代际支持视角下家庭结构对老年人医疗服务利用的影响研究

Research on the Impact of Family Structure on the Utilization of Medical Services for the Elderly from the Perspective of Intergenerational Support

目的:研究家庭结构对老年人医疗服务利用的影响和作用机制。方法:利用中国健康与养老追踪调查数据(Charls)2018年数据,使用Probit和IV-Probit两种模型分析家庭结构和老年医疗服务利用之间的关系,并通过逐步回归法检验代际支持在两者之间的中介作用。结论:家庭结构是影响老年人医疗服务利用的内生解释变量,在控制内生性后,与子女同住的家庭结构显著增加了老年人门诊服务利用(β=1.159,P<0.01)和住院服务利用(β=1.046,P<0.1),并且亚组分析显示这种影响在不同年龄、区域和性别样本中存在异质性。进一步的检验发现家庭结构通过子女经济支持和照料支持影响老年人医疗服务利用。结论:与子女同住的家庭结构有利于提高老年人医疗服务利用水平,应积极提倡和支持家庭养老,完善家庭政策,进一步优化老年医疗服务体系建设。

Objective To study the impact and mechanism of family structure on the utilization of medical services for the eld-erly.Methods Data from the China Health and Elderly Care Tracking Survey(CHARLS)2018 were used to analyze the relation-ship between family structure and elderly healthcare service utilization by using Probit and IV-Probit models.The mediating role of intergenerational support was tested by using stepwise regression.Results Family structure is an endogenous explanatory variable that affects the utilization of medical services in the elderly.After controlling the endogeneity,the family structure living with chil-dren significantly increased the utilization of outpatient services and inpatient services in the elderly,and subgroup analysis showed that this influence was heterogeneous across samples of different ages,regions,and genders.Further examination found that family structure affected the utilization of medical services for elderly people through their childrens economic support and care support.Conclusion The family structure of living with children is conducive to improving the utilization level of medical services for the eld-erly.It is necessary to actively promote and support family elderly care,improve family policies,and further optimize the con-struction of the elderly medical service system.