城乡居民医保整合对老年人自评健康状况和生活满意度的影响研究

Effects of the Integration of Urban and Rural Residents Basic Medical Insurance on the Self-evaluation of Health Status and Life Satisfaction of the Chinese Elderly

背景关于医保制度改革与老年人健康状况、生活满意度三者之间的关系,尚缺乏一定的实证研究和依据。目的探讨城乡居民医保制度整合对老年人自评健康状况和生活满意度的影响。方法本研究以中国健康与养老追踪调查(CHARLS)研究为基础,选取2015年和2018年随访数据,以≥60岁且信息完整的老年人作为研究对象,提取问卷调查中的人口学信息、健康状况与功能、医疗保健与保险等内容。根据是否实施城乡居民医保制度整合分为整合组和未整合组,建立Logistic回归模型,分析城乡居民医保制度整合对老年人自评健康状况及生活满意度的影响。此外,进一步以城乡居民医保制度整合作为自变量,自评健康状况作为中介变量,生活满意度作为因变量,构建结构方程模型,进行中介效应分析。结果本研究纳入研究对象4364人,其中整合组694人(15.90%),未整合组3670人(84.10%)。整合组自评健康状况优于未整合组(20.74%vs 17.41%,P=0.038),自评健康状况更好(OR=1.281,95%CI=1.038~1.581,P=0.021)。整合组的人群生活满意度优于未整合组(94.80%vs 91.87%,P=0.009),生活满意度更高(OR=1.378,95%CI=1.037~1.831,P=0.027)。自评健康状况在城乡居民医保制度整合对生活满意度影响的作用中存在部分中介效应,效应值为0.050(P=0.043),中介效应在总效应中所占的比例为46.66%。结论城乡居民医保制度整合有利于老年人健康状况得到改善,提高老年人的生活满意度,具有积极的现实意义。未来应继续加强对城乡居民医保制度的普及,提高医保待遇水平,建立健全更加合理的筹资机制,促进农村医疗服务质量提升,进一步改善老年人健康水平。

Background Empirical research and evidence on the relationship among the medical insurance system reform,health status and life satisfaction of the elderly are scant.Objective To analyze the effects of the integration of the urban and rural residents basic medical insurance(URRBMI)on the self-evaluation of health status and life satisfaction of the Chinese elderly.Methods Based on the follow-up data of China Health and Retirement Longitudinal Study(CHARLS)from 2015 to 2018,elderly people over 60 years old with complete information were included as the research subjects.The demographic information,health status and function,medical care and insurance were extracted from the CHARLS questionnaire.According to the integration of URRBMI or not,subjects were assigned into URRBMI integration group and non-integration group.Logistic regression model was used to analyze the effects of the integration of URRBMI on the self-evaluation of health status and life satisfaction of the elderly.In addition,a structural equation model was constructed to analyze the mediating effect with the URRBMI integration as an independent variable,self-evaluation of health status as a mediating variable,and life satisfaction as a dependent variable.Results A total of 4364 subjects were analyzed in this study,including 694(15.90%)in the URRBMI integration group and 3670(84.10%)in the non-integration group.The self-evaluation of health status in the URRBMI integration group was significantly better than that of the non-integration group(20.74%vs 17.41%,P=0.038).The self-evaluation of health status in the URRBMI integration group was significantly superior(OR=1.281,95%CI=1.038-1.581,P=0.021).The life satisfaction of the URRBMI integration group was significantly higher than that of the non-integration group(94.80%vs 91.87%,P=0.009).The life satisfaction was better in the URRBMI integration group(OR=1.378,95%CI=1.037-1.831,P=0.027).There was a partial mediating effect of the self-evaluation of health status on the impact of URRBMI integration on the life satisfaction,with the mediating effect value of 0.050(P=0.043),and the proportion of mediating effect in the total effect accounted for 46.66%.Conclusion The URRBMI integration is beneficial to improve the self-evaluation of the health status and life satisfaction of the elderly,which has a positive practical significance.In the future,further efforts should be made on strengthening the publicity of the URRBMI,constantly improving the medical insurance treatment level for urban and rural residents,establishing a more reasonable financing mechanism,promoting the quality of medical services in rural areas,and finally improving the health level of the elderly population.