老年健康与照料需求:理论和来自随机实验的证据  

Health Status and Elderly Care: Theory and Evidence from a Randomized Experiment with COPD Patients in China

作　　者：宗庆庆[1] 张熠[1] 陈玉宇[2,3] ZONG Qingqing;ZHANG Yi;CHEN Yuyu(School of Public Economics and Administration,Shanghai University of Finance and Economics;Guanghua School of Management,Peking University)

机构地区：[1]上海财经大学公共经济与管理学院,200433 [2]北京大学光华管理学院,100871 [3]北京大学经济政策研究所,100871

出　　处：《经济研究》2020年第2期36-51,共16页Economic Research Journal

基　　金：国家自然科学基金(71804104,71503154)的资助

摘　　要：本文分析了中国老年人身体健康对照料需求和照料模式选择的作用。实证上,通过大样本慢阻肺随机干预实验,采用双重差分估计的结果表明:(1)在慢阻肺干预实验后,实验组老年人身体健康显著改善。照料需求大幅度减少,健康改善带来老年照料利用概率减少了35.5%;(2)实验组照料需求的减少主要发生在社会照料需求方面,健康改善带来社会照料利用概率减少了67.8%,而家庭照料基本保持不变;(3)异质性检验表明,潜在家庭照料资源越少的家庭,社会照料需求的下降越明显。从理论的角度,上述实证结果支持家庭在老年人照料模式选择中存在“啄序偏好”:家庭首先动用所有内部照料资源,然后再使用社会照料,从而导致社会照料对健康的敏感度更高。本文的政策含义是,事前的预防性健康干预政策能够显著减轻家庭在照料特别是社会照料方面的负担。对于内部非正式照料资源较少的家庭,预防性健康干预政策的减负效果尤为显著。China s population is rapidly aging,and the elderly have the highest incidence of disability and dementia,creating an enormous demand for elderly care.Health status is one of the critical factors affecting care needs,but how does health status affect the care needs of the elderly?Research on this issue has substantial theoretical and practical significance,but due to the obvious reverse causality bias(Zunzunegui et al.,2001;Stabile et al.,2006;Unützer et al.,1997;Vasiliadis et al.,2013;Barnay&Juin,2016)and omitted variable bias,it is difficult to identify an appropriate and sufficiently powerful effect-identification strategy.In this study,we conduct a randomized controlled trial(RCT)to accurately identify the causal effect of an exogenous health care treatment on the health status of an elderly group suffering from chronic obstructive pulmonary disease(COPD).Thus,we randomly select patients from a large sample randomized experiment with elderly COPD patients,and separate them into treatment and control groups.We then vaccinate the treatment group(with influenza and/or pneumonia vaccines),and observe the level of elderly care needs in the treatment group compared with that in the control group.To the best of our knowledge,this is the first economic study to explore the effect of elderly health on care via a large-sample randomized experiment.In addition,we examine the choice of the family pattern of care,given that the elderly has a choice between informal family care and formal social care.Care resources are scarce,and the integration and interaction of different care resources is very important.How can limited financial resources be deployed to maximize the utilization of care resources and reduce the burden on the elderly and their families?To answer these questions,we need to study the choice of pattern of care for the elderly.There is a long history of research on this topic(such as Freedman,1996;Charles&Sevak,2005;Yamada et al.,2006;Boaz&Muller,1994;Byrne et al.,2009).These studies examine the complementar

关 键 词：老年健康 照料需求 照料模式 慢阻肺 随机实验 

分 类 号：D669.6[政治法律—政治学]