还担负着向辖区居民开展疾病预防与控制、健康教育、居民健康档案管理、慢性病患者健康管理、老年健康与医养结合服务等初级卫生保健服务的职责,可以改善老年人健康管理水平;基层医疗服务发展能够提高老年人健康素养,有助于培养健康生活方式与行为,最大限度消除健康危险因素,从而促进老年人健康。机制检验发现医疗服务需求满足程度、健康管理状况、健康素养与行为在基层医疗服务发展影响老年人健康过程中发挥了部分中介作用。异质性分析结果表明基层医疗服务发展对老年健康的影响在不同地区、不同年龄阶段、不同收入水平和健康状况的老年群体之间存在显著差异。中西部地区和农村地区老人、中低龄老人、低收入老人和罹患慢性病的老人从基层医疗服务发展中受益更大。政府应进一步优化基层医疗资源配置,增强基层医疗服务能力,增加服务供给,在提高老年人医疗服务需求满足程度的同时提高老年人健康管理水平,提升老年人健康素养,培养健康行为方式,更好地发挥基层医疗服务促进老年人健康的作用。

Healthy aging is an important strategic task for China to deal with population aging actively.Primary medical services play a crucial role in promoting the health of the elderly.It is of great practical significance to study the impact of the development of primary medical services on the health of the elderly in order to analyze and evaluate the achievements and deficiencies of the development of primary medical services in China,and to better play the role of primary medical services in promoting healthy aging and healthy China.This paper constructs a comprehensive index reflecting the development level of primary medical services from three dimensions of the elderly’s perception of accessibility,availability and adapta‐tion of primary medical services.Using the data of China Health and Retirement Longitudinal Study(CHARLS)in 2015 and 2018,this paper empirically tested and analyzed the influence of the development of primary medical service on the health of the elderly and its mechanism,and found that the higher the development level of primary medical service perceived by the elderly,the higher the self-rated health level and the better the self-rated health improvement,indicating that the development of primary medical service has a positive effect on the health of the elderly,and the conclusion is robust.The development of primary medical services will improve the convenience of medical services,reduce the cost of medical services,promote the utilization of medical services for the elderly,and reduce the degree of unmet demand for medical services for the elderly.Primary medical services are also responsible for providing primary health care services such as disease prevention and control,health education,residents’health records management,chronic disease patients’health management,elderly health and combination of medical and nursing care to residents,which can improve the health management level of the elderly.The development of primary medical services can improve the health literacy of the elderly,help to cultivate healthy lifestyles and behaviors,and eliminate health risk factors as possible.The mechanism test found that the satisfaction degree of medical service demand,health management status,health literacy and behavior played a mediat‐ing role in the influence of the development of primary medical services on the health of the elderly.The results of heterogeneity analysis showed that the impact of the development of primary medical services on the health of the elderly was significantly different among regions,different age groups,different income levels and health conditions.The elderly in central or western regions or rural areas,the elderly in the middle or younger ages,the elderly with low incomes and the elderly suffering from chronic diseases have benefited more from the development of primary medical services.The government should further optimize the allocation of primary medical resources,enhance the capacity of primary medical services,increase the supply of services,improve the satisfaction degree of the elderly medical service demand,improve the health management level of the elderly,enhance the health literacy of the elderly,cultivate healthy behavior patterns,and better play the role of primary medical services in promoting the health of the elderly.