医养结合对老年人社会参与的影响研究——基于身心健康的多重中介效应分析

Effect of Integrated Medical and Elderly Care Services on Seniors’Social Participation:An Analysis of Various Mediating Factors Pertaining to Physical and Mental Well-being

厘清医养结合试点城市政策对老年人社会参与的影响机制,是积极应对人口老龄化的现实需要。本文基于积极老龄化理论,探究医养结合试点城市政策促进老年人社会参与的机制,利用中国健康与养老追踪调查(CHARLS)2020年数据,实证分析了医养结合试点城市政策对老年人社会参与的影响,并运用多重中介效应模型分析生理健康、心理健康在医养结合试点城市政策影响老年人社会参与过程中的中介作用。研究表明,医养结合试点城市政策对老年人的社会参与具有显著促进作用,在经替换被解释变量、分样本检验、更换不同数据、倾向性得分匹配等稳健性检验后此结论依然成立;医养结合试点城市政策对老年人社会参与的促进作用在年龄、性别、受教育程度、居住地和所在地区等方面存在差异;生理健康、心理健康在医养结合试点城市政策对老年人社会参与产生影响的过程中起到中介作用。为更好发挥医养结合试点城市政策在积极老龄化战略中的重要作用,需做到宣传与质量兼修,推广医养结合养老服务模式;供给与需求匹配,扩充医养结合养老服务内容;生理与心理并重,提升医养结合养老服务效果。

Clarifying the mechanisms by which the policies of integrated medical and elderly care services in pilot cities affects the social participation of older persons is a practical need to actively respond to the aging of the population.Based on the theory of positive aging,we explored the mechanism of the policies of the pilot cities combining medical and elderly care to promote the social participation of the elderly.Using data from the China Health and Retirement Longitudinal Study(CHARLS)in 2020,the paper empirically analyzes the impact of policies in pilot cities for the integration of medical and elderly care on social participation among the elderly,and uses a multiple mediation effect model to analyze the mediating role of physiological and psychological health in the process of policies affecting social participation among the elderly in pilot cities for the integration of medical and elderly care.The results of the study suggest that the policies of the pilot cities have a significant effect on the social participation of the elderly,which is still valid after the robustness tests of replacing the explanatory variables,split-sample test,replacing different data,and propensity score matching.The effect of the policies of the pilot cities on the social participation of the elderly varies in terms of age,gender,education level,residence,and region.ADL and depression level play a mediating role in the effect of healthcare integration pilot cities’policies on social participation of the elderly.Accordingly,this paper suggests that to better play the important role of the policy of integrating medical and elderly care in the active aging strategy of pilot cities,it is necessary to achieve both publicity and quality improvement,and promote the integrated medical care and elderly care service model,to expand the content of the healthcare integration of elderly care services by matching the supply with the demand,and to improve the effect of the healthcare integration of elderly care by focusing on the physiological and psychological aspects.